Is Society Shortening Lives? the Lifespan Inequity Crisis

Tyler Evans: [00:00:00] There was a recent study that came out, and essentially it was looking at California since the pandemic. Longevity is not increasing. It’s actually it’s stagnant to decreasing. That’s a serious concern. I mean, this is now over five years since the beginning of the pandemic.

Peter Bowes: [00:00:22]  This podcast is all about living as long as we can without succumbing to chronic diseases like diabetes, dementia, cancer, heart disease. And there is much we can do with lifestyle interventions. Diet, exercise, sleep, stress reduction, social connections all play a role in keeping us as healthy as possible. But then, as we are all acutely aware following the pandemic, we are not fully in control of our own health destiny. There are bigger forces at play, factors beyond our personal control that can suddenly change the course of history and our lives. But is that entirely correct? Could we as individuals do more to prevent infectious diseases taking hold across populations, especially in the poorest communities? Hello again. Welcome to the Live Long podcast, I’m Peter Bowes. This is where we explore the science and stories behind human longevity. Doctor Tyler Evans is the author of Pandemics, Poverty, and Politics Decoding the Social and Political Drivers of Pandemics From Plague to Covid 19. Doctor Evans, it’s good to talk to you.

Tyler Evans: [00:01:38] Great to be here PETER

Peter Bowes: [00:01:38] Is that a fair assessment that there is perhaps more than we realize we can do to have some control over these infectious diseases? And of course, we’re very familiar with Covid, and especially as it applies to those poorer communities around the world.

Tyler Evans: [00:01:54] It’s a great question. I do think that we have a reasonable amount of control or agency. But there’s a lot that we do not have control over, and that is really where public health comes into play. You know, public health as a sort of common good is there to to sort of provide the, the sort of, you know, the population prevention sort of, you know, parameters or barriers or boundaries almost, or your sort of, your, your wiring, you know, around the lands in which we sort of live, again, to kind of just for, for us to sort of live in this sort of free terrain and for us to make sort of, you know, individual choices and whatnot. But we have to have some sort of, you know, wiring around us to ensure that we’re able to kind of make those sort of individual sort of choices.

Peter Bowes: [00:02:41] And I asked that question in part because in your book, you say you wrote the book because you want to try to increase personal awareness of of where we all stand and our position in the world, especially as it applies to these matters.

Tyler Evans: [00:02:55] Yeah. I mean, the goal really of the book is to a to depoliticize public health as much as possible. Although the current sort of space we’re in, you know, we’re not moving in that direction, unfortunately. but, you know, I’m still optimistic or confident that we will. and number two is really is to try to promote as much agency as possible for folks to really understand the importance of building that infrastructure, so that we can kind of focus on, the social and political drivers of, of individual health outcomes as well as sort of, you know, the sort of common or population of public health sort of outcomes. That awareness is very, very important. And this book is not intended for, for healthcare professionals. This this book is really intended for, you know, sort of lay communities that just want to understand more about why do we continue to have these epidemics or pandemics and how much of it is driven by components that are socially and politically driven?

Peter Bowes: [00:03:55] And that is exactly what drew me to the subject and the book, because hopefully this podcast has the same philosophy. It’s aimed at a lay community in terms of our everyday health. Just before we dive into it a little bit more in detail, just tell me a little bit about yourself and your work to date and your experience. That’s certainly piqued your interest in this area.

