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Aman: Folks, welcome to yet another installment of the "I Am GPH Podcast." On this episode, we have two very, very special guests who I'm excited to chat with: Dr. José Pagan and Helen Arteaga. José Pagan is currently a professor and the chair at the department of public health policy and management at the NYU School of Global Public Health. Alongside his multiple rules in the industry, which are many I must say, Dr. Pagan is also the chair of the Board of Directors of NYC Health and Hospitals, which brings us to our other guest, Helen Arteaga. Helen is the chief executive of officer at New York City Health and Hospitals, Elmhurst, which is the largest healthcare public system in the United States. They provide essential inpatient, outpatient and home-based services to more than one million New Yorkers every year in more than 70 location across the city's five boroughs. In addition to that, Helen is also currently teaching at NYU and we will hear a lot more about that throughout the podcast. With that said, I would love to give a warm welcome to our two guests to the "I Am GPH Podcast": José and Helen, we're glad to have you here. Welcome.
Helen: Oh, thank you.
José: Thank you.
Helen: Excited to be here.
Aman: I'd like to start off with the two of you, since it's a joint podcast and I'd love to hear, how did the two of you connect and what are your roles at GHP? What's the story like in this world?
José: Yeah, I mean-
Helen: So José, do you wanna start?
José: Yes, sure. You know, so I joined the Board of Health and Hospitals in 2019, and basically you get appointed by the mayor to do this. And Health and Hospitals is the largest municipal healthcare system in the U.S. 11 hospitals, it's a huge system for over 45,000 employees. So Helen and I went on the Board of Health and Hospitals. I met her through that and we had to tackle a lot of complicated issues, especially when the pandemic hit and then Helen on move on to bigger things as she became the CEO of Elmhurst Hospital, one of our hospitals. So Helen can tell you more about that part.
Helen: And José, Dr. Pagan is too humble. When he became chair of the Health and Hospital board member, I was a board member and I basically like stalk him a little bit. And I was like, "oh my God", 'cause he has the greatest mind of economics and you know, being a person of color and being a minority, seeing someone of color at that high level is huge. Not only was he the chair of Health and Hospital, but also like his prestige and the research he's written and the stuff that he was doing at NYU, which is my alma mater. I was just like, "Oh, this guy needs to be my friend." So I kind of stalked him a little bit for two reasons. One, because I thought he was the coolest guy on the planet. Three, seeing someone of my background at such a high position, I knew I needed to learn from him. And third I was getting my doctorate. So part of my doctorate degree I have to teach. So I was like, "Oh, if I'm gonna TA or teach, I'm gonna teach in this man's footsteps." So that's how we met.
José: Helen, basically, you had a role working on the healthcare side in the community. And to me that was very important when I met you because part of that role of Health and Hospitals is a safety net system. So having access to Helen to understand the landscape of healthcare, the provision of healthcare services in the city was very important to me.
Helen: So during that time when José was talking about this was pre-COVID, of course, one of the major things that I was doing, I opened up a federally qualified health center in Corona, Queens. So I always like to say, I'm a mom first, but then I'm an advocate. And one of the things I advocate for a lot in my community, which is a low income community here in the borough Queens is access to healthcare. So I sought out, I guess I don't fall too far from the tree. My dad was an activist in our community, so I guess I became an activist as well. And one of the things that we have is no access to healthcare, which is how I kind of came into the public system. And we opened a federally qualified health center in Corona, Queens. And we started with 38 patients. And then 11 years later we had 38,000 patients that we were taking care of that didn't have access to healthcare otherwise. And we worked a lot with Elmhurst Hospital. So that's how we got connected.
Aman: Oh man, that is a lovely story with an even more awesome direction with a lot more to come going forward. I'm curious to even chat about the other intersection where the two of you are a part of NYU GPH as Jose is in different forms and Helen, you have been a student and now you're teaching as well. I'd like to hear about both your roles at the university, maybe from the past or currently, what do you two do at NYU GPH?
José: Yeah. So I chair the department of public health policy and management. We have a lot of MPH students, a PhD program. We have DrPH students. We also have undergraduate students that take Health Policy in a Global World course. And I think as part of those activities and knowing what Helen was doing, I was very glad that she also teaches a course for us at the school because she has a lot of experience in the health policy world, so you can see the value of our students to being exposed to a leader in the community, and somebody understand many health policy nuances that you only get from like being out there, doing the work. And that's what I find most fascinating about Helen's role within our program and our policy work.
