convocation

Dr. Bisola Ojikutu to Deliver the 2022 SPH Convocation Address

Taking the helm of a major public health organization as it navigates a pandemic likely isn’t the most ideal way to begin a job, but that challenge—daunting as it is—is exactly the task that Dr. Bisola Ojikutu has shouldered in her new role as head of the Boston Public Health Commission.

Since September 2021, she has headed the nation’s oldest public health department, a role originated by Paul Revere in 1799. Then, the mission of the BPHC was to combat any potential infectious disease outbreaks such as cholera, smallpox, yellow fever, and plague—all of which had decimated populations around the globe in preceding years. Today, the BPHC has a significantly broader mandate: “to protect, preserve, and promote the health and well-being of all Boston residents, particularly those who are most vulnerable.”

The latter part of that statement has been a key part of Ojikutu’s career since attending medical school at Johns Hopkins, whether caring for patients in an AIDS ward as a student or delivering basic medical services in gritty parts of East Baltimore. She went on to complete an internal medicine residency at New York Presbyterian Hospital and an infectious disease fellowship at Massachusetts General Brigham. In 2003, she earned an MPH from the Harvard School of Public Health, and is currently an Associate Professor of Medicine and of Global Health and Social Medicine at Harvard Medical School, although her new role at the BPHC has meant shifting her academic work to part-time status.

She grew up on the South Side of Chicago, an area that has been a destination for working-class immigrant families for nearly 200 years, and she has worked to center the needs of that population in each of the stops along her career path. In a wide-ranging conversation ahead of her convocation speech, we asked Ojikutu to discuss her plans for improving the health of Boston residents, and how our students can help.

Improving the health of marginalized populations has been a central goal of public health for generations. What are some of the most immediate ways that new public health professionals can apply their skillsets toward achieving that goal?

I think one of the issues, as we think about improving health from marginalized populations and we think about issues of inequity and achieving health equity, is that we haven’t used our skillsets, used all of our knowledge base, and had enough resources to build sound public health infrastructure. Without infrastructure within the institution that should be doing the work, we can’t uphold the tenets of equity, and work towards achieving good population health.

 If you look at what is public health infrastructure, it’s certainly our data systems, our surveillance systems. Certainly, it’s the institutions, the entities, the ability to do cross-sector alignment with other institutions and working within cities. But number one, I think, is our workforce. It is having the people who know how to run public health systems, who want to do this work within public health infrastructure, within public health institutions. I think that’s been an overwhelming problem for us, as a department of public health here in Boston, and beyond. We haven’t been supporting our workforce. We haven’t been paying them enough. We haven’t been elevating them. We haven’t been providing good career paths for people within public health. We need to do that, full stop.

Every time I hear somebody talk about building public health infrastructure, if they aren’t talking about the workforce, and if they aren’t talking about working with students who are coming out of schools of public health so that they stay in the discipline of public health, then they’re not talking about infrastructure.

Why has there been that disconnect between what people hope for the field of public health, especially at ground-level, and what actually happens?

There’s very little value placed on what we do until there’s an emergency. We’ve just seen that. If surveillance mechanisms weren’t in place, if there weren’t the right tools and testing in place, we would never have understood where we are in terms of COVID-19. People may argue that we have a lot more work to go. Certainly, we do, and there are a lot of unknowns, but if there weren’t strong public health institutions, we would not be here.

Now, if we had been stronger, we may have gotten to a better level faster, but there hasn’t been that true investment in public health. I think that part of that has been political will. I think that’s been unfortunate. There has been investment in healthcare, but not public health. There’s been an investment in revenue generation, in the ability to get somebody to the hospital, and do something to them, the procedures and whatnot that are going to actually generate income. That isn’t what public health is.

Public health is about providing resources, a safety net, overall support systems for communities at large. It really is. It’s bigger than providing one individual with “X” procedure. I think that there’s been a devaluation of that larger need. I think part of that has been just the way that we, as a society, don’t view help as a collective good. That is really what public health does. That’s what public health institutions do.

Has your prior experience in HIV/AIDS research and treatment provided any insights into launching large-scale public health efforts? If so, what are some of those?

