New Haven Register (Sunday) (New Haven, CT)
Daughter of immigrants, CT’s top health official says diversity in medical field helps bridge ‘cultural differences’
Every so often, state Department of Public Health Commissioner Manisha Juthani gets together with public health department leaders from other states.
At the height of the pandemic, she was meeting twice a week with other members of the Association of State and Territorial Health Officials.
It’s a select group, including chief public health officers from across the country. Of the more than 80 members, Juthani, the daughter of immigrants, is not alone. More than half are women and some are women of color.
“When you look around the room, there are people of various different backgrounds,” Juthani said in an interview with Hearst Connecticut Media at her Hartford office. “There there are other people of Indian descent, there are other people of East Asian descent, of African descent, Middle Eastern descent and a good number of women.”
That’s important, Juthani said. The majority of the health care workforce are women, she said, so they should be in public health leadership positions as well.
“It’s important for leadership to reflect the workforce,” Juthani said.
It’s also critical to represent the communities most at risk.
“When we look at health disparities, access and all the issues that are tied with that, what we see is that time and again, in our society, there is diversity of either socioeconomics, race (and) ethnicity,” she said. “I do think that having that breadth of types of people who are at the table makes a difference when you’re thinking about representation and what you’re trying to accomplish.”
Juthani said women tend to make good doctors, though making the jump to a public health leadership role can be somewhat jarring. Women tend to be nurturers, she said, but in public health leadership “you have to have a thick skin.”
“You have to know in your heart that you’re doing things for the right reasons and be comfortable with that,” she said.
The role, she said, requires a strong sense of identity, as well as emotional intelligence.
“One former state health official told me that whatever comes at you, good or bad, (it) is coming at you because of the position that you hold, and the moment you don’t hold that position, all that will go away, the accolades and the negative comments,” she said.
That mindset, she said, keeps her humble and helps her remember that when someone wants something from her, or when she’s attacked, it’s not because of who she is, but because of the position she holds.
“I identify as a mother, as a wife, as a sister, a daughter, as a physician,” she said. “People can say whatever they want to say about me as commissioner. That does not take away from who I am as a person. So, if I can keep that that way, then, you know what? At the end of the day, you can laugh a little and not take it so personally.”
‘Cultural differences’
Asha Shah is director of infectious diseases at Stamford Hospital. She’s one of the few women of color in public health leadership roles in Connecticut.
She said that made a difference when the COVID vaccines were first available. Before Stamford Hospital had a vaccine mandate for employees, they worked to convince staff to get vaccinated.
“We noticed pockets of employees that were refusing, did not want a vaccination,” she said. “A lot of that was related to cultural differences.”
The solution was to have “a group of people that was representing different cultures” talk to employees about and address their concerns. Shah said it made a difference.
“I’m not white, and I’m a woman,” she said. “Maybe that had an impact. Like, ‘Oh, this is not, like, an old white dude that’s telling me to get vaccinated or telling me about COVID.’”
Shah’s in-laws, who live in Florida, will only see doctors of Indian descent.
“They’re very traditional Indian people, they will only go see Indian doctors, period,” she said. “Having diversity on medical staff helps because, you know, it attracts people just because of culture. There are the assumptions like, ‘Oh, you’re going to understand my health better, because we’re from the same culture.’”
Representation matters, Juthani said, to combat bias.
“It absolutely matters. We all have unconscious bias. We all have it. No matter how hard we try. It’s programmed deep inside,” she said. “So if that’s the case, then it matters. You have to have different opinions, views, perspectives, types of people at the table, because it matters.”
Though there are few women of color in public health leadership roles in Connecticut, neither Shah nor Juthani, who are both of Indian descent, feel like outsiders. Shah regularly gathers with her peers, leaders in infectious disease prevention from around the state.
“I’m probably the most vocal person on that call,” Shah said. “I probably talked the majority of the time, and nobody’s on video. So nobody knows what I look like unless I know them personally.”
Pandemic appointments
Juthani and Shah took over in their respective jobs during the pandemic. Shah took the role in July 2021, though she was not new to the hospital.
She’d grown up in Darien, and said Stamford was her community hospital.
“This is my 10th year at Stamford Hospital. I came straight here from fellowship. First job, and hopefully my last job. I love it here,” she said. “I think our institution is unique in that it’s predominantly run by women. Many of the members of our executive team are women, and many of them moms, working moms, which I am as well. I have three kids under the age of seven.”
Juthani’s path to lead the state’s public health agency was a bit more circuitous. She grew up in Bronx, N.Y., and Westchester County, studied to be a physician and infectious disease specialist, most recently at Yale New Haven Health.
“My husband is originally from Connecticut,” she said. “He was very happy to come back.”
Her first step away from the hospital and toward public health came when she was a third-year resident at New York Hospital.
“There was a case of a person who had typhoid fever. We reported the case to the New York City Health Department. This person hadn’t traveled anywhere. Usually you get typhoid fever if you go out of the country. When you have somebody in the United States who gets it and hasn’t gone anywhere, that sort of suggests that there’s some outbreak going on,” she said.
That case, and others, were tracked to one fast food restaurant in Queens, where a single infected employee was transmitting the disease to others.
“They infected three people who were identified,” she said. “That is public health, and that got me really interested in infectious diseases because that’s specifically an infectious disease aspect. But it also got me interested in public health.”
She came to the attention of Gov. Ned Lamont when she signed off on a letter “complaining” about indoor dining.
“That opened this invitation to speak with the governor, and that’s how I got connected with this administration,” she said.
She admitted the transition from hospital to state agency leader has not been without its issues.
“It would be untrue to say that it’s not been difficult at times. Of course, it’s been difficult,” she said. “What I said from day one is, ‘I will give my advice to those who are making ultimate decisions.’ And at the end of the day, whatever decisions are made, I’m going to keep public health and guidance to people as clear as possible for them to be able to make personal choices when personal choices are what are at hand.”
Workforce development
Shah said her hospital is working to specifically recruit doctors of color.
“I can’t even keep up anymore. Primary care physicians, pediatricians, and you look at the names and they’re diverse people. You’ve got Hispanic last names, you’ve got a lot of Indian last names,” she said. “While they may not be in leadership positions yet, because it takes time to do that, I think a lot is being done through DEI efforts to really incorporate a diverse medical community.”
The pandemic, Juthani said, pushed many people out of health care, but it also inspired some young people to be doctors, and to seek roles as public health leaders.
“There’s some who were dissuaded, and that’s OK. But there’s some that were inspired. We have to capitalize on that,” she said. “We have to capitalize on that and build programs and build the types of things that are going to be able to help us invest in those people, inspire them, help guide them, to be able to help bring them through and take my place someday.”