Ep. 82: Urban Planning Meets Public Health

[00:01:00] Dr. Joanne Conroy: Good morning. I’m Joanne Conroy, President and CEO of Dartmouth Health, and I welcome you to her story. We are thrilled today to be interviewing Leslie Mehan. Leslie is the Deputy Commissioner of the Tennessee Department of Health and a professional colleague of mine. Now, just to let everybody know, Our podcasts really speak to not only young leaders, but also senior leaders that are interested in understanding some of the challenges that all of us face as we navigate our professional lives. Leslie has an incredible breadth of experience during a very difficult time. During the pandemic, and we’re gonna ask her a lot of questions about that, but certainly about her career journey. She’s got an incredibly interesting background, for all of you that are really interested in public health and public service. Welcome, Leslie is great to have you.

[00:01:53] Leslie Meehan: It’s wonderful to be here.

[00:01:54] Dr. Joanne Conroy: So Leslie, talk a little bit about your career journey. Many of our listeners are interested in how you got started in this career path, and you have a very interesting background.

[00:02:04] Leslie Meehan: It’s definitely been circuitous. I started off when I left undergrad at Emory University and of all things became a stock broker. I did that because I thought it’s probably a really good idea for a woman to understand the investment world and be able to take care of her own finances, but I knew that wasn’t fueling my soul. It’s not what I was passionate about. So I volunteered on the weekends with an organization that did parks projects. So we did playground builds, we did landscaping. We would spread mulch, we would beautify parks. And it was during that time that I learned that there were. Very different discrepancies in terms of how parks were maintained and how safe you felt in parks, who was welcome in parks. And to be frank, there were places in the city that were primarily in white neighborhoods. The parks were beautifully maintained. They had sidewalks and fresh flowers, and the trash was emptied. And there were places that were in predominantly minority neighborhoods where the parks were not maintained. They had a lot of overgrowth. They felt unsafe. There was trash everywhere. The playground equipment was broken, and that was the first entree I had into really thinking about where you live matters. And if you’re a child, the environment that you’re growing up in is really impacting. Your quality of life. I ended up working for a regional transportation organization, Joan. We had a 7 billion budget, which in the world of public health is almost unheard of, but transportation beyond armed forces and Medicare and Medicaid in our countries. The third largest expenditure. We spend an enormous amount of money on interstates and bridges and train systems, but we don’t often think about what the ramifications of those decisions are. So we worked very closely with the CDC to do some of the first work on the country to look at health and equity. So if we’re building a highway, what about somebody who has a mobility, needs mobility aid, and is trying to cross an eight lane street? What about a child whose street is, or whose home is across the street from a school, but there isn’t a stoplight or a marked crosswalk for them to get there. What about air quality in its relationship to pediatric asthma? What about a lack of tree canopy in what we’re seeing with all kinds of diseases and some of the things that are common household names, unfortunately. So we, many of us know someone with diabetes, with hypertension, with heart disease, with asthma. A lot of these are exacerbated by the way we’re building our c. And I believe we have a responsibility as public servants to think holistically about those decisions and to really think about the health ramifications, not just for everyone, but also for populations that are just proportionately affected. That led me to the job where I currently am. I came to the Tennessee Department of Health seven years ago because the department has a wonderful clinic arm of the organization. So we see over a million patients and about 1.7 million patient encounters a year where the largest provider of healthcare in the state. We have clinics in all counties in our state, but we know that by the time folks come through our clinic doors, it’s really too late. and what we can provide in terms of a solution really isn’t gonna solve the upstream problem, which is affordable and stable. Housing, transportation, education, so that you can get a good job and provide for your family a food system, places to spend time in, recreate in your community. So our opportunity was to create a whole planning and built environment division within the department. And we did that. And now I’ve got an opportunity to lead the organization from a more senior level position. And that has been really such an honor because we’re able to take the focus on social determinants of health and equity. and really bring it to the forefront in our state so that it’s not a plus one or a want to, but it’s really a core tenant of what we are doing across the state enterprise, not just in the Department of Health.

[00:06:10] Dr. Joanne Conroy: Now, talk a little bit about the pandemic. The pandemic was a crazy time for everybody in public health. It didn’t really matter whether or not you were on the primary administration of that healthcare or whether or not you were on creating the right infrastructure, but, Everybody felt like they were a little bit under attack and I think people just were distressed, wri large about what was going on with the pandemic. But can you describe what the last two years have been for you?