Tyler Evans: [00:04:15] Sure. Happy to. So I am, I guess on its surface, I am a physician trained in adult infectious diseases as well as addiction medicine. I’ve worked in a number of different spaces throughout the US and and abroad. most of my career has been focused on HIV and sort of, synergistic infectious diseases. We we define them as syndemics. so syndemics are essentially, coexisting, epidemics, they don’t always have to be infectious disease, that sort of come together and sort of work together in a multiplicative or amplified sort of fashion so that the outcome again is amplified that could, you know, often be behavioral health including, you know, addiction as well as mental health crisis. Right now. You know, we’re working on a program in New Mexico where I often sort of describe a convergence of sort of three epidemics, which is because we’re working in the jails. So it’s one is the sort of the epidemic of mental health to the epidemic of, of addiction and the third, the epidemic of mass incarceration. So we’re trying to kind of, break that cycle of that sort of convergence. And we often see that. So that’s sort of a concrete example of those Syndemics. but I’ve worked in a community health settings where public health settings in the states, like I said, a lot of it’s been focused on HIV, but you can’t when you’re in the exam room or where you’re working on the system level, you can’t just focus on HIV again, and you really have to think about all the intersecting elements that sort of exist there. And, and then, I’ve worked in a number of leadership positions. Missions throughout the States. I was the chief medical officer for New York City, overseeing Covid operations in 2020. That’s really sort of in the beginning, until the city was able to kind of stand up their own sort of operations. And I previously had this very useless skill set of understanding the sort of difference between isolation and quarantine. And you know, how to stand up, mass euthanizations, you know, in in a country like the United States, we really didn’t have much of a need for that prior to the pandemic, but turned out to be pretty useful. there and then, went on to, to be the incident commander for the Bay Area in California on mass immunizations and then ended up jumping into to run my own company, where we administered over 2 million Covid vaccines in ten states. We did over a million in California. When I was really proud of was the ability to scale and work with government systems to sort of, you know, build capacity in a very sort of quick sort of surge capacity way, but also really focus on the most historically marginalized communities because those were the folks, you know, that we as the founders of the company, who had been as docs, providers, nurses, working in those spaces, working in the foxholes of health inequities both in the US and abroad. and we really saw those amplified during infectious disease outbreaks. And that’s really what the what the book is all about. So I spent many years working in the Global South, low and middle income countries, working with organizations like MSF, Médecins Sans Frontieres, Doctors Without Borders. Other organizations like Partners in Health, worked in the Ebola response, twice, worked in war zones, complex humanitarian emergencies. And what I found was really that the sort of the feeders into those outcomes in those countries like South Sudan, Central African Republic, Democratic Republic of Congo, are not that dissimilar from the United States. the magnitudes of the burden of disease are considerably different. but the feeders, the drivers, the determinants are very much the same.

Peter Bowes: [00:07:47] You’ve also worked in the city of Los Angeles, where I’m based in Skid Row, a huge, vast homeless encampment in downtown Los Angeles. I’m just curious. As a reporter, it’s something that I’ve covered for the past 20, 30 years and depressingly watched very little progress. What did you learn during that time? Learn not only about the the cross-section of disease and mental health, but learn about people and the people that you’re working with.

Tyler Evans: [00:08:14] Yeah, well, it’s still very much in operation. I was just there last week, so we still we still have operations down in Southern California. So it’s called street medicine. It’s providing direct clinical services to the unsheltered unhoused. So that’s different from the sheltered right. So very, very different the shelter capacity in really most cities in the United States, certainly in Los Angeles, are completely saturated. So there is just not enough capacity for these folks to to be sheltered in any realm of possibility. There are some hotel or motel programs that sort of emerge as a result of the pandemic. You know, it’s called project Home Key in the beginning. And then it was room key, you know, and that’s again provided some capacity. But a lot of these folks don’t actually want to be sheltered as well. So anyhow, what we’re talking about is the unsheltered. And that makes a little bit more complicated, right? For years, decades really, there was this sort of there was this movement to get folks into brick and mortars and, you know, at the end of the day, the street medicine movement doesn’t really feel like that’s going to that is the end point for a lot of these folks. It’s not a practical end point, and it’s not what the folks want. So our philosophy, you know, much like a lot of the other California street medicine groups out there and USC really sort of takes the charge. There is, is just meeting folks where they’re at. Right? You’ve just got to meet folks where they’re at. You’ve got to work, and understand work and understanding their goals, both as, as individuals and as communities. And if we can better understand that, then we can work to navigate those goals together. Now those goals are complex to achieve, right? Because it’s it’s taking permanent supportive housing, which is a goal. It’s not the only goal. Right. and ensuring that they have, all of the, the, the healthcare needs, for them to be successful in, in that permanent supportive housing space. And a big one is behavioral health. So if we’re not delivering behavioral health and that includes we define behavioral health as, mental health or psychiatry services, addiction medicine as well as behavioral health counseling. So if we’re not providing those services to those people in the streets, we’re never going to get there. Right. And the systems that are currently set up, LA County Department of Mental Health, despite all of the the good intent of that system, it takes at least 12 weeks to get an appointment, right. So you’ve got people that are living in the streets. If you think that they’re going to they’re going to wait for that appointment for 12 weeks, at which point they can decompensate further, you know, and then end up in the editor. Probably forgot about that appointment to begin with. And that appointment doesn’t matter if it’s, you know, three blocks or 30 miles away in a place like LA. I mean, the ability to, to, to get there is going to be seriously constrained, mostly because the social determinants of transportation. So all of these, all of these elements make it really, again, that systemic sort of perspective, all of these sort of converge into sort of one, one place and they amplify and it make it very difficult for these populations to to navigate. So it’s very easy for us to just point fingers and say, oh, it’s all them, it’s all drugs, it’s all mental health. That is a part of it. But it’s part of it, part most of it is because the way that the system is set up, it is not set up for success for these folks. And there are a lot of these externalities that sort of come into play, whether it’s the the pandemic, whether it’s, s, you know, increase in housing prices, whether it’s, the LA fires, all of these components sort of come together and, impact people’s ability to sustain their way of life. And if you look at if you look at the United States, you know, at least a third, if not, if not more, probably close to half of, of, uh, of of citizens in the United States or non-citizens, are one paycheck away from being housing insecure. Right. So you just take that one, that one blow and, you know, that’s it. They’re out there on the streets.