The reason that I was attracted to HIV research and treatment, was because it had this profound impact on communities of color and population-level health. Even though I was in medical school when I first really started seeing patients who had developed AIDS because they didn’t have access to treatment, it was really the impact that it had community-wide that I found most disturbing. It was the fact that much of what was happening at that end-stage was related to problems that significantly predated that.

It was about homophobia. It was about not having access to healthcare, as well as not having access to health information. It was about stigma related to substance use, not having harm reduction, and not having access to those services, particularly in certain communities. It was about structural racism. It was about systemic inequity. So many things led to what we saw, and what we’re still seeing, in terms of the inequities in HIV-related outcomes.

It wasn’t until much of that was amplified, brought into the public discourse, and you saw community-based organizations being developed around HIV and communities of color, you saw the Black AIDS Institute evolve, you saw local community-based organizations coming together and rallying. As you probably remember, in the early days, it was really many white gay men who brought their resources together and used their political will to get AZT, to get medications out there on the table to save people.

I think that’s great, but what does that tell you? It tells you that you have to have true community engagement. You have to have advocacy. You have to have this mobilization of people, people within communities, in order to move the agenda forward. I think that’s also what we’ve seen with COVID-19. Particularly here in Boston, we’ve seen coalitions develop. We’ve seen the Black Boston COVID Coalition. We’ve seen La Colaborativa.

These are organizations of people who said to themselves, “You know what? The system has never worked for us. Therefore, we’ve got to work to make this happen for ourselves.” That is a lesson that we need to learn and we need to not allow those organizations to die, because, say, COVID becomes endemic. We need to support them and actually make them part of the system. Otherwise, what are we doing?

I’m hoping that you can briefly outline some of your priorities over the next couple of years, from the most immediate to some of the longer-term ambitions you might have for the BPHC.

I think any leader going into a new job or a new organization creates their 90-day plan. You have your list of things that you need to do. I’ll run through them, because I think that they still hold true. I have a lot of work that remains to be done, even though I’m beyond the 90 days.

One, when I initially started at Boston Public Health Commission—even before starting—what I did was to just talk to people. I’m not talking about the people who are recruiting me at City Hall, I’m talking about the people who work there. I’m talking about the staff, the people who do the community outreach. I’m talking about the people who clean the floors. I just said, “Let me talk to people.”

In fact, in that first week, we did a survey. I said, “What is it that’s missing here? Tell me how you’re feeling about working here.” Overwhelmingly, staff appreciation, the feeling of respect, the feeling that people belong here, the feeling that they are getting paid enough for their work, the feeling that there is a career path for them…it’s still not there.

But we were able to at least quantify that and say that, “Look, we need an investment in our staff. We need an investment in our people,” because…it’s required that you live in Boston to work at the commission. This is Boston, who’s working here. Some of them are getting paid abysmal salary.

 I said, “You know what? We’re going to start a program.” It’s called, The Workplace Improvement Program. We call it WIN. Within WIN, we have priorities. Priority number one, we are going to fix our compensation structure, such that people are getting paid. They’re getting valued. Then, they feel valued by their compensation.

We’re actually changing our culture, so that it’s clear that we’re respecting people, even thanking people. There was a very disturbing comment and I’m sharing this because it still bothers me. In the survey, we had some open-ended questions. One of the people who responded said, “I’ve been here 10 years and no one’s really thanked me for my work.” I just was like, “How could that be? How could you not feel thanked?”

But it’s an example of how we’ve devalued public health. “The people who go into that, I guess they couldn’t make it in corporate America. I guess they couldn’t make it in medical school.” You see what I’m saying? We haven’t elevated this to the highest pinnacle that it should be. That’s part of this WIN Program that we put forth. That’s really priority number one.

Priority number two, mental and behavioral health. We know that there are clear unmet mental and behavioral health needs that people have been suffering with for a long time. There are not enough therapists. There’s a lot of stigma in regards to accessing mental health, as well as behavioral health services. People don’t feel comfortable with even thinking about mental health as being a part of physical health, in general. They don’t see it as one and the same thing, the interconnectedness of mental and behavioral health.

But we also don’t always look at mental and behavioral health as a public health crisis. What does that mean on a population level? If you have high levels of depression, if you high have high levels of PTSD, if you have these issues that are smoldering within our communities, then what is it that that’s doing to the community health, overall?

