Upstream - An Epidemic of Insecurity with Dr. Abdul El-Sayed

Episode Date: April 7, 2020

It’s unfortunate that it’s taking a global pandemic to reveal it, but the unprecedented crisis catalyzed by the coronavirus has exposed our capitalist economy for what it is: an economic system that puts profit over people (and the planet). This pandemic is an unprecedented event, but it’s the sharpening of class divides, the gutting of our social safety net, and the mentality of selfish individualism encouraged by capitalism which have turned this pandemic into an unimaginable crisis. In this conversation we speak with Dr. Abdul El-Sayed about our current epidemic of insecurity and how it has unfolded through this current crisis. El-Sayed is a doctor, an epidemiologist, a candidate in Michigan’s 2018 Democratic gubernatorial primary election, and the author of "Healing Politics, A Doctor’s Journey Into the Heart of Our Political Epidemic," just out this month (April 2020). Senator Bernie Sanders has referred to El-Sayed as "One of the brightest young stars in the future of the progressive movement."  This episode of Upstream was made possible with support from listeners like you. Upstream is a labor of love — we couldn't keep this project going without the generosity of our listeners and fans. Please consider chipping in a one-time or recurring donation at www.upstreampodcast.org/support If your organization wants to sponsor one of our upcoming documentaries, we have a number of sponsorship packages available. Find out more at upstreampodcast.org/sponsorship For more from Upstream, visit www.upstreampodcast.org and follow us on Twitter, Instagram, Facebook, and Bluesky. You can also subscribe to us on Apple Podcasts, Spotify, or wherever you listen to your favorite podcasts.

Oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, When you think about this moment where we're facing a COVID pandemic, it's this epidemic of insecurity that's laid the groundwork for the experience we have right now. A, we stripped away the basic public services that we needed to protect us in the first place. And then, you know, people are so vulnerable right now that even when we talk about flattening the curve and social distancing to do that, a lot of people are choosing between their lives and their livelihoods. You're listening to Upstream. Upstream.

Upstream. Upstream. I'm Della Duncan. And I'm Robert Raymond. In this conversation, we speak with Dr. Abdul El-Saeed, a doctor, epidemiologist, candidate in Michigan's 2018 Democratic gubernatorial primary election, and author of Healing Politics, a Doctor's Journey into the Heart of Our Political Epidemic, that just came out in April 2020.

This interview is part of a series of upstream conversations about the coronavirus, capitalism, and potential systemic interventions and solutions during this challenging time. interventions and solutions during this challenging time. Welcome, Dr. Abdul El-Sayed to Upstream. Really happy to have you. Yeah, excited to be on here. Thank you so much for inviting me. I'm wondering if you wouldn't mind starting by telling us your personal journey from being a doctor to an epidemiologist and then a political candidate? How did you go about that journey? And what have been your guiding questions along the way? Yeah, I think you're right to ask about guiding questions. I grew up in Metro Detroit in a

relatively affluent suburb, but my parents immigrated here from Egypt and I was raised by my father, who was an immigrant from a very working class community in Egypt. And my stepmom, who was a daughter of the American Revolution, whose family were quite rural. And so in the summers, I'd spend a lot of my childhood summers in Egypt, where I'd hang out with my grandmother, who never got to go to school, despite being the smartest and wisest person I've ever met in my life. And she would always take great pains to remind me that there was nothing special about me. There was something special about the opportunities that I had insofar as they were extremely rare. The crazy thing is that when I'd travel 15 hours to Egypt, I'd travel about 10 years difference in life expectancy, but I could travel the same gap if I were to just go 25 minutes South to any community in Detroit. And that framed my why. I wanted to do

something about those deep disparities in people's health, which led me to go into medical school, but really quickly came to appreciate that in a lot of ways, our healthcare system and the way it's set up is more a part of the problem than a part of the solution. And so left clinical medicine for epidemiology, really enjoyed social epidemiology research, but also found that the nature of academic epidemiology left us publishing a lot more for people who already agreed generally with what we had to say about the way the world worked. And more empirical data and academic journals doesn't necessarily change much about the actions that we need to take. Got the opportunity to come home from New York where I was working as a professor to rebuild the health department in the city of Detroit. We took on big projects,