Helen: So I took on course called Global Health and Health Policy, and it's taught for undergrads. So usually mostly juniors and seniors. And we basically what we do, we take policies, current policies in healthcare, not only here in the U.S., but at a global level and say, you know, what are the tools to make sure these policies become real? Or like, if we wanna change a policy, what tools do we have to make them a reality? And we really discover, like, what I really try to do with the students is try to use real examples of the stuff that's going on and saying, "Okay, this is the current policy. Do you think it's right? Do you think it's bad? How do we make it better? And if you could, how would you make it better? What are the pros? What are the negatives?" And, you know, a lot of my students say, "You know, Helen, Professor Landaverde, you're so busy, how is it that you wanna come and teach?" And I have to tell you it is the best part of my day because I get as much as they give me because, you know, sometimes they have so many innovative ideas that, you know, I just go back to the hospital, I'm like, "You know, I heard we could try to do this. What happens if we do X, Y and Z?" And my staff looks at me like, "That's so out of the box." But I'm like, "But is it possible?" Because sometimes our students have so many innovative ideas. They just need to be heard. And then what I do with them is I give them the tools on how they can get heard, especially in policy. You know? And I think that's what I get the best out of it. And you know, I also like to feel young. When I'm with them, I feel a little younger, but they remind me very quickly how old I am. 'Cause they're like, "Professor, when did you graduate? There was no Google?" I'm like, "No, there was no Google. I had the library, that's it."
José: So, yeah, that's one thing that actually we try to do with our programs to make sure that our students get exposed to as many experts in the community or, you know, folks with very practical experience when they join our programs, for example. So it's critical in your education, especially in a place like New York City where, you know, this is really complex and having someone that can help you navigate different spaces and partners and so on, and how things operate, will make your life a lot easier in the city.
Helen: Dr. Pagan, do you wanna tell them about the partnership that we did during the summer with 10 MPH students?
José: Why don't you? You may be able to tell the story better than I do.
Helen: So one of the things, you know, in being a professor and making sure our students get exposed to real life issues, health issues, I post to Dr. Pagan and said, "Hey, can I take 10 students over the summer and really he helped them focus on vaccine hesitancy?" Not among adults, or, you know, at that time they were not children, but among teenagers, 'cause at that moment, the mandate allowed anyone 12 and above to get vaccinated. I was like, "Why not have the youth speak with the youth?" And he said, "Sure, why not?" So he was able to get me 10 NYU students to spend six weeks with me at Elmhurst Hospital, be exposed to all different things that we were doing, you know — in the recovery stage of the pandemic which was the vaccination — and really collect data, really talk to people, be exposed to different leadership. And also at the same time, come up with a plan — a marketing plan, a policy plan for the hospital and how to better reach the youth. I mean, and they got to present to the commissioner of health, which was huge. So that was very exciting. So that's what we did in the summer with 10 students.
José: Yeah. I mean, it's important to know that Elmhurst Hospital was the one that was most impacted by the pandemic even before Helen became CEO. So it's known around the country as the hospital that was most impacted by it. So having an opportunity for students to understand issues connected to vaccine uptake and looking at it from... And it's also a very diverse area of the city. I mean, the New York City is very diverse, Queens is even more diverse.
Helen: Actually, Dr. Pagan, Elmhurst Hospital is the most diverse ZIP code in the nation.
José: Yeah. How many languages do you-
Helen: So we speak 125 languages, more than Google, by the way. Google only is able to translate 109, we are able to talk and translate 125.
José: So you have a lot of staff that are from all over the world that speak different languages and so on?
Helen: Yes. We speak around, when we looked at our data the last, I wanna say like six months ago, when we hit through our annual report, Elmhurst Hospital, the workforce represents 93 different cultures and religions.
José: Wow.
Aman: Wow.
José: Does that also mean you have great places to go for lunch around?
Helen: Yes. Oh my God. We have so much good food. That's why I gained 10 pounds coming to Elmhurst. All I do is eat different foods. It's delicious.
José: Wow. This is an amazing collaboration. And the stories we've heard in the past few minutes have been just wow to me right now. I'd like to talk a little bit about what happens when a student might graduate? You know, the possible opportunities with regards to vulnerable communities. We've been talking about the diversity for the past few minutes and how New York City is a very diverse place. And that's obviously one of the most wonderful things about it, but that also entails many vulnerable communities that have certain barriers to healthcare. So what is New York City Health and Hospitals doing to encourage patients from all these communities to come in and get access to that care? And what could students also know about this future or current students?
