A healthier New York City

Dr. Ashwin Vasan, Commissioner of the New York City Department of Health and Mental Hygiene, visits Brown to share perspective on public health response in New York — from the Omicron wave to today.

On October 24 Dean Ashish Jha hosted the second installment of this year’s Dean’s Conversation Series, which aims to address crucial public health issues by engaging with prominent figures in the field. For this event, Jha was joined by Dr. Ashwin Vasan, who currently serves as the 44th Health Commissioner of New York City.

Vasan is a seasoned public health expert, primary care physician, and epidemiologist with nearly two decades of experience upscaling HIV treatment in developing countries and improving the mental health of underserved populations in the United States. As health commissioner, his focus is the transformation of health, social welfare, and public policies to benefit vulnerable populations in New York City. He assumed the role in early 2022 and is spearheading a comprehensive overhaul of the city’s public health system. His newly launched initiative, Healthy NYC, addresses the root causes of declining life expectancy in the post-COVID era, which includes tackling crises related to overdoses, chronic diseases, birth inequities, climate change, and gun violence. Simultaneously, Healthy NYC strengthens the Health Department’s readiness for emergency responses.

Vasan has also implemented a citywide plan to combat what can be described as a ‘second pandemic’ – a mental health crisis affecting young people, people living under the poverty line, vulnerable New Yorkers with severe mental illnesses, and those affected by the overdose epidemic.

Vasan took office in the midst of the 2021-2022 Omicron wave, with New York grappling with 50,000 COVID-19 cases each day. His tenure began with the task of building political and social relationships, an essential foundation for the work that lay ahead.

As Vasan settled into his role as commissioner, he made it clear that his focus extended beyond being “the COVID guy.” His primary concern was the mental health of the city’s population, particularly the youngest residents. “I had to decide what stakes to put in the ground and focus on creating a positive agenda,” he said. “I began with mental health as data from 2020 and 2021 clearly showed that depression and anxiety, especially among youth, were on the rise.”

In March 2023, Vasan and his team launched a comprehensive citywide mental health plan. “Speaking it into existence was crucial, as it turned down the emotional intensity of the pandemic,” he said, “and opened up space for me and my team, enabling us to work on various initiatives.”

Vasan described how public health at that moment was viewed almost exclusively through the pandemic lens. The situation was extraordinarily polarized and many people’s first interactions with public health policy were related to mandates, authority, and regulations. “For me, mental health is a unifying issue,” he said. “It’s bipartisan, and we can find bridges there – bridges that we can’t find on vaccination, public health funding, and mandates.”

“The history of mandates in public health isn't flawless,” Jha acknowledged. During his tenure as White House COVID-19 Response Coordinator, Jha helped lift mandates before the COVID-19 emergency ended. “Looking back on the past few years, I question how these mandates were used and their impact on broader engagement with the public.”

“ We must build up skills in persuasion, engagement, trust-building, and expand our presence within communities and people’s lives so that, when we do need to offer guidance, there’s a greater likelihood that people will listen. ”

Ashwin Vasan, MD, Ph.D. Commissioner of the New York City Department of Health and Mental Hygiene

Vasan acknowledged that the decision to implement public health mandates isn’t an easy one, and it relies on available data and historical precedents. He stated that mandates in New York had indeed contributed to high COVID-19 vaccination rates, but noted that the inherent health consciousness of New Yorkers and their trust in science also played a role. “Mandates remain a tool in our arsenal, but we should exhaust other approaches first,” he said. “I believe in using them as a last resort. We must build up skills in persuasion, engagement, trust-building, and expand our presence within communities and people’s lives so that, when we do need to offer guidance, there’s a greater likelihood that people will listen.”

Dean Jha turned to the issue of the decline in life expectancy over the last three years. “New York City saw a drop in life expectancy in 2020 due to Covid, and the recovery has been limited,” he said. “We are the only high-income country without a life expectancy rebound.”

Vasan’s priority in addressing life-expectancy decline lies in forming a unified response. “We believe that rising life expectancy should be a civic expectation, especially in the richest city in the world,” he said. “Our response includes launching a population health agenda for New York City, setting ambitious goals for 2030, and investing in data. Our goal is to unite experts, civil society representatives, healthcare providers, taxpayers, community groups, activists, and supporters to align with our mission.”

The challenge here for public health officials is to present the issues and the data clearly and simply in order to gain public support. “Storytelling is vital, especially when dealing with the public and communities,” Vasan emphasized. “It goes beyond numbers and statistics, particularly in the context of vaccine mandates and vaccination campaigns.”

He cited the Information Futures Lab at Brown as an example of public health practitioners rethinking how messages are delivered and received. In addition to directly and routinely engaging with the public, Vasan champions data-driven narratives as a way to convey what are often life-saving messages, with the ultimate goal of connecting with the community. “If the story is delivered correctly,” he said, “the public will be more likely to embrace the evidence.”

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