things like making sure every kid in Detroit had a free pair of glasses delivered at school if they needed them, making sure that we were standing up to big corporate polluters who were putting poison in the air that kids breathe, and making sure that schools were tested for lead in their water, but also realized that so many of the issues that we could work on had a lot more to do with the political choices of the politicians I worked for. And after I watched the Flint water crisis up front and center and watched Donald Trump win the presidency, I realized that I needed to be a part of helping to set the agenda about what we care about in our society if we were really going to be able to take on those inequities that I cared so much about. And that's when I decided

to run for office. And now, you know, I work sort of at the edge of politics and public health, really trying to drive the conversation around what we need to do if we really want to be a more equitable, just, and sustainable society. Thank you. Yeah, I really appreciate what you said that you learned from your grandmother about that it was the opportunities that you've been afforded and that others have been afforded that give them access and also capital and all of that and influence, of course, instead of the narrative that it's those of us who are kind of born special or that we deserve all the wealth that we can get because there's something unique about us. So I appreciate you sharing that insight

from your grandmother. Yeah. Or that we just worked hard, right? And that's the one that I think is so damaging is that, you know, I know many people who work far harder than I've worked and I work hard, but who work far harder to earn $11 an hour in a job that has no benefits, that has no vacation, and that they'll never see, you know, an increase in that pay. And so, you know, we've got to really interrogate the narrative that says that, you know, hard work is the difference between success and or working in a dead end, flat wage job, because a lot more of that has to do with opportunity that is the multiplier on your hard work. And just think about a very basic linear equation, Y equals MX plus B,

X being your work, but the M changes how much Y you get out of that X. And I think that's the difference between privilege and the lack thereof. Yeah, absolutely. So you write in your book, which just came out, your book called Healing Politics, A Doctor's Journey into the Heart of Our Political Epidemic. You write about something called an epidemic of insecurity. And you just told us about how you became interested in epidemiology. So I'm wondering, what do you mean by an epidemic of insecurity, both in general, maybe how you've seen it in your own work and in your own life? You mentioned the Flint water crisis, for example, but also just to acknowledge where we are right now, specifically in this time of the coronavirus, this pandemic, how is an epidemic of insecurity manifesting

right now? Yeah, Adela, I'll tell you, I thought I was going to leave epidemiology behind when I decided to run for office. But that way of thinking about the world, of trying to understand patterns that emerge out of individuals, to tell you something about the broad experience, that stays with you. And I traveled my state for 18 months, meeting people in their VFW halls and in their living rooms, and being able to interact with them one by one on the scale of hundreds, if not thousands. And that experience taught me a lot about what my preconceptions coming in were and what the truth was. I thought that the challenges that people faced in communities as diverse as Detroit or Flint versus, you know, Petoskey, right up at

the upper tip of the mitten of Michigan, those experiences would be completely different. But in fact, even though I was talking to people who would not have experienced one another, they experienced the same challenges, asking the same questions about why their kid has to take hundreds of thousands of dollars in debt just to pursue a higher education, why they have a paywall on their healthcare, why they now work a gig when they used to be able to work a full-time job that paid a living wage and came with benefits. And coming out of that, I realized that the systems that interlock that we've depended upon to provide us the basic means of a dignified life for a long time have been failing us. And they've been failing us largely because we've allowed them to be, you

know, in effect stripped away and sold for parts to the highest bidder. And they interlock with each other, right? Our healthcare system is run for profit. It's why it is so expensive and 10% of Americans don't have healthcare at all. And so many others have to pay a deductible that leaves them in effect without health insurance when they need it most. You've got an education system that has been privatized out and public funding even for higher education has fallen precipitously. You've got an economy that's a lot more interested in financializing and delivering a bonus or dividends rather than delivering a job in a high quality product. And so all of these things interlock with each other to form this epidemic of insecurity, this experience of feeling like the things you

