Re-thinking health and healthcare post-COVID-19

Dr. Mandy Cohen, ‘00 (PAM, HD)

As North Carolina’s Secretary of Health and Human Services, Dr. Mandy Cohen ’00 (PAM, HD) has been leading NC’s COVID-19 response. The pandemic brought into sharp relief some of the systemic problems Cohen has seen in her years as an internal medicine physician, her time in the federal government under the Obama administration, and in her current role. She shared her three big takeaways from the experience, and the through line she sees from the education she received in the College of Human Ecology (CHE) to the work she does today.

“My first takeaway is to think about health more broadly than the care needed when a problem arises,” Cohen said. “We were starting to do that before, but COVID brought to stark light the fact that health isn’t just about having access to testing or even a vaccine. Do I have stable housing to isolate appropriately? What if I miss work in a gig economy, then I'm not paying rent, I can't put food on the table. We need to think comprehensively about non-medical drivers of health.”

Thinking more broadly about health also applies to thinking about how and where people receive care. Cohen expects the use of virtual appointments to grow beyond the pandemic and is looking at ways to ensure virtual care is high quality care.

Her second big takeaway is the importance of getting existing systems to work in concert by building systemness among the various services that support health and well-being.

“Right now I have a public health system, a hospital system, a social services system and a mental health system. This crisis needed all of them to work with each other to help our communities, and now I would say we were successful in doing that. But it was a lot of duct tape and elbow grease to get these different siloed systems to come together around shared goals.”

Cohen said a new system needs to be built that integrates public health, primary care, mental health and social services, so that no matter which door you walk in, you will get the help you need. She said that work starts with a common language, common platforms and sharing data, “because all of those systems are taking care of the same patient, family or community.”

As the pandemic hit, Cohen was already marshaling resources to connect service providers by leading the state in launching NCCARE360, a first-in-the-nation statewide coordinated care network. The platform helps providers electronically connect individuals with community resources, allows for feedback and follow-up, and offers individuals an easy-to-use local resource-finder.

“My third takeaway is we have to focus on equity. COVID shined a light on the fact that there are disparities, and frankly, the pandemic made them worse in many ways, and highlighted the systemic racism that exists in many of our systems,” Cohen said. “It starts with the data. What was the race and ethnicity on every single test? Who was being hospitalized? Where are the deaths? What is the race and ethnicity for every single arm that gets a vaccine?”

That data collection effort enabled the state to make data-driven decisions about the allocation of time, money and resources, and Cohen said it will be part of how systemic racism is rooted out of health and human service systems moving forward.

Cohen received her medical degree from Yale School of Medicine and a master’s in public health from the Harvard School of Public Health. She said the systems-thinking she learned in CHE and her experiences as a medical resident had her wondering if she could make more of an impact working on the systems that support human health rather than one-on-one with patients.

“Human Ecology was incredibly foundational to what I do now and my understanding that it is the ecosystem that shapes health and well-being for our entire state. The things we talked about in class—about race, ethnicity and equality, about economic mobility and education—play out in my job every single day. The college’s multidisciplinary view of the world, the interrelatedness that links everything, was such an important and unique learning experience. It shaped the leader I am today.”

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