Peter Bowes: [00:12:13] And which is quite a shocking statistic if you think about it. I think the rest of the world would be surprised about that 1 in 4.

Tyler Evans: [00:12:19] Yeah. And I mean, you know, when it comes to the other OECD countries, homelessness is, is is I mean, homelessness exists, you know, universally, globally. but, in the States especially, you know, especially again in California for a number of reasons. You know, the the problem is really sort of magnified. So, so we really, you know, it’s that information is powerful and there’s a lot that we can do as a community to help to help these folks. I’m a I’m a doctor. So I focus on the health and the wellness. And, you know, Peter, the focus of your of your podcast, I think is really meaningful here because the our the genesis of our organization, Wellness Equity Alliance, was to really kind of focus on how we could meet folks where they’re at. And mostly we, you know, our focus is the historically marginalized communities. You know, that’s that’s our space. But we didn’t call ourselves Health Equity Alliance. We called ourselves Wellness Equity Alliance because we wanted to go above and beyond just physical health. Right? We wanted to go into all those other sort of, you know, domains or dimensions of wellness. And we don’t think that wellness necessarily just needs to be, you know, all, all yoga, organic foods, chia seeds. Right. Like, we think that, you know, wellness could be a lot more and we could provide that to historically marginalized communities. Right now, we’re actually working on a program in New Mexico. We’re actually trying to provide complementary alternative medicine, yoga, uh, acupuncture, to these folks because they’re actually like emerging evidence that this can actually be very effective for all communities. And, when we’re looking at sort of, you know, alternative modalities, something like behavioral health, there’s not enough there’s not enough conventional behavioral health, practitioners or providers out there. So we have to get sort of creative.

Peter Bowes: [00:14:05] But what is striking is the differences in terms of access to wellness. And we’re not talking about living very long time and longevity. We’re just talking about wellness today. And if you compare the communities that you’re talking about with perhaps those communities who consume the chia seeds and look at the vegan protein and think about their yoga class every day, the gulf is enormous. And I think the challenge is to just to try to bring everyone together in terms of looking to the future. Yeah.