used to rely on are not there anymore, and the anxiety that comes with it. And when you think about this moment where we're facing a COVID pandemic, it's this epidemic of insecurity that's laid the groundwork for the experience we have right now. A, we stripped away the basic public services that we needed to protect us in the first place. Public health funding has fallen precipitously over the past two decades. Last 15 years, you've seen state and local funding drop by about 45%. And the CDC has seen on net budget losses over the past two decades. And then, you know, people are so vulnerable right now that even when we talk about flattening the curve and social distancing to do that, a lot of people are choosing between their lives and their

livelihoods. Do I go out and expose myself and my family to this coronavirus and make a living so that I can feed my kids? Or do I stay home and worry about whether or not they're even going to have a meal at the end of the day? And so, you know, it's this epidemic of insecurity that forms the framework, the baseline in the name of your podcast that takes us upstream from a pathogen creating a global pandemic to a circumstance, a host and an environment that create the circumstance for a global pandemic. Yeah, your story of traveling around your state and getting to know folks, it reminds me of the story of the King of Bhutan and how gross national happiness was created. He actually, he was a young man who went around the country and asked people what they wanted from him as their king. And that's how he realized that they wanted to be happy instead of traditional economic development. So just noting how beautiful it is for political candidates to listen to folks,

to travel, to speak with folks. And so it's great to hear that that touched you and influenced your work. So I'm wondering, and you mentioned the upstream metaphor, what happens when you go upstream? You talked about the epidemic of vulnerability. You talked about the systems that we have that are failing. So I'm just wondering, like, when you go upstream from those downstream problems and challenges, what do you see as the root causes and their systemic solutions? Well, I mean, I think it is a focus on a couple of key things. Number one, that we have to build out public solutions to public problems. to public problems. And that comes in the form of healthcare, but it also comes in the form of infrastructure, taking on climate change, and regulating the power and the size of major

corporations that themselves have drowned down their sector and turned it into, in effect, an oligopoly. Independent of what sector you're talking about, you have very, very large oligopolistic actors across the board. And so that ability to provide public goods, that ability to regulate major corporations basic needs that they have to live a dignified life, so critical to being able to create economic opportunities that really do deliver for everybody, and so critical to allow our society to move nimbly and quickly to do both of those things. And so they interlock with each other, but they are all a really, really critical aspect to being able to create an America where people thrive. And over the long term, when you can deliver economic well-being at scale, when you can deliver healthcare at scale, when you can deliver housing and infrastructure, when you can

deliver access to a voice and agency, it creates the space where people can live their best, most dignified life. So those sound like some of the systemic solutions. I'm wondering, what do you see, though, as the barriers, the root causes for us not having that? It makes so much sense what you're saying. But what's stopping us as humans, as Americans, you know, in the world from having those more healthy systems? Well, one of the things that I think is really important for folks to understand about the epidemic of insecurity is that it's self-reinforcing, is that we are so worried about what we're going to lose next, that we're so focused on stopping loss than we're focused on creating gain. And we have chosen as a society to allow ourselves to be torn apart, to be divided,

rather than to bring empathy to one another, to understand that actually all of us are suffering the consequences of this epidemic and that all of us need to heal together. And so, you know, you look at what would it take to build an equitable economy? Well, it would take being able to address the power and size of major corporations that have choked it off. But then to do that, you have to make sure that our political system isn't bought off by those same corporations who get to hop the line to make sure that our political system benefits them. And to be able to rectify our political system, you need to invest in people who are willing to stand up to that corporate power and

to come together behind them. But the problem is, is that it's so self-reinforcing that sometimes we don't step back and take a look at how the whole system works. And so that's what I try to elucidate in the book is how this, I call it a miasma of insecurity, have created the insecurity epidemic we suffer. And then how that insecurity epidemic self-reinforces the miasma by allowing us to be divided, by allowing us to blame each other for what we don't have rather than to come together to build it. And one piece that you've already touched on is the profit motive. And one of the quotes that I love that I heard you say in a recent interview on Democracy Now was that we are suffering a public health emergency,

not a private health emergency. So bringing in this question of public versus private and for-profit institutions. And many of the stories from your book actually relate to this problem of finding the profit motive, whether it's in a medical association or a healthcare system. So for me, when I think about this, I do think it makes so much sense for hospitals and especially pharmaceutical industry to not be profit motivated. It just it doesn't make sense to me because it feels like it will not support human and planetary health and well-being. So can you talk about this, this profit motive, how how much you see that as a root cause? And also, what are the potential alternatives instead of being profit motivated? So what are the potential alternatives instead of being profit motivated?