[00:06:40] Leslie Meehan: Now that we’ve had a little distance from the pandemic, there really are some silver linings that have emerged. Of course, during the pandemic it. An unprecedented time, and you’re absolutely right. We were pulling everyone in any kind of skillset they had, if they had done an undergraduate in accounting, they were now helping us with budgeting. If they had ever done some freelance web design, they were helping us with a website. So it was definitely an all hands on deck. It was seven days a week. It was long days. It was a really hard time for these public servants. We saw a lot of. Devastation and death in our state. We in within our workforce, experienced a lot of illness and even few deaths there. It was just a really hard time where you didn’t even feel like you had a moment to pop your head up and breathe. However we got through it, which is a lesson I think, in perseverance. And so there’s that camaraderie now that, Hey, we did it together. And it’s actually set a really good precedent for how we can look at health disparity and chronic disease because if we can pull together as a nation and really address the things that are killing us, yes, we have infectious disease, we’ll always have something like a monkeypox or a flu season. Hopefully we won’t have a global pandemic again. But what really is killing us on an ongoing basis in our country is not the infectious disease, but the chronic disease. So we have this model now for what it looks like when you come together, not just from public health, but bringing in the military, bringing in the private healthcare sector, bringing in the business sector. Everybody pitched in and figured out what they could do. You even had breweries who were making hand sanitizer, right? It was this really unusual time of thinking about how can we contribute in a different way to a problem that we might not have normally thought of. So if we can do that around the health disparity that we’re seeing in our nation, then it really can provide us an opportunity to look at our resources in a way that we haven’t. Often describe public health as being the downstream recipients of other sector’s decisions that are made upstream. So again, going back to those tenants of housing and food systems and education, their government departments and all of those areas. So if we can be at the table with them, and it’s really important how we do this because we don’t wanna show up and tell them how to do their jobs. We are not the experts in their book of business. , but we can come and describe the way things look from our perspective. Help look at those inner relationships. We can form really solid partnerships with them. Invite them to be at the table when we’re making decisions. When we’re doing strategic planning.

[00:09:23] Dr. Joanne Conroy: We have so many students that are really interested in public health. What advice would you give for. A young woman that is actually interested in going into the public sector, which is really public service, and it doesn’t have to be with a public health degree, but how would you guide her?

[00:09:41] Leslie Meehan: So the advice I have for someone is, Go where your heart is. Start a program that’s interesting to you, but also look at it broadly. Maybe there’s a dual degree that you can get, Maybe you can get an internship in another area. One of the biggest things we do is encourage our employees to go to conferences that have absolutely nothing to do with what they perceive their day job to be. So for example, today I’m at an economic development conference, and that’s really important because I wanna hear. Important to our state in terms of how we’re attracting business to our state and how we’re attracting residents. And if you look at the video that was shown yesterday, we are showing walkable downtowns and parks and we’re showing housing near coffee shops and we’re painting. Tennessee is this place where you can come and recreate. You can have your remote business, you can be an entrepreneur, you can live an. Little downtown, you can live in a thriving big metropolis if that’s your desire. That we have a lot of resources here. Everything from office jobs to automotive manufacturing. So we’re marketing our state is this, We’ve got something for everyone. But the overarching theme is quality of life and in public health. That’s really what I think serves us well is to not necessarily try to be that big brother. And this goes back to the student looking to pursue a career, is that we don’t necessarily wanna walk in any room, whether it’s a patient’s room or a board room, and. Say we’re here to save the day. We’ve gotta get these diabetes rates down. We’ve gotta get physical activity up in children. What we wanna do is really lead with a conversation about what, how do you envision your life? What’s your best life look like? Is it playing with your grandchildren? Is it running your first 5k? Is it enjoying a walk in the park in the afternoon, spinning Saturday morning at the farmer’s market? What does this look like for. and then helping our students actually get engaged with community members through, maybe it’s their health councils or other avenues, but there are really good ways that we can create practica for students where they are engaged in real world decisions that give them insight, again, into what is driving the health of the patients that they see. But it’s also helping us create community visions that end up bettering our. But we actually don’t even have to use the word health, and I think people resonate more when they think about a livable community or what brings them joy, what brings them happiness versus somebody saying, Hey, are you paying attention to your health?

[00:12:07] Dr. Joanne Conroy: So a lot of students like to. work overseas. Students that think about the Peace Corps or they do medical mission trips, but my expectation is that in every single state, there are areas that have substantial need within this, their own state. So to actually see some very challenging public health issues, you actually don’t have to go out of state. As deputy Commissioner of Health, my expectation is that you have a pretty good idea how Tennessee is dealing with some of those. Which one of those actually keeps you up at.

