EP93 Public Policy Symposium on Public Health 2020 with Pavel Shirley & Sonia Wiecek

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I AM GPH EP93 Public Policy Symposium on Public Health 2020 with Pavel Shirley & Sonia Wiecek
EP93 Public Policy Symposium on Public Health 2020 with Pavel Shirley & Sonia Wiecek

Maureen: Hi, my name is Maureen Zeufack and you're listening to the I AM GPH podcast. In this episode, I speak with two NYU undergrad students, Sonia Wiecek and Pavel Shirley. Sonia is a junior majoring in public policy with a minor in public health and Pavel is a freshman studying public administration. In November of 2020, Sonia and Pavel both were attendees of the Public Policy Symposium on Public Health, which was presented through a collaboration between NYU GPH and the NYU Politics Society. During the two-day virtual symposium students from across New York City gathered to present and debate policy proposals on various topics regarding public health, ranging from the opioid crisis to gun violence. In my conversation with Sonia and Pavel, I got an insightful, closer look into certain topics discussed at the convention, specifically national healthcare insurance as well as housing, and got to hear more about the current state of debate on these topics and what reform and solutions might look like for these issues. Sonia and Pavel even channeled a bit of the spirit of debate in our conversation! And you'll definitely want to listen to our conversation about the intersection of the fields of public health and public policy and what they both bring to the table. Stay tuned. 

Maureen: You're listening to the I AM GPH podcast. Today I'm joined by Sonia Wiecek and Pavel Shirley. I'm so happy to have you guys on the podcast today.

Sonia: Thank you for having me.

Pavel: Yeah, I'm really happy to be here

Maureen: Fantastic. So can you tell us a bit about the experience of the Public Policy Symposium from debates, presentations, how the event unfolded? Why did you choose to attend this event?

Sonia: One of the reasons I did the Public Policy Symposium last year... I was actually a committee member last year, but this year I was really interested in participating primarily because it's about public health and I am a public health minor. I'm a public policy major. And I was really interested in combining those two because I would like to go into health policy after college, graduate school, whatever comes next. So I was really interested in having the experience in writing a policy memo. That's actually in a policy area that I am super, super interested in.

Pavel: Yeah. So I came to it a little bit differently just because this was my first year and I was a committee member this year. I mainly did it less for the public health aspect, but more just for the specific role I had as one of the background paper leads. I wanted to join the Public Policy Symposium because I just liked doing general public policy research. It's something I did a lot of before NYU and which I'm continuing to do now. I guess my motivations are pretty similar to Sonia's. Maybe not specifically public health, but after college I would really like to go into some sort of policy analysis, policy writing, that sort of thing. And the public policy symposium is a really good way to do that. It just happens that we focused on public health this year, which I also do think is really interesting.

Maureen: Pavel, I know that you were on the planning committee for this event for this year. Can you briefly tell me how the preparation and development for the event took place?

Pavel: Yeah. So I'm a freshman, so I was only involved in it from September until the November date. We did have two directors who worked on it a little bit over the summer. And so what happened essentially is they created a general outline of how the symposium would work. They had the topic, they had the partnership with the School of Global Public Health, and then there were applications to join. I did that. Eventually got my role as the research paper lead, which meant that essentially my job on the committee was that I helped direct, edit, format the background papers we produce, which are pretty much short summaries of each of the subtopics we had underneath public health, to help the participants have a launching pad off of which to write their own memos. So I spent most of my time editing and researching.

Maureen: That sounds like a great effort to fit this all together. So this was a crossover event, a public policy and politics event centered on public health. In what ways do you feel that public health and public policy intersect and why is it important for us to have both schools of thought at the table?

Sonia: I think it's really important to have both at the table because I think a lot of the time people think of public health as exclusively a scientific major or scientific topic. Whereas I think so much of public health... And we're especially seeing this with the COVID pandemic and the laws that are being put into effect right now. So much of it is really public policy-oriented. And so much of public health is also an economics thing. And it's also a public safety thing. And there are so many ways in which public health is so much more than just epidemiology or a research lab or a vaccine or whatever. And it's really important to consider the fact that public health policy specifically is going to intersect with so many other types of policy. And that's why it's really great that they combined them this year.

