Editor’s Note: The news that Dr. Megan Ranney, M.D., MPH, has been chosen to be the next dean at the Yale School of Public Health is a story where the underlying narratives contributing to her decision have not yet become part of a robust public conversation. Why is that?

ConvergenceRI is republishing the interview with Dr. Ranney, which first ran on Dec. 5, 2022, “Taking Action: One-on-one with Dr. Megan Ranney: A brief chat with one of nation’s brightest stars in the public health galaxy.”

In her interview, Ranney articulated many of the challenges facing health care delivery in Rhode Island that no doubt contributed to her decision to leave – including the lack of adequate staffing at hospitals, the for-profit nature of digital health where apps are designed for those with disposable income, and the unmet need for women and minorities to be in the room where decisions are being made.

“The most important thing is that there is more than one of us in the room,” she said. “That is the first step. And so, the best way to amplify our voices is to have [us] there.” Ranney continued: “It’s about thinking about public health and health care as being part of the same spectrum.”

In a recent essay published online on Jan. 30 in JAMA Network by Dr. Donald Berwick, MD, “The existential threat of greed in U.S. Health Care,” he wrote: “No sector of U.S. health care is immune from the immoderate pursuit of profit, neither drug companies, nor insurers, nor hospitals, nor investors, nor physician practices.”

The question is: How do we create the public space to reframe the narrative when it comes to health care? To spur on those conversations, ConvergenceRI is adding a fourth sidebar, “Guess who is coming to dinner,” to encourage friends and families to talk about the issues, in person, face-to-face, not on Facebook, Twitter, or Linked In.

What is needed is a way to have the actual conversation – not as a podcast, to be listened to while driving or doing chores. Instead, it is a conversation that needs to occur in public, at the dinner table.

PROVIDENCE – She does not duck the tough questions, nor does she shy away from controversy. Dr. Megan Ranney, MD, MPH, Deputy Director of the School of Public Health at Brown University, has emerged as a prominent national voice of common sense in an age of constant health disruption and misinformation.

Ranney’s voice resonates with courage when she speaks out on hot-button topics – preventing firearm violence, promoting common-sense public health practices such as masking, and advocating for better interventions when it comes to domestic violence.

The camera likes Ranney, but she eschews self-congratulation. The biggest metric for her, Ranney told ConvergenceRI in a recent interview, is not whether she is being seen or heard, but rather: “Seeing change happen on a community level, …translating the evidence or empowering the individual physician or patient community members to take action.”

When the ceremonial shovels were poised to mark the groundbreaking for the construction of the state’s new public health laboratory on Monday, Oct. 24, Ranney was there, representing Brown, taking her place alongside the state’s Congressional delegation. At the ceremony, R.I. House Speaker Joseph Shekarchi described her as “Rhode Island’s own rock star.” [See link to ConvergenceRI story below, “An arranged marriage between public health, real estate.”]

When the results of the fourth annual R.I. Life Index were revealed on Monday, Nov. 14, at the South Street Landing, Ranney was the first speaker, framing the event from the perspective of optimism. “I am quite optimistic,” she said.“My optimism flows from the knowledge that everyone in this room, and everyone attending virtually, are committed to addressing the inequities in our health care, public health, and community in Rhode Island.” [See link below to ConvergenceRI story, “Taking charge in health care.”]

And, last week, Dr. Ranney was featured on CNN, with an op-ed column published on Nov. 28, “Why the US is having shortages of antibiotics now.” Ranney wrote: “Remember the shortages of personal protective equipment in March 2020? Now it’s medications for kids.” She continued: “Around Halloween, some manufacturers began reporting shortages of the liquid [pediatric] formulations of amoxicillin, an antibiotic used for everything from strep throat to ear infections. …I’m hearing about pharmacists coming in early and staying late to try to get their hands on limited supplies.”

Translated, Ranney has emerged as a thoughtful, influential leader in asking and answering the tough questions about health care, seeking to change the narrative during a time when it is an increasingly complicated task to navigate the health care delivery system.

ConvergenceRI spoke briefly with Dr. Ranney last week, in a one-on-one phone interview, covering a broad landscape. Here is the interview.

ConvergenceRI: If you could design a billboard to be placed on highways across Rhode Island to promote public health messaging about gun violence, what would it say?
RANNEY: I would emphasize the value of safe storage. And, making sure that your firearm is locked up, that kids and your family members don’t know how to access it, and, that you have an awareness of folks around you that would be high risk if they did get access.

In terms of the actual language, I would be designing it in collaboration with my colleagues who are firearm owners and experts. I would defer to them in terms of the actual messaging language.

ConvergenceRI: Given all the work that you do and your frequent appearances in the news media, most recently with your CNN editorial about the shortages with child antibiotics, what makes you feel heard and seen in your work promoting public health?
RANNEY: I think the biggest metric for me is seeing change happen on a community level. Sometimes that is local, state, or federal policies that allow that change to happen, but often it’s about either translating the evidence or empowering the