Tyler Evans: [00:14:34] There was a you know, when when, you know, the focus being sort of living, living longer and living well, there was a recent study that came out, and essentially it was looking at California and the act. The fact that we’re actually since the pandemic, longevity is not increasing. It’s actually it’s stagnant to decreasing. That’s a serious concern. I mean, this is now, you know, five years since the beginning, over five years since the beginning of the pandemic. And this is California, right? We should be leading. I’m based in the Bay area, but I go back to back and forth to LA all the time. We should be leading the, the, the charge in terms of sort of, you know, advancing longevity and not just not just survival as a goal in and of itself, but but survival and living well. Right. quality is is key here. And so the fact that we’re going backwards is, is, is is really unfortunate. You know, and I actually, made some comments in LA times that I think that it’s largely because we put our foot, we put our foot on the pedal when it came to the pandemic hit us. We we realized, wow, there are lots of lots of cracks in the pavement, right? Lots of cracks in the pavement. And that sort of when you have a massively seismic event like the pandemic, you know, those sort of cracks, those tectonic sort of plates increase further. And and so and the first folks to really fall through those, those cracks as they sort of, as they sort of enlarge in or widen are the most historically marginalized. Right? Those are the folks that come through because they’re not engaged in primary care, right? They don’t know how to navigate the systems. They’re not engaged in prevention. Right. Because they don’t a lot of times they don’t have the the health education to really sort of understand that. And so when those folks are falling through the falling through those cracks, the systems that that exist, the public health and population systems that that exist in order to absorb and to, provide sort of safeguards around the entire population, they get gummed up, right? They get gummed up. And so the capacity for that system to then provide services to just any suburban or privileged or sort of blue skies. You know, your aunt, uncle, wife, spouse, whatever, trying to get in just because they’re having, you know, a heart attack or something like that, their ability to get in is going to be seriously compromised. Right. And so the entire community. whether we like it or not, whatever your politics are, the entire community is going to get impacted. So we realized that during the pandemic, I mean, there was tons of data data points on this when we looked at, you know, the folks that were that were most at risk of of not just infection, but the adverse sequela of infection, were, you know, largely socially determined, right? It was obesity. Those, those, those that were chronically obese or morbidly obese, those were the highest risk of not just the infection, but again, the adverse consequences of those infections, black and brown communities. Why? It’s not because it didn’t have some sort of, you know, predilection for, for, uh, you know, sort of melatonin, right? This is because of the communities. These communities that are most at risk, of of of in access. Right. And a lot of that is socially determined. So all of those components that we saw, we started to invest more. The you know, California has something called Cal Aim, which is our 1115 Medicaid waiver. So we focused on innovation and enhanced care management for the most historically marginalized, as well as a few other programs, community supports, and a few others. And we have contracts for those programs. And, you know, they they work relatively well, but we, we we took our foot off the gas. Right. And we took our foot off the gas too early. And a lot of that we couldn’t control because, you know, the the feds were basically removing a lot of that, that sort of support. And so, you know, as a result we we went a few steps forward, but we went, you know, several more steps backwards. And again, that’s where we’re we’re at right now with, with survival. And so it’s those historically marginalized communities that are really that are skewing those numbers. Right. And so if we want a health, healthy and, well society, we have to focus on on everybody. We have to or, or or the data points are going to continue to reflect this polarization in society. And if that’s what we really want, you know, as a society okay. But, you know, that’s I don’t think that’s most of the folks that I know on, on both sides of the political spectrum, that’s not really what they’re what they’re sort of seeking.

Peter Bowes: [00:19:05] And of course, it’s impossible to separate that aspiration for wellness for everyone from the current political situation, which you referred to earlier. And there is a and I don’t want to go too far down the road of politics, but it is overshadowing everything in terms of some people feeling that they really have no role in society because of things changing at a political level around them. And there is a certain desperation amongst some people

Tyler Evans: [00:19:37] There is a sense of desperation. There is a sense of, a lot of folks that I know, particularly that are working in, you know, some of the sort of frontline services, education, healthcare, government resources, paramedicine, etc. they do feel hopeless. They feel hopeless and helpless. And and that’s unfortunate. I don’t I feel as if we have a lot of work to do. I feel actually, as as the government systems are, the reality is the government systems are receding further. Now, my hope is that the pendulum will swing back and, and we will sort of recover a lot of the, uh, a lot of the steps, a lot of the sort of the receding steps that we’ve currently been or recently or currently sort of seeing and hope and I think probably will continue to see that’s the short term. I think in the long term, again, that pendulum will swing back and we’ll try we’ll be able to kind of recover, some of that. Having said that, right now, I actually see that, organizations like ours that are working in the private sector actually think we have more agency because there are more gaps. So there’s more people are going to continue to be sick. Right? That’s just the reality. They’re going to continue to be sick. In fact, they’re going to get sicker because they don’t have those prevention mechanisms there. They don’t have they don’t have those sort of government systems there that we’re already anemic to begin with. But now they’re getting even sort of further anemic. and so it’s really going to depend on the private sector, and, you know, community based organizations to get out there and to work harder to fill that gap. But I think that there’s more opportunity, it’s more work, but there’s more opportunity for us to to to do things and to do them differently. You know, I think that one again, I’m I’m an optimist. So I’m always looking for opportunities. what the current, you know, Secretary of Health and Human Services. You know what, trying to get into his mind. And that’s that’s challenging to do. But if I try, what I see is somebody who’s saying, you got to bootstrap this, right. We’re looking for communities to bootstrap their health and their wellness. And he actually does believe a lot in wellness. doesn’t really quite understand the science behind it. But, you know, I think that there are opportunities to really, to really sort of get in there and, do things differently because we at status quo for many, many years, decades. Right? We have the status quo. We have these safety networks. We had federally qualified health centers, which were a part of the safety network. We have safety network, hospitals, etc.. the problem is it doesn’t work as well as it should. There’s a there’s amazing humans that are out there, docs, nurses, epidemiologists, community health workers that have that have broken their backs to try to sort of make these systems work. But the way that the systems are set up in the US, it just it just doesn’t work to the in the way that it should. so there are there are so much more that we need to do. So I actually think the, the, the, the silver lining here is the ability is our ability to reevaluate where we’re at and reconfigure it. Right. Because when we look at the way that the systems are set up, you know, I always look at National Health Service and UK. Peter, which you’re probably from. Yes. Yeah.