José: I mean, outside of the outreach and activities that Helen and the hospital do, I mean, 'cause they wanna make sure that everybody that access is equitable, that everybody has good access to care, that everybody feels comfortable and at home and because it's important if either you have an emergency or you're trying to manage a chronic health condition, you want people to have a place to go. And that's an important role that that hospital plays. In terms of our students, you know, we want to make sure that they get exposed to these issues to sort of the challenges that different communities face. When students come in, if they say, "I'm interested in learning more about how to serve vulnerable populations or diverse populations." Or whichever population they're interested in working with. We basically work with them to say, "Okay, is that what you wanna do? So let's think about," we sit with them and say, "Let's think about then how do we get you there?" So we have a very tailored approach to helping our students find their place and do what they wanna do. Maybe I said too much there. So I don't know Helen, if you want to add anything.
Helen: No, I totally agree. I think what Dr. Pagan has said is very true. I think one of the best things, and remember I came from NYU as an undergrad, I think that's one of the things NYU does really well. It takes a student, and if the student is really committed and passionate about a topic or a sector or a population, I think the resources that NYU has is huge. I mean, the fact, you know, just look at me and Dr. Pagan, you could have a student in Gallatin or in Stern saying, "Hey, you know, I wanna really understand better, you know, health economics." I mean, the professor at Stern can call up Dr. Pagan and Dr. Pagan is like, "Oh, let me tell you, you know, blah, blah, blah. Oh, you wanna see it live? Oh, I actually have a friend at Elmhurst Hospital. You can go see it there — how finance works at a hospital." He has actually access to 16 hospitals, so he can pick any one. But I wanna think I'm his favorite, so that he would pick Elmhurst.
José: Helen, I moved here from Texas before I moved here. And one of the things that I didn't understand about cities like New York is things like what you just mentioned now. Which is like the advantage of coming to a city like New York to go to graduate school or get your degree, or getting a job is that the density is so high that all these connections happen extremely quickly and no other place has that, that I've seen, which was very eyeopening to me, I'll tell you that, 'cause I never lived in a city like this. And so you quickly find your way around the place on that. And you just have to be not aggressive, but you have to be very vocal on the professors. So you gotta hustle, you know, and find your way because the resources are incredible.
Aman: I like this aspect of community that we have mentioned quite a bit and building a strong community within an organization is very important. So I'm curious to know about this from a more managerial perspective, and Helen, you can even contribute to this a bit where it's probably a big job to manage doctors, nurses, public health professionals, hospital administrators. And even for you, Dr. Pagan in the role of a chair, there's so much happening in a university setting as well. What have you learned around building strong communities within an organization setting?
Helen: Well, for me as a CEO of a hospital, I think the most important thing is to listen. And I know that might sound so simple, but it's the hardest thing you could do, 'cause so many things are being thrown at you. I can tell you sitting right here, I probably have like a thousand balls in the air, but to really sit here and be present and listen and really understand the need of the person talking to me, it's super important because it's the only way to get that focus attention and believe it or not, until you don't have that focus attention to that specific problem or that specific approach or that policy or that pattern, you're not gonna be successful because then you're just gonna have a thousand balls in the air and you're never gonna address one of the issues. And I think the second thing that's super important for me is that once I listen and I address what the issue might be, if I'm not sure what the answer is to look up for advisors and mentors. Like, I can call Dr. Pagan when I have an issue and be like, "Hey, I have X issue, I wanna go this way. What do you think?" 'Cause sometimes your mentor, your advisor will see the consequences of your decision that you might not be able to see. And I think that's something important that you need to have. So I would say those two things are important.
José: Yeah. Many times there's not a right answer. I mean, you may have a complex question you have to address, so there's no right or wrong answer, so you wanna get the advice of several people on protecting confidentiality or any of that. But you know, being able to make a decision. But one thing that I'd add to what Helen said, which I agree with everything that she said is when you then listen to the needs and then you communicate your action or what you're gonna do about a situation. I mean, over the years, I've learned to be more clear on how I do that, because words have consequences and you don't know, you only notice that when you have positions of leadership that you have to make a decision because every word you say is being parsed and that just come from experience. So if you make a joke or something, be careful about how you do that or you might... Any comments that could be construed in very different ways, you just have to be very careful with how you say things. The things are taken literally. And that I've learned. And if I want somebody to do something, I tell them, "This is what I want." And I try to be very direct. That's very New York.
Helen: Yes. But I agree. I agree, Dr. Pagan. I think once you... And you can be a leader even in small groups, you know. I think that's something that I wish students would realize you don't have to be the chair you don't have to be a CEO. The fact that you're a leader of your study group, or you're the leader of your dorm or your club or whatever it is, actions, words, you know, could really break or make you because now everything everything's put on social media, everything is tracked, everything's Googleable. And I think if you could learn that lesson early on, I think that's very important to do.