Pavel: Yeah. I definitely agree with that. My view on this is that I think in public policy and in these discussions when people come together and they talk about whatever policy they want... Say they want Medicare for all or they want to abolish Obamacare. It doesn't matter what political persuasion they're coming at it from. There's a lot of discussion of public policy ideas and there's very little discussion of public policy implementation. I had a professor this semester who did a bunch of research about graduate-level public policy, public administration, master's degrees that people get. And he did some breakdowns of how much they emphasize public policy invention and public policy implementation. And at an academic level, this is true that we just completely neglect the actual implementation of policy. And so I think it's important to have public health and public policy combined together because public health... At least I see it as the public policy implementation of, say, something like a COVID restriction. That the state can't just come out and say, "You need to have a mask mandate," and then do absolutely nothing else, though some states have done that and we've seen how well it's worked. But public policy actually works when you have public health officials and you have public health professionals actually doing that work. We're going to see this with the vaccine rollout. It's going to be a huge problem and if we neglect the public health sides of things, then we might completely botch vaccine rollout.

Sonia: Yeah. I feel like the pandemic is a really great example of the intersection of these two schools of thought or whatever because you can talk about the CARES Act as being an economic policy through the extra $600 in unemployment or the stimulus checks that went out to most families in the US. But fundamentally those are also health policies because they're giving people the ability to stay inside. And I know that so many people without the extra $600 in unemployment would have had to go back to work way earlier. And they would have had to do that just to pay rent or put food on the table. And so without that policy, which is an economic policy in and of itself, the virus cases would have skyrocketed over the summer... Which they did regardless. But I think we would have seen the pandemic just spread to a much greater extent.

Maureen: So one of the topics discussed at the symposium was health insurance and national healthcare insurance. What is the state of the debate over that topic and the sides represented in this conversation in the US?

Pavel: I personally don't think the state of the debate is super healthy about health insurance. In general, we get really pulled in the popular imagination towards very big public health changes that... I think there's this conception of the public health insurance debate specifically that the way you're going to reform health insurance is you either go in and you need this 60 seat Senate majority and you're going to change absolutely everything or you're going to fail. And while, sure, you may think that that really big change is good and that that's something you can work towards, I do think that in the meantime, there's a lot of things that you can do just around the edges in health insurance. And that there are ways you can meaningfully improve people's lives and people's access to health insurance in the intervening time between which you can actually have this great triumph. It's not a very sexy thing to talk about, abolishing surprise billing or something or changing the standards on an Obamacare bronze plan so that it's better and more affordable to people. These aren't things that you're going to see people super animated about, but these are also probably the things that are most feasible to help people in the short term before we can have a broader transition to some better form of health insurance.

Sonia: To push back on that a little bit, I would say while I agree with what you're saying, it is important for me not to lose that big idea that's guiding everything. Because Medicare for all... I'm a huge proponent of a Medicare for all plus system where you would have private insurance but everyone would have government-subsidized insurance just as a base level. But I think the Medicare for all plus system solves some of the highly debated issues, like people don't want to lose their private insurance. But regardless there are so many issues that could be solved if we gave everyone just basic socialized insurance or government insurance or whatever you want to call it. And I think it's really, really important not to lose sight of that and instead get caught in the little small things that we continue to right now. So I intern for a state senator right now and she's the chair of the women's issues committee. And so many of the policy things that come through her office are related to that and not necessarily to health policy. We're trying to write and pass a bill right now that's related to New York State's Sexual Assault Survivors Bill of Rights. It's similar to the bill of rights that any crime victim or victim of a violent crime would have in that you have access to medical services if you choose to do so, you can have your evidence processed in a timely manner, stuff like that. But basically, so many issues with the current Sexual Assault Survivor Bill of Rights would be solved if we had Medicare for all or some form of Medicare for all. And I think it's really, really important not to lose sight of that.

Maureen: Thank you for sharing that perspective. So a lot of research and preparation was done for those who were participating in the event. With this particular topic or the topics that were discussed, was there anything you were surprised to learn about or feel strongly about?