Peter Bowes: [00:23:13] You can tell.

Tyler Evans: [00:23:13] I, you know, the integration of, of public population, direct clinical services, the integration of all those services into sort of one, program is ideal. Now, I know that’s you know, I have a lot of British colleagues and they complain. So there’s not there’s there’s a lot of imperfections in every system. But I think I think that system, as well as other systems throughout Asia and whatnot, are systems that we can aspire to. And I write a lot about that in my book too. I basically the first section is all about social medicine and the social determinants and why it’s important. Again, this is for a lay community. So I really try to I try to demystify and I try to I try to take away a lot of the unnecessary academic or sort of pompous sort of language or pedantic language that we often see in our journals or whatnot, to make it as digestible as possible for all communities to read. I’m sort of channeling my Malcolm Gladwell as I write the book, to just to make it really as, as as understandable as possible. And so I break down systems because we often talk about systems either academically or abstractly and, you know, and I, you know, thought deeply about, well, I really think we need just a primer for systems, really for lay communities to really understand the way those systems are set up globally. So I write about that a bit. And, and I think, you know, getting to the point that you were I think sort of, uh, eliciting here, I think what we need to do is reconfigure, reevaluate, and then reconfigure our system. And so I think that that’s that’s an opportunity, uh, for us right now, that’s a silver lining.

Peter Bowes: [00:24:49] And when it applies to the pandemic, which 99.9% of people will now associate with being a pandemic Covid 19, ask people five years before 2020 about a pandemic. And it was just a historic thing that they didn’t really know much about, but it is now very much a reality. And looking to the future, what key mistakes were made, do you think, in terms of, again, putting this in a very lay perspective for the future, because you say in your book that it’s very likely that we most people will experience something similar in their lives to come.