[00:12:43] Leslie Meehan: Housing is something that we’re seeing not only across Tennessee, but across the nation, Across the world is a big challenge. We have cities that have grown up around the car, and so you have to have a car predominantly to get from point A to point B. In most places in our country, not everywhere, but particularly when you look outside of the coastal areas, you, there’s not a lot of public transit and what we are finding is that housing, which is close to where people want to work, where the grocery stores are, where the parks are, where their schools are, is higher and higher. Even in Nashville, over 50% of the residents here are out-priced for the housing, meaning that they truly cannot afford, or they’re spending way more than they should. Of their income. So typically any one of us should be spending no more than about 30% of our income on housing, but we have residents that spend up to 80% of their income on housing. If you’re doing that, you have very little left, probably nothing left for transportation. And then that’s when you get into those horrific decisions where families are deciding, do I buy food or do I buy medicine? Do I buy clothing for my children or do I pay the electric? and those are the kinds of decisions that we want to try to avoid. And that’s again where city planning can come in, where we’re thinking about providing different types of housing and we’re making it attainable. I like that better than affordable because we all have different points of attainment for our income levels and. Thinking about teachers and firefighters and those who are working in some of our local restaurants and things like that, there’s different price points that they need from the CEO of the local business down the street. So we have to be thinking about housing. Another huge need again across the country is daycare. We haven’t caught up with the times. We don’t have enough daycare providers, and it’s exceptionally hard, obviously, to earn an income if there’s no childcare, and in some instances childcare can be 50% again, to 80% of family force income. How are you gonna do that? You really have to make choices there because if you’re engaging in c. You can’t, you don’t have anything left over for your family bills, but if you stay home, you’re not working and you’re not bringing in an income. Those two are two of the biggest that we hear. Transportation and food systems don’t fall far behind

[00:15:07] Dr. Joanne Conroy: Yeah, so you’ve identified the things that we actually struggle with as a health system. You know, We subsidize housing up here for new employees that are. front lines clinically. and we struggle with childcare even though we have a number of facilities, it’s never enough. And you do wonder when we as a country are actually come to grips with making the working mothers life manageable, which I don’t think we’ve actually addressed. Yeah, other countries have, but we have not. Your career is really fascinating and we ask a question of all of our interviewees. If you are an intentional or an accidental leader, how would you describe yourself?

[00:15:50] Leslie Meehan: Oh, that’s a really interesting question. I, for many years didn’t consider myself a leader. I considered myself somebody who perhaps looked at things in a different way, and I feel very fortuitous that I’ve, whether it’s by happenstance or part creation or a little bit of both have. Worked for some organizations where I’ve ha been given the latitude to dream and we’ve created some things that haven’t existed before and got to do some things that were either first in our nation or one of the first in the country. And that’s been fascinating. At first, that space was intimidating to me because when you’re creating something with no model to replicate, It’s that fear failure you, you don’t have guidance, you don’t have a template to follow, and what if it doesn’t go well? But then I learned that there’s so many lessons to learn just in the journey, whether you fail or you succeed. And these last two decades in particular, have been so fascinating for me because I’ve got to address public health from the urban planning and the transportation planning. And now I’m in public. Addressing the transportation and the planning side. So I’ve gotten to be on both sides of the coin, which has been incredibly helpful to understand both landscapes and to understand how really as government and as nonprofits, we are under resourced, we’ll never have under the current models that we have enough funding to do what we need to do. So it’s truly important that we engage with the private sector and think creatively, like the housing that you’re talking about. We’re actually having a healthcare and housing. Summit here, Hosti or Governor’s office in the spring. And the intent of that is to think about healthcare systems that are providing housing, because sometimes it’s cheaper to ride off an ear, a visit of someone who’s coming in who may or may not have chronic conditions, but might be unhoused and really looking for a meal and a, a place to get out the cold for the night. Well, That could be a $1,500 er visit that they’re gonna ride. They could actually provide two apartments for about that much money and help get someone connected with social services for the same amount. So it’s those kinds of models that we would like to bring to our state and to think differently. So back to your question. I would say that I think I, early in my career felt a little bit like a fish outta water because I didn’t think like others, and I was very self-conscious of that. And so I was probably more of an accidental leader. And now that I’ve figured out how to do innovation in a way that is intentional, so it’s not radical because you have to have a game plan and you have. Be able to pull it off. But now I would consider myself more of an intentional leader.

[00:18:31] Dr. Joanne Conroy: Now you did talk about the importance of the lessons you learned from something not turning out as you would like. When you look back into your career, what was the failure that actually taught you the most about yourself as a leader?