Pavel: I wasn't super familiar with this until we discussed it in more detail at the Public Policy Symposium, but I learned a lot about all-payer rates, which is a specific method of trying to expand the affordability of health insurance in a pretty big way by essentially unifying private health insurers that they negotiate and bargain as one unit, which has the effect of increasing their bargaining power and theoretically lowering prices. And I just wasn't super familiar with that as a mechanism of reforming healthcare and of trying to lower prices for people. And I especially wasn't familiar with the fact that Maryland has actually implemented that sort of system. And I haven't done an extraordinary amount of research since then, but it is really something that I think is informing my thinking as I go forward. I'm definitely going to have to look into how Maryland has implemented that because I think it has implications for a bunch of different things. For one, it's just an alternative way of performing health insurance in general that may be considered a national level. But I also think it's interesting to think about it as a roadmap for how much a state can do in the absence of federal action. And so how effective that is in Maryland could be really important for say if New York does that or another state.

Sonia: To go along with the whole insurance debate, something I just never really thought about before, when we were talking about national health programs, Medicare for all and all of that, one of the co-directors is from Connecticut, which is where a lot of insurance companies center their administrative operations. And something that I never really knew about was how many benefits these insurance companies offer to their employees. Obviously, they get free health insurance, but beyond that Matt was talking about how they have really good retirement plans and they provide college funds for employees' children and things. And that's one of the reasons why he was not the biggest supporter of Medicare for all. And that's just something that I never really knew about at all prior to him bringing it up.

Maureen: That's fascinating. So another topic that was discussed at the Public Policy Symposium was housing, which some might find surprising to hear discussed at a public health symposium. So how are the two correlated?

Pavel: Some of the ways that housing is related to public health... On some level, it's almost basic to think about that when you get sick, you stay home. And the ability to stay home is an important part of not spreading that disease, which has become really important in COVID times because that's the whole public health strategy, to be honest. That you just stay home. And especially if you're sick you stay home, but in general, you should try and stay home just so you're not putting yourself at risk.

And the quality and the availability of housing is a huge, huge factor in your ability to stay home and your ability to isolate and things like that. And it applies even beyond COVID, that there's a ton of evidence and research we have about how the quality of your home, both literally in a structural sense and more figuratively in terms of interpersonal relationships you have in your home... Which is also, again, related to the structural quality of your home. Has a huge impact on people's mental health. That having an affordable house that you don't have to worry [about] every single month or [an] affordable apartment every single month that isn't weighing down on your entire life to be able to make that rent payment is a huge deal for people's mental health. It's a huge deal for people's physical health. As you know stress relates to physical health issues. Having to overwork can really wear you out and things like that. So it's actually a huge deal in public health that we just totally ignore. Not to mention homelessness, of course, which in and of itself is a giant public health crisis.

Sonia: To build off of that, housing is the intersection of so many issues within public health and public policy because low-income tenants only have access to worse housing. And this worse housing can lead to higher rates of respiratory infections because of mold, damp, dust mites, whatever it may be. And obviously like Pavel talked about there's all the mental health implications that come along with that. And also the same is true for many communities of color, in that they have access to worse housing than white communities because of redlining, because they may also be low income. There's a whole host of issues that go along with that. And then those communities, communities of color and low-income people, are also affected with higher rates of some diseases like diabetes or like asthma, which is because of lack of housing or other structural issues. It's not a genetic thing or anything. And they also have worse access to healthcare or access to no healthcare at all. And those just all compound around a housing thing in that if you don't have enough money to pay for a safe place to live or if you cannot access a loan to live in a safe place because of the remnants of redlining, then your health, both mental and physical, will be negatively affected.

Pavel: So there's actually a professor here at NYU, his name's Jacob Faber. He gave a talk earlier this semester, actually... Just building off the redlining point. Where he has gone through and he's mapped New York City and you can still see so clearly the racial lines in city neighborhoods. And then you can overlay that onto [the] prevalence of diabetes and prevalence of respiratory disease and homelessness rates. And it follows the same lines that were drawn in the thirties through redlining. So that was another huge focus of the Public Policy Symposium to address and acknowledge and try and alleviate some of the underlying social, structural public health problems that we just have been dealing with for hundreds of years in this country.