Tyler Evans: [00:25:23] We well, thank you. That is that is the core. That’s the premise, of this book. So, so thank you for asking that. Uh, right. So pandemics, in the simplest possible way to describe them essentially are infectious disease outbreaks that become epidemics. So that is beyond any sort of reasonable sort of, expected distribution of, of disease. that reasonable, uh, or reasonable or sort of common normal distribution of disease is called endemic. And so anything that goes beyond that is epidemic. and then anything that essentially crosses borders and gets a little bit more complex than that. And I define that in the book. It becomes a pandemic. so international international epidemics essentially become pandemics. The way that I define it. You have to hit a certain number of, there has to be a certain number of mortality or casualties, for me to sort of describe it in the book. But yes, there actually have been several pandemics. I, I essentially this is all in the second section. I start with, plague. Now, most people think plague is is is completely some eliminated or even eradicated disease that, you know, sort of, you know, died with the Victorian age or something. It is very much alive. In fact, there was a there was an outbreak of plague here in California recently. It’s Yersinia pestis. It’s typically through rodents. It’s not something to, you know, to, to get too concerned about. But the reality is plague still exists. So this was during the third plague, 1899  beyond. And, so I start with that and then I end with Covid 19. But there are a number of, of pandemics that we have experienced. And some, you know, if, if, if we’re dealing with sort of folks that were, uh, I guess centenarians or beyond that have actually been sort of experienced several of those. Right. And many of those were influenza pandemics. so we have, you know, uh, the H1n1, we had, just recently in the last 30 years, H1n1, we have HIV, we have Ebola, we have Covid 19, And then we have all of the other top infectious diseases that are the biggest killers or the, you know, have the largest impact in terms of morbidity as well. And that’s your pediatric, uh, diarrhea. That’s your tuberculosis. That’s your malaria. and that’s that these are diseases that are not a lot of folks think that they are in the US or OECD countries. They don’t think that they’re necessarily at risk for. But the reality is, just like the Covid pandemic, while, you know, people may think that they’re separated, you know, in terms of sort of, you know, space, they do impact the systems. And the more that we remove the detection, the detection and the response mechanisms that public health systems are set up, a good public health, the way that I describe it, a good public health system is one in which the communities don’t know it actually exists. Right. It is almost a silent sort of mechanism that, again, creates those safeguards around communities and, you know, could be helping to to provide the health education and the protection modalities, but it does so in a stealth like manner that people don’t need to be to sort of, you know, concerned with that.That is probably the most effective sort of public health mechanism. and so as, as, as, you know, the book sort of demonstrates throughout all of these pandemics, we have continued to make these mistakes over and over again. And we’re doing the same thing right now, which is essentially removing further, removing those safeguards, removing those abilities for, for the most historically marginalized to gain access, to give them a fighting chance. That’s equity. That’s what equity is. That’s very different from equality. Right. So equity is basically providing more access, more help to folks that are struggling the most. And it doesn’t necessarily matter what your politics are. Okay. And that’s really what the book is. The book really tries to make the argument. It doesn’t matter. It doesn’t matter if you’re if you’re, you know, on the left or the right. Humans are humans, right. And at the end of the day, if the system is so jammed up. Right, that’s what we were talking about earlier. If the system is so jammed up, it’s going to impact you as well. And so it’s all these concentric circles of sort of of impact. And if it doesn’t impact you from a material or from a, from a direct clinical service standpoint, it will it will impact you from a material standpoint. It’s going to it’s going to impact your local budgets. You may or may not be aware of it, but it is impacting your budgets. on a, you know, city, town, county, state standpoint. So being really mindful of that is is really important. But the again, the focus of the book is if we continue to, to regress more and take away these, these, these sort of central elements that are there for prevention and detection and response, then we are going to we are going to basically provoke the next pandemic because and we have to work harder because we’re also when we’re looking at climate change. I just talked about this on, on uh, news channel on Fox the other day. you know, there’s a, there’s a increasing outbreak of, Vibrio vulnificus, which is essentially this flesh eating bacteria. It’s it’s very sounds very scary. It’s not as scary as it sounds, but the reality is it has increased roughly tenfold in the last 20 years. Why? Climate change. Right. So and so we have to naturally be able to detect this. And we have we’ve had a lot of advancements in our technology in our ability to looking at wastewater, for example, is brilliant. You know, being able to kind of use that as a sample. But the more again, that we’re removing these sort of elements and again, importantly, the response, the more that we’re going to sort of set us up, set us up, set, set, set ourselves up for disaster.

Tyler Evans: [00:31:19] And then the last piece I’ll say, And then I’ll stop. Is the, is is the coordinated response is key here. And so we are going to have epidemics, outbreaks, outbreaks, epidemics and, you know, possibly pandemics. But it’s how quickly we respond to it which determines essentially, you know, how much impact, how much devastation will exist. And so what what we learned during the last pandemic, but unfortunately, we’re not sort of sustaining is that, responding as early as possible is key. And when I, when I, when I’m, when I’m talking about responding, I’m talking about responding from a clinical standpoint, but also from a communication standpoint. So what’s key is having central federal agencies working with the states in a coordinated network, not having a bunch of different people talking about a bunch of different things. Right, because that’s going to confuse the communities. And that leads to the divisiveness that we are currently in. So if you have the feds working with the states who are then working with the municipalities, who are then working with the communities all in lockstep, and this is very, very possibly done, and it is well done in other countries if you have that taking place with the community health workers being sort of the trusted messengers to the communities that look and the communities that they that sort of have the faith and trust of those folks, that is an effective response. And that’s how we can sort of that’s how we can mitigate any potential disaster in the future.

Peter Bowes: [00:32:50] But a big part of what you’re saying is that it starts with awareness. And I think essentially this is what you’re trying as a starting point. This is what you’re trying to do with the book, that it’s more than just thinking about personal health, that community health will ultimately affect us all. And that that perhaps, is the aspect that many people don’t give any thought to.