[00:18:47] Leslie Meehan: Oh, that’s really an interesting question. I would say one of the ones that. Really stuck with me. We did a health and transportation survey. So many of us in the health world are familiar with national surveys that are done on a regular period for those in public health, the behavioral risk factor surveillance system is one, it’s where we ask sample folks across the country and ask a lot of about their health and their behaviors. and we did something similar in transportation, and that’s something we do typically every 10 years. But for the first time we, we married the two types of philosophy. So we were asking transportation questions, where you live, where you work, how far do you drive, how long does it take you to get there? Are you stuck in traffic? When we had GIS data, so we knew where people, we could plug in these points and actually see their routes. And then we were asking about their health, a self assessment of their mental health, their physical health. Do they walk? How much time a day do they spend sitting? Do they feel like they get enough physical activity? Do they feel like they have access to healthy foods? And we put all of this data together and we were so proud of ourselves. We raised the money to do this really innovative survey. It was over a million dollars and then we ended up not having enough money to do the analysis on the data, and that was a real hard pill for me to swallow. It was an afterthought, if you will. We had spent so much money working closely with the CDC and designing everything and implementing it and doing the fundraising and cleaning the data. And we did do some analysis. It’s not to say we didn’t do any, but to dig in and do the really robust kind of analysis that we truly wanted to do. We simply ran out of money as an organization. And then it was very hard to fundraise for that kind of analysis because it was, again a data set that was a little bit before its time. And so that was one of the biggest, if I could go back and have a do over it, would be that. And as a leader it helped me to understand that it’s great to. A nice idea, but just to make sure that you can see all the way out and sometimes that’s five to eight years to make sure that you have a long term game plan for what you actually wanna acheive.

[00:20:51] Dr. Joanne Conroy: So we’re. At the end of our time. Talk a little bit though about advice you may have for young women leaders, not leaders at large, but sometimes there’s an unwritten playbook of how women actually need to navigate process. And it’s not just being right. You’ve got a lot of political. Navigation to do as well. What advice would you give for young women that are interesting in falling a path like your.

[00:21:17] Leslie Meehan: I would say to study the landscape, listen to your heart, and know when to speak up and when to step back. . And the reason I say that is because if you don’t know the landscape and you come in with great ideas, they may or may not fit within that current landscape. And it goes back to that first impression saying you don’t want your first impression to be, to walk into somebody else’s room and again, tell them that you’ve got the solution for their problem or how the, their business should be run or how they should do their. So it’s frustrating sometimes, particularly if it’s something that we’re passionate about. But we often need to listen and learn first, learn the system, learn the players, learn how the decisions are made, how the priorities are set, how the funding is spent, and then think about how we can be a part of that in a way that, again, doesn’t come off as threatening. And I think it’s women, it’s a very, it’s a lifelong dance. At least it has been for me. because too assertive. And you might put off some people in the room to me or mild, and your voice may not be heard. And so it’s a real challenge to think about how do you come across as intelligent, thoughtful, skilled, and educated in the decision. without connoting that, that you are better than somebody else in the room or you’re trying to force an agenda. And I think it’s a real challenge for women because it’s been a lifelong observation for me that men emote much more in the workplace than women do. I’ve seen. Full grown men, time after time have a full blown tantrum. Not unlike those I’ve seen of my children when they were young, and then they can just walk out of the room and get away with it. It’s just it’s, there’s no afterthought for that. But women don’t have that same opportunity. We get labeled as one thing or another, and then that label sticks. Whereas with our male co. It’s just forgotten. They walk out of the room, it’s just forgotten. That was just so and so having hi, his say and now that they’re going on. So it’s really hard for us. So how you show up matters. That’s one of the things that my, my favorite executive coach taught me. How you show up matters. How you walk in the room, how engaged you are in the conversation, even if you’re not speaking, the times you choose to. and the way that you phrase your points, it all matters. So sometimes we go to school thinking that what matters is just the subject matters that we’ve learned. Are we a biology major or pre-med, or maybe we just graduated from residency. But what really matters when we’re interacting with our colleagues is how much they can trust. And how much of a team player they see us being. And so a lot of this is really not what you went to school for, but a lot of it is strategy.

[00:24:08] Dr. Joanne Conroy: Yeah, that’s great advice. It’s not just having the right answer. It’s making sure that the right answer actually lands in a way that everybody else can hear it. That’s the art of how you actually navigate the politics of personalities and serve up the solution so well, thanks Leslie. This has been really wonderful.

[00:24:26] Leslie Meehan: No, thank you, Joanna. It was my pleasure to be with you today, a true honor.

[00:24:30] Dr. Joanne Conroy: Thank you and thank you everybody for listening to her story.