Aman: The jokes, the parsing, there is so much there and there is an element of power, respect, understanding. And my favorite thing is we have two ears for a reason and one mouth for a reason, listen twice as much as you speak. I love that. And it's something that I'm gonna employ after this podcast as well. I'd like to talk a little bit about more into globalization and how we were talking about diversity and the importance of it. And in your hospital, for example, there's so many languages, so many religions, so many cultures. And what are your thoughts on globalization when it comes to public health? It's a very open-ended question, but I'm curious to know maybe some stories or personal experience of the power of globalization in public health.
Helen: So I think for me, I see it two ways, right? One way I see it as the CEO of Elmhurst Hospital, where I see it as the hospital needs to get ready to receive all these type of diverse population, diverse patients, they all come with their needs, advantages and disadvantages. And the hospital needs to think ahead of those issues and those barriers, those cultures, or different language barriers that might exist. It's very cool that I speak 125 languages, As a CEO, how do I get my hospital ready to speak 180 languages? Like, do I need to get more interpreters? Do I need to get a better software? Do I need to invest more on what are my next up and coming populations growth in the ZIPs code that I service. So as a CEO, for me, it's like, I need to get ready for like the next round of the next round of languages. And also how do I teach, you know, compassion and understanding in a team of 4,500 employees? 'Cause the more diverse you assume, oh, we're all diverse, we're all inclusive, it's in our mission statement. But in your groups, when you get to the line staff and, you know, teens and stuff like that, how do you ensure that message gets down to that level? You know, because sometimes, you know, and racism is real. Something to say that it doesn't exist is a lie. So we might have pockets of it. So how do we get to those pockets where we get to train on inclusion and train on diversity, train that me and you are the same, we just look a little different, speak a little different, eat a little different, but at the end we both have a heart, we both have bones. You know, we function the same, we put on pants the same. You know, so I think as a CEO, that's what I worry about. And that's what I need to function as. I wanna say, as a scholar, as an educator, and as a professor, you heard that Dr. Pagan, I call myself a professor. I just gave myself a promotion. I think I really wanna ensure the stuff that I'm teaching shows example of diversity, shows that, you know, and perfect example in one of my class, I showed different policies on the COVID mandate. You know, how the U.S. did the COVID mandate for employees and how London did their COVID mandate for their own employees. 'Cause they have a universal health system. We don't, you know, we have half private, we have a mix. And how these two power nations address the COVID mandate differently, you know, and how like one policy can affect different populations differently and getting my students ready to understand that when you create policies, you have to think of it as a global issue because now your policy, because of the world of internet and the world of Google, your policy can be transferred as a template in another country, you know, which is a great thing. But we have to keep that in mind. And as a professor, I'm trying to make sure that my students understand that. So, which I think is an amazing thing. I didn't get one that when I was an undergrad, whether I was an MPH student nor an undergrad, 'cause the world was not that accessible. Now the world is literally a click away or a TikTok away, you know?
José: Yeah. I mean, one thing that given that our school of public health is so diverse and makes in terms of students coming from all over the world, the U.S. and all of that, it's an interesting environment to like learn how other systems work. People come here to get new ideas, go somewhere else. So when you think about globalization in general, especially in public health, maybe 'cause the pandemic is also driving a lot of that too, that you need to have those exchange of ideas to solve problems. And many times, because we're such a large country, like in the U.S., we don't necessarily do that in every area, but sometimes the answers are somewhere else. We just don't know that they're there. So to the extent that you can have the exchange of information, that's gonna be critical. How do you structure the whole healthcare delivery system or the public health component of it? Maybe the answers are somewhere else. Maybe some ideas are there and the same, you know. You're in your country being exposed to so many ideas means that at a minimum you'll learn something that you didn't know on how to solve a problem.
Aman: Like I said in the beginning, I think there's gonna be a lot of golden nuggets in here and we haven't been disappointed yet. I'd like to add a cherry on top of this cake that's been provided to us so far and talk about some critical steps that the two of you have taken in your career so far to make it to the level where you are. I'm sure a lot of people are looking up to you and just figure out their own paths, ways to emulate, ways to learn. As you said, we're all interconnected. What are some key decision points in each of your careers that formed a robust path for you, a clear path? and it might be, yeah, it was never a design path or what are some things that stand out to you that might help future student or even a future leader in the healthcare space?
José: I mean, I'll throw a few ideas there mind. The first one is when you get invited, I mean more like just general ideas more than about myself. But like when you get invited to something, show up, if you think it's important, you just don't know who you're gonna meet. And also ask a lot of questions along the way, don't be shy about asking questions. You know, don't spend too much time thinking that you may look dumb in any situation. There's not much time to be thinking about that or it's not worth the effort.