Maureen: So could you both tell me more about the factors that are playing into this issue with housing, such as landlord licensing and zoning, and the memos you wrote regarding it?

Sonia: I can talk about my memo first. I wrote about landlord licensing, which is more of a state or city issue whereas I believe Pavel's memo was more of a federal issue. And landlord licensing is super simple. It works just like a driver's license essentially. So each landlord would get a license for every building they own. And to get this license each building would be put into a tier based on maintenance issues, access to heat and hot water, and other just structural issues with the building. So the worse your building is, the more that you end up paying for a license. And I would make all of that information publicly available. So before buying or renting a building or a unit, any person would be able to see what tier their building is in. And then the money that was collected from this would go towards a proactive inspection regime of all the buildings in the city. Since right now to get your building inspected in New York City, you actually have to make an appointment with HPD [New York Department of Housing Preservation and Development]. You as a tenant have to reach out rather than HPD going around to every building and inspecting it. Though I think they do inspect every building every 10 years or so. I don't remember off the top of my head. But basically, the whole hope with this is that all the issues with the building would be found and fixed more readily and then tenants would just have a safer, healthier home to live in. Obviously, it's not only politically difficult but also difficult in the sense that some buildings are just so rundown that people should not be living in them, to put it super matter-of-fact. And in many of those cases right now the city is aware that these buildings are rundown and not safe and healthy homes. But if they have taken the landlord or the management company to court, they have settled for super low or they haven't collected on fines or whatever. And so I think in conjunction with landlord licensing, there needs to be increased... They need to collect all the fines and they need to actually take landlords to court and actually sue them instead of just letting them be.

Pavel: Yeah. So as Sonia said, my memo was more focused on something the federal government would do rather than a New York State-level action. And it was primarily focused on zoning, which most basically is essentially when a city government says you can use this plot of land for this purpose. They're zoning it for whatever that purpose is. And across the United States, we have very, very inefficient zoning. We have a huge, huge portion of homes in cities... I think it's about 75% are zoned for what are called single-family detached housing, which essentially just means a house that is not connected to any other house and which only houses one family, which makes sense in some places. It really does. If you have a ton of space and you're not living in a city and you don't have an affordability problem, then yeah, it's fine to have detached single-family housing be the overwhelming norm. But at the same time, we have this huge affordability crisis that... You see it happen over and over in an American city, that a city will start growing and it becomes really prosperous and everyone wants to move there and it's a great thing for the city. And then it hits this roadblock of just housing becomes incredibly unaffordable. And we've seen that happen in New York. We've seen it happen in San Francisco. It's happening in rising metros like Atlanta and even Charleston, South Carolina, that repeatedly city planners and cities run into this roadblock where housing just becomes unaffordable. And it's because we are so inefficiently zoned. So my memo would essentially use a carrot and a stick at the federal level to try and incentivize states and localities to reform their zoning procedures, essentially just to make housing more affordable, more available, to incentivize building larger structures that can house multiple families at once, which are much more efficient. There's lots of reasons this is good beyond just housing affordability. Of course, it also improves the economic growth of those cities, because when people can continue to move to your city, they can continue to bring their talents and continue to bring their productivity there. And also it's a really big deal for climate change, that when you have more dense cities where people can walk to things, they don't drive. And so they don't use as much gasoline. It's a lot more efficient if we're going to be trying cutting down on our use of fossil fuels, which we absolutely have to. So I agree with the sentiment of Sonia's memo, that a lot of this work is going to have to happen at the state level, but I was just trying to propose something the federal government can do to nudge states along that work that they'll have to do themselves.

Maureen: Were there any solutions that you came up with or brainstormed for this topic at the event?

Pavel: I'm trying to remember the amendments. Did we make amendments to yours, Sonia?