We are hiring a chief behavioral health officer. We should have that person identified by May. We have a $12 million commitment on behalf of the city, to develop a center for behavioral health and wellness at the Boston Public Health Commission, that will work across the city to elevate these issues, as well as to hire. We’re going to be spending a lot of time looking at workforce development, training, hiring, developing a pipeline of diverse providers across the city. This is something that Mayor Wu is obviously very interested in, too.

 One piece of that is developing a better data system, so that we get data more quickly, so that our data is aligned with data from other organizations, so that we can take a better and a broader citywide view of what’s happening. Not just in COVID-19, but in other diseases. We are developing a center for public health innovation. It’s public health science, technology, and innovation, where we’ll have a larger body of individuals who will be working in public health, particularly looking at data, technology, informatics, and actually understanding what’s happening in the city of Boston better. Those are some of the priorities that I have.

Our graduates are heading out into a world that, as you know, is experiencing fundamental changes, especially in the field of public health, but also in society at large. What do you hope that they’ve learned as they embark upon this new chapter of their lives, and what good should they doing in terms of public health?

I hope they’re learning to be visionary. I hope they’re learning not to just kick the can along, that there are big things out there that we need to tackle. I don’t believe that we should be limiting ourselves. I think we need to tackle those big ideas and that we need to be confident in our ability to do that. I don’t believe in the word “impossible.”

I believe in having a vision, thinking to the future, and building as we go forward. I hope that was part of the curriculum, or it was part of the culture and the spirit of the School of Public Health, because I think public health needs that. I don’t think there’s been as much of that visionary innovative thinking in public health, as one might see in industry, per se. I’m hoping that is the case.

 I think, secondly, what I’m hoping is that people will constantly be thinking about cross-sector alignment. Sure, if you stay in public health, that’s wonderful. That’s great. How do we grow? How do we synergize? How do we learn from other sectors? You work very closely with our academic hospitals. We have wonderful ones across the city. You work with technology firms. You think about what’s possible, how you can work together to develop something that’s more innovative, in terms of predictive modeling, understanding how epidemics will actually occur, and who they will affect within the city.

What has opened your eyes over the last few years? What did you go into thinking that you knew, but today you’re thinking, “You know what? I have had an awakening?”

That’s a good question. I think when you’re outside of public health, meaning when you’re outside of a department of public health, and you’re looking in and you’re critical of what’s happening or not happening, I think that’s typical. I am still an academic. I’m an Associate Professor of Medicine at Harvard, though it’s part-time. I’ve taken a bit of a break from my clinical care.

But I think, myself, I’ve been critical of departments of public health and saying, “They’re not doing enough. What are they doing?” You realize a couple things. One, you really have to have the right political will in order to make anything happen. I think we could all say, “Okay, we get that.” But when you are in it, and you truly understand just how important it is to have the support of the mayor, to have the support of the governor, as you’re thinking through issues.

If you just take COVID-19 as an example, there’s so much that we know within departments of public health about evidence, the science, and whatnot. But if somebody’s not listening to you, for whatever reason, then you’re not going anywhere with that thought. It was almost meaningless, all the work that you put into it, because departments of public health are within the political spectrum. It’s very much so how our leadership is addressing this and what kind of leadership you have.

 Is it a progressive leader? Is it a leader who’s also a visionary? Is it a leader who follows science, who understands data, who will turn to you and say, “What do you really think about this issue? We’re thinking about masking. Tell me why we should or we shouldn’t?” As opposed to making a political decision.

I think the other piece of it is just understanding the bureaucracy. Those two go hand in hand, but it is challenging to get things done. I think one of the things that we need to do in public health is trim that bureaucracy, cut through that bureaucracy, that red tape, because there’s so many things that we need to do and we need to do urgently, and we have to go through so many channels to get it done. Then, by the time you get to the point where you could get it done, the thing has already caused the damage that we didn’t want it to cause.

 I think both the importance of political will, having outstanding leadership who you can turn to, and who turns to you, then realizing just how challenging bureaucracy can be and how it’s really critical to come up with strategies to cut through the red tape in order to get things accomplished.

 I think those are the two things that gave me pause. I was like, “Wow.” If you don’t have these two things, then I might as well just have any job. It’s not like you can really create change within your city, if you’re not able to deal with those two.