Helen: You know, for me, my path, you know, has always been like a little, it was not a straight path. It's been little zig-zaggy-ish. I don't know if that's even a word, but the one thing that was always constant and I thank my parents on this one is reading. You know, my dad was always like, "If you don't know something, there's a book for it. There's nothing you can't learn, Helen." And that really opened up the world for me. And I come from a low income community here in Queens, Corona. And I migrated from Ecuador from Chone which is like hardcore farmland, where we only had like three channels. And even then, my dad and my mom would say, "Well, if you don't know something, that's not an excuse. Find a book, a book will teach you. Or if not, someone will teach you." And I think no matter whatever my question was, I always found time to find the answer. You know, I tell my students that if I had Google, I would already had like 20 FQACs because I had to learn. I still remember being in the library, looking up like statistics and epi and stats on healthcare access, provider ratio. Now you can just Google, create graphs. I had to do my own graphs in like SAS. And I think I had SAs 0.1. I don't even know what... I think SAS is like 15 now. I think that's what really changed me. I agree with Dr. Pagan, show up, show up and know your stuff. If you wanna make the best cheeseburger on the planet, well, cheeseburger is not healthy for you. Let's say peanut butter and jelly. You know, you gotta figure out how to make the best peanut butter and jelly on the planet and you can read and find out how to do that.
José: I think that's one thing that I, you know, peanut butter and jelly or cheeseburgers example, following up on that, what I've learned on that is the difference between people that are good and excellent or very good and excellent in whatever they do is the level of detail that they put and the effort that they put to... It's easy to go off, relatively easy, what I mean is to... In anything to be very good at something, but it's very hard to be excellent at something. And that takes time to realize and so if you're writing something, if you're developing a policy, if you are doing anything, you have to spend a lot of time to get it right. And that's what I've learned from like, places that I've been to, that I go like this guy, this folks know what they're doing more than anybody else tends to be something connected to that. They prepare for the presentation instead of doing two hours, they'll do 10 hours, you know.
Helen: You know, and Dr. Pagan has a real life story on that, 'cause, you know, he's in my doctoral committee. I'm not gonna tell you how many times he made me rewrite my outline. But my outline was so amazing that by the time, you know, he also took me off my anxiety cliff one night that I called him and he was like, "Helen, just write, you have it all there." And I think, you know, making sure my outline was to the level that it, you know, that it wasn't good, it was excellent, that by the time I needed to write the whole thing, like it just flowed. The process was so much easier that in less than a month to write 45 pages, which by the way is super hard to do when you're writing a proposal for your dissertation. It was not difficult. But because we put in the work in the outline and you know, making sure not only that it was good, but that it was excellent, that we pushed the bar, I think that result made me the writing so much easier. And the confidence that what I wrote, the post that I wrote, is really good. So that's just an example.
José: Yeah. You always wanna hang out with people that are smarter than you.
Aman: Folks, replay this clip anytime you're thinking what makes good to excellent. And this is very, very, very helpful feedback. I'd like to ask one final question before we conclude the podcast today, you two are clearly incredibly hard workers and have done so much. What keeps you going every day? What motivates you to put in these long hours?
José: Impact of what you do, you know? I mean, you care about your students, you care about your community, you care about the world around you. And I wake up every day and I think like, how can I make a difference on what I'm doing? So that it doesn't become just something mechanical, but it's something like mission-driven.
Helen: And I think for me, it's a faith issue. Not only is it impactful, but my dad believed in like, you know, he would be like, "Helen, you know, you can't change the world, but you can change this block." And for me, part of my faith is like, okay, I can't change the world, but can I change this block, the next block? Can I change that person? Can I give that person access to healthcare? And what is the potential of that person getting access to healthcare? 'Cause when you're healthy and you have good access to healthcare and you start to feel good and when you start to feel good, you work a little harder. And when you work a little harder, you get closer to your dreams and that becomes... You're more passionate, you're more happier and happiness spreads, you know? And hopefully that, for me, it's like, you know, I'm passing the message of that good healthcare makes you happier. And because you're happier, you're a nicer human being, which in my faith, that's like our main goal to make sure people are nice to each other.
Aman: Couldn't have ended on a happier and a better note than that. Dr. Jose Pagan and Helen Arteaga, thank you so much for coming to this podcast. It's been a joy to speak with the two of you and thank you for the messages you have provided to our audience.
Helen: Oh, thank you.
José: You're welcome.
Helen: This was fun.
José: Thank you. Yeah. It was fun.