Sonia: I don't think so. I remember we talked about making every apartment a rent-subsidized apartment, which would make the whole issue that goes with... So one of the worries that I have with my policy would be that the costs that have to be paid to the city for the license would essentially get passed back to the tenants. And also the cost of repairs would get passed back to either the current or future tenants, which obviously no one wants... Well, maybe the landlords want it, but I don't want it. I don't want my policy to negatively impact tenants in that way. And so I remember we talked about advocating for everything to become rent subsidized, but I don't remember if that was just something we talked about or if that was something we actually did as an amendment.

Pavel: Yeah. I don't think we actually ended up passing that one as an amendment, just because... Sonia, you made the point just that you didn't want the bill to be killed by the housing cartel and so that we wouldn't amend it that way. But yeah, we definitely did discuss that.

Sonia: Yeah. Yeah. The landlord lobbying in New York State is I would argue the strongest lobbying organization in the state and Cuomo is in their pocket. So I think making everything rent-subsidized while great is just politically not feasible at this point in time.

Maureen: So building off of this, a major overarching theme of conversation was reform and solutions for all these different types of topics. What does that look like? And do you feel that outcomes that were brainstormed are more public health or policy based?

Pavel: So, yeah, I think that there's a wide variance between the many topics we talked about. Because we talked about everything from bioethics to health insurance to housing. So of course at varying points, we had different balances here. But I do think one of the things that we accomplished that I think we did a pretty good job of was always keeping the ideas, even though they were literally policies, very cognizant of the role or the part that they're going to play in a broader public health apparatus. We didn't want to pass a policy that would be like, "Everyone be healthy," because that would just ignore the actual realities that you have to do the public health implementation further down the line. And that was something that we were really cognizant about. And then there was just in the discussion we had about Sonia's memo that we didn't want to just make it be maybe the absolute perfect way we would want it to be because we want the implementable version of what it will be. And so I think we did a pretty good job, to pat ourselves on the back there, on keeping public health-centered.

Sonia: I was going to say that it depended on what topic you're talking about. In general, for instance, when you talk about housing or about national health programs, they are by nature more policy-oriented than they are public health-oriented in the traditional sense. I think it's mainly due to the fact that they are issues where politics comes into play a lot. Not to say that's not true for bioethics or gun reform or whatever it may be. But I do think they are just much more policy-driven. But I was also part of the discussion on opioids. And I think that what we talked about there was a lot more public health oriented. It's so hard to separate them because everything that we talked about is policy about public health or policy that impacts health in some way. But just the policy that we talked about in the opioid debate or discussion was far more health-oriented than the policy that we talked about in housing, for instance.

Maureen: So the final question I have is what are some takeaways that you got from Symposium that you want others to know?

Pavel: I would say that one of the most significant things about an event like the Public Policy Symposium and one of the things that is really valuable about it is just the breadth and diversity of solutions and perspectives of how to resolve these different issues that you get to hear at these sorts of things. I mean, it's a symposium, so you'd expect that. But once you actually start hearing... the fact that you can have two housing memos that are maybe in intentionality sense directed towards the same direction, but they just do completely different things. And it doesn't reflect that you have to pick one or the other, but I think it just reflects the hard policy work of just having to do so much that there isn't a final victory ever and that you're just constantly progressing. You're constantly adding things and changing things and you're going in multiple directions, you're adding and changing multiple things at the same time. And so having that perspective of the breadth of policy issues and solutions is just important for grounding the way you view these debates.

Sonia: To go along with what Pavel said, something that I took away is just that young people have the answer to many issues and it was so great to hear so many people talk about wide-ranging issues. And everyone's memo was incredibly well-researched and incredibly well thought out and they could really talk about their topic for the entire time if we let them. And I think that's just so amazing to see, especially... I view COVID or our current political state as a time of turnover right now... Or at least hopefully it'll be a time of turnover towards a younger, more diverse government. And I think that this symposium really showed me that we do have policy thinkers that know what they're talking about, that can talk about it, and hopefully people that'll go into government or go into nonprofits or think tanks and be writing policy in the future.

Maureen: That's such a wonderful note to close on. Thank you guys for such an insightful and interesting conversation. Thank you for coming on.

Sonia: Thank you so much for having us.

Pavel: Yeah. Thank you.