So I think, you know, I think it's the question is, is how do you regulate the destructive capacity of a profit motive? I think, you know, the idea of a simple profit motive unto itself in and of itself is not a noxious idea. It's what happens when we allow the profit motive to go unchecked, right? It's the difference between feeling hunger and then, you and then gorging yourself out of gluttony. And so I think the key question here is, how do we prevent the unchecked profit motive and the ability for a profit motive to supersede all of the other motives that we have in our society?

all of the other motives that we have in our society. And so it's about finding a balance and regulating the system of growth and protecting our democracy from what unchecked, capitalistic, profit motive driven behavior can do in terms of destroying all of the other choices that we need to make in our society. Yeah. And yeah, for me, one of the other issues with that is how can we see profit and money in general, not as a bad thing, but as a means to an end and that end being social or environmental good so that it can be a tool used. But when it's an end in itself, and like you're saying, when it's an end that's unchecked and when it's an end that's dominant or more important than other ends, that's when it gets problematic. So definitely I hear you. So let's talk about politics, because obviously from the title of your book, Healing Politics, obviously from your own professional journey, it's obvious that you see politics as a potential leverage point for change. So can you talk about your relationship with

politics, maybe how it's developed or changed during your work time? And also, what is the type of politics you are working to create? You mentioned, as you mentioned in your book, bringing empathy into politics. So can you talk about your relationship with politics, why you see it as a potential leverage point for change, and then what type of politics you are working to create. Yeah. I never intended to run for office. I was sort of a political bystander, as I think most folks think of themselves to be, until I took that role at the health department and came to appreciate just how damaging the wrong kind of politics can be to the lives of everyday folk. And then I decided to run and

I had a front row seat to seeing just how broken politics can be. And I think there needs to be a change in the process of politics around where money can go and where it comes from and how we open up the suffrage to folks in a true way. You know, everybody in theory has the right to vote, but that doesn't happen in practice. But then also it's the kind of politics, the culture of politics that I think needs to change. And in my book, I talk about an empathy politics, which is more framed on understanding why someone does what they do and how the epidemic of insecurity can shape that than it is on pointing at the other and saying how wrong they are. Us versus them doesn't

work very well when you're trying to do things together. And collective action is going to be critical to taking on the challenges we face. And so we have to step out of us versus them, and we have to step into all of us versus the challenges we face, all of us against the miasma of insecurity. And so you're now promoting the book, Healing Politics, The Doctor's Journey Into the Heart of Our Political Epidemic. What else are you working on as we close? What are your leading questions and what are the things that you're working on now? Yeah, I'm actively trying to get the word out about how to process this pandemic. And so I host a podcast called America Dissected, and our second season is focused entirely on coronavirus. Though, if you haven't listened to the first season, we do deep dives into a number of different

challenges that we face. And then, you know, I've got a second book coming around the way in February and putting the final touches on that. And then lastly, just trying to be a good dad and to learn the lessons of this thing, while trying to make sure that the public recognizes where we are and why we're here, doing that work on CNN, where I'm a contributor. So, you know, a lot of different irons of the fire, but all focused on trying to answer that why that we started with. And I'll look forward to hopefully in the fall, I hope that we're well past this by then, but we'll be joining the Honors College at the University of Michigan as a DeRoy professor, teaching a course called Wellbeing and Public Policy, which I'm

really excited about as well. Wonderful. Well, the upstream metaphor does come from public health. So we're definitely grateful for that field. And thank you so much for the work that you're doing. And best wishes on all that you're facing right now and to your family. Della, thank you. Stay safe, stay home, stay well. And thank you so much for having me. I really appreciate it. You've been listening to an Upstream conversation with Dr. Abdul El-Saeed, author of Healing Politics, A Doctor's Journey into the Heart of Our Political Epidemic. Thank you.