Tyler Evans: [00:33:09] Yes, yes. Awareness. Awareness is key. That’s really that is the that is the ultimate endpoint of the book as a as a as a baseline success. If awareness is the only when I’ll take it. Right. Because that collective awareness, is going to follow folks to the, to the, to the, to their voting booth, to the ballot, right, to be able to, uh, to to connect to their communities. Right. To understand more, knowledge is power, right? I know that sounds cliche, but it really is. And, and a lot of folks have turned off, right, because they’re in their echo chambers of their social media and their, their subscription, their, their, their news channel subscriptions, you know, and whether folks are aware of it, I mean, there are strongly politicized. And so we’ve turned it. We’ve turned off, right? We’ve turned off open minds in a lot of ways. And most, most Americans, most humans throughout the world, I’ve traveled to over 120 countries. And, you know, I find a very a core universal theme among most humans. And most humans want to just, you know, they care about their communities. They care to some, to some extent about the globe, but they really care about their communities. How to protect their families, how to, you know, get food on the table. And and they and but they ultimately, you know, they want to serve humanity in some extent. There’s there is so such a charitable element that exists really, you know, across the world. And, and there the, the amount of privilege, almost doesn’t matter. In fact, sometimes I see a sort of it’s inversely proportional. I see a lot of folks who are, you know, more kind of low income communities that actually want to help more.

Tyler Evans: [00:34:57] But, you know, the reality is there is there is a there is a core, humanitarian element, I think, to to many of us. And so the more that it’s activated and the more that it’s evidence based. Right? That’s what the book really tries to demonstrate. This is not this is not an opinion. These are facts. And the facts are, you know, that every pandemic that we have seen has had a very profound social and political driver. And until we address those, we will continue to see more of the same. And that’s what the third section is about. Okay. Now that we’ve now that we’ve got your attention, now that you’ve, now that you, are hopefully in agreement here, what can we do about it? And again, if you just are aware that will influence, you know, that will influence your actions in sort of years to come. And that could be again, that could that could be just voting, that could be, you know, calling up your the sort of the, the quintessential, you know, calling up the your congressmen or you know, or or, you know, uh, volunteering at, at the local shelter or, uh, you know, whatever. But it, it doesn’t even have to be that, that collective awareness posting that on your echo chambers because it’s just going to get worse, I’m afraid is. And and that will that will disrupt the current paradigm and hopefully start to kind of break down some of these sort of, perceived barriers.

Peter Bowes: [00:36:18] And just in closing, in more of a personal question, can you give me a snapshot of how you live your life with these goals and these big aspirations in mind in terms of everyday living?

Tyler Evans: [00:36:31] Sure. Uh, I try to lead by example. So, you know, talking on the media circuits and, you know, working through a lot of these virtual sort of screens. But I’m still seeing patients. You know, I’m still seeing patients. I’m still trying to to to work to, to, to improve these folks lives in meaningful ways. I’m still meeting with, with with our teams, not just on zoom or teams. You know, I’m there, you know, in person, trying to, strengthen the, the solidarity that we have. I, I try to, to really inspire leadership among our local teams. We now have, multiple teams across across the country, And I really try to to be there as much as possible again, so we can sort of inspire them to do more. I try to create some of that sort of self-care. It’s hard, you know, we’re a lot of hats, so I try to create some of that self-care space as well. I think my wife, uh, you know, hopes it would be a little bit more. But, you know, I’m there for the kids. I’ve got, I’m taking my my, my five year old to his pediatric dentist today to talk about oral health. So that’s, that’s my that’s my sort of, you know, my, my personal way of sort of, you know, engaging in my, my own sort of, you know, family’s, health and wellness. We enjoy we have fun, you know, we we, you know, we travel, uh, you know, sometimes for work, sometimes for fun, exercise, regularly. you know, read, continue to kind of feed our minds. That is such a that is such a, a prevention mechanism for, you know, neurodegenerative disease, diseases and whatnot, keeping our minds sort of active, just being, a, you know, diverse and engaged, you know, human, but really being there, leading by example, not just talking about it is really important to me.

Peter Bowes: [00:38:20] Yeah that’s great. Tyler, this has been an inspiring conversation. It’s a great book. It’s a deep dive, much more detail, obviously in the book than we’ve had time for in this conversation. The book is pandemics, poverty, and Politics Decoding the Social and Political Drivers of Pandemics from Plague to Covid 19. Doctor Tyler Evans, really good to talk to you. Thank you very much.

Tyler Evans: [00:38:40] Thanks, Peter. Great conversation.