For many New Yorkers, Dave Chokshi was the face of New York City’s public health response to Covid-19. He often appeared on public service announcements in a white lab coat emblazoned with“N-Y-C” in big, bold letters, urging urbanites to mask up, get tested, and get vaccinated.
Appointed as New York City’s 43rd health commissioner in August 2020, Chokshi was thrust into the city’s battle against the coronavirus just months after it was deemed an epicenter of the pandemic. Following those chaotic and harrowing early months when hundreds died daily in overcrowded hospitals and freezer trucks were made into makeshift morgues, Chokshi was tasked with rebuilding trust with residents and steering the city’s vaccination campaign, through waves of new variants and the release of new boosters.
Chokshi stepped down from his position as “the city’s doctor” in 2022 and now chairs the newly formed Common Health Coalition, a nonprofit that aims to prepare the U.S. health system for the next crisis by getting public health organizations and health care systems — which Chokshi says typically operate in parallel — working together before calamity strikes. In June the coalition announced it had signed on more than 50 members, including the American Public Health Association, Northwell Health, and the Yale School of Public Health.
“People have been talking about unifying medicine and public health for decades and frankly, have failed,” said Chokshi. “I’ve inhabited both sides. I’ve been a leader in health care and had the privilege to lead in public health as well. This is a chance for me to serve as that emissary and bring a different way of reimagining our health system to reality.”
Chokshi was previously the chief population health officer at NYC Health + Hospitals, the largest municipal health care system in the U.S., and is now a practicing physician at Bellevue Hospital and teaching at the City College of New York. He sat down with STAT in June at the Aspen Ideas: Health Festival to talk about his goals for the coalition, lessons learned from the pandemic, and bridging health care and public health. This interview has been edited for length and clarity.
I no longer see you on my TV during commercial breaks for SNL talking about masking and vaccines. What have you been up to since leaving the New York City Health Department?
As chair of the Common Health Coalition, I’m building on the memories from the pandemic and turning things into not just “lessons learned,” but “lessons mobilized.” We saw, along with all the tragedy and the suffering, a huge amount that was positive. We saw the walls come tumbling down between health care and public health — whether it’s through our vaccination campaign, or testing, or any of the other things that we did to mobilize this once-in-a-generation pandemic response. This has been one of the animating ideas of my career. I’ve spent time in health care, and I spent time in public health, and in each of those experiences, I always felt like I was kind of a mole for the other side. I was the guy in health care saying, “Why aren’t we reaching out to the health department, who’s working on these similar issues?” And then vice versa. When I had the chance to lead the New York City Health Department, the question was always, “What can we do to better engage our health care partners who are seeing all of these people that we aim to serve as well?” It’s about knitting those things together.
What are those biggest “lessons to mobilize” from the pandemic?
I think about it in two ways: relationships and results. Relationships are all about how we need to, when we’re in peacetime, build the connections that we know we’re going to rely upon in a time of crisis. The time to build them is in times like now, where, for example, when it comes to preparedness across hospitals and a public health department, those should be shared plans. Those should be plans that we deliberate on and organize together rather than in our separate silos.
Then on the results side. We’re not in a crisis like the Covid-19 pandemic any longer, but we’re confronted with all of these other slower-moving disasters. Whether it’s the opioid crisis or climate change, these are all things that we know will have catastrophic effects, but which, if we muster the full will and the resources of our health system, we can be far more effective [at addressing] than we are today.
What health equity lessons from the pandemic can we now mobilize for the next big public health crisis?
We know that equity has to be baked into our plans from the ground floor. Equity is not an add-on. It’s not a sideshow. It is the main event. If that wasn’t clear for you before the pandemic, it has to be in the wake of it. That means that, if you’re a leader in health, it is your responsibility to ensure that when you have a vaccination plan that you’re rolling out, that equity is part of that vaccination plan, it’s not something that comes a few months down the road.
I remember very vividly, during the Omicron wave of the pandemic, we had made really great strides in closing the Black-white vaccination gap in New York City by the end of 2021, [through] a lot of painstaking, deliberate work in partnership with community-based organizations, using community health workers, fighting misinformation, etc. We were proud of that.
Then I remember my team brought me data showing the difference in the hospitalization rates between Black and white New Yorkers during the Omicron wave after we had closed that vaccination gap, and Black New Yorkers were twice as likely to be hospitalized during Omicron as white New Yorkers. For me, this is one more lesson in the challenges that we face, and the accountability that is needed for people to say, “If you’ve moved a little bit, you know, toward where you need to go, you can’t be satisfied if you still have the data showing you, such a stark inequity.” So it’s about building that accountability loop in a way that can recognize some of the successes, but also show you when the job is not yet done.
What is the Common Health Coalition, and what are your goals?
People who care about this mission of strengthening partnership between health care and public health, we invite them to think about joining the coalition. To do so, you have to make a commitment. This is something that I felt very strongly about as chair, to say that we’re not going to be another organization that issues a report that sits on a shelf, or makes recommendations that we hope other people will follow. We want to lead by example.
In March, we announced our first slate of six areas of commitment and 33 concrete actions under those six areas. Any new organization that joins the coalition has to either sign on to one of those actions or say, we’re going to do something else under one of the focus areas of the coalition. Those priorities distill down to sort of four areas. We use the acronym CARE.
C is about coordination between health care and public health. Again, doing so in peacetime, not just in a time of crisis. A is about “always on” emergency preparedness. R is about real-time disease detection. Whether it’s measles or H5N1, how can we have visibility into cases as quickly as possible when they’re reported so we can mobilize our response as quickly as possible. E is about data exchange, particularly to advance health equity.
How has your experience as NYC’s health commissioner prepared you for what you’re doing now?
One of the things that I think about a lot is how do we make sure our conversations in the health sphere get to the kitchen table. How do we communicate about them in a way that eschews the jargon, that gets us into a realm that is less abstract and far more tangible and concrete. That certainly infuses into the work we’re doing with the coalition, because this, frankly, can feel kind of wonky. Like, if I were to think about this from the perspective of one of my patients, the response that I would get is, “Well, why aren’t you guys collaborating already? I didn’t even know this was an issue, that health care and public health don’t work well together.”
The other is just for me to give voice to some of the stories of not just what went wrong during the pandemic, but what went right. How the largest vaccination campaign in our city’s history simply would not have happened if we did not have robust partnership between health care and public health. And how much I had to put my shoulder to the grindstone, as a leader of our pandemic response, to forge that partnership. That is very much borne of my experience.
What diseases are you working on now? Are you jumping onto bird flu?
Bird flu is a really important example for us to think about because we need to be able to bring to bear what health care can contribute, and then marry that to not just public health departments, but also, agriculture experts. Marrying all of those things under one banner is one of the ways that we’re trying to contribute to the H5N1 response. Syphilis is something that is on our radar screen, particularly because of the very rapid and concerning rise in congenital syphilis. This is tied to all of the ways that we need to improve maternal health in this country, but particularly to prevent perinatal transmission of syphilis, which relies on health care being able to bring to bear what we know works with respect to treating syphilis, particularly latent syphilis, and then making sure that public health is at the table.
What are the biggest barriers you’re facing bridging public health and health care systems?
The biggest barriers are often barriers of inertia. It’s not recognizing that the pandemic brought to the fore all of these cracks in our health system. We’re suffering from this collective amnesia when it comes to Covid-19. I think the coalition is really about choosing action over amnesia. We’re making progress with that because of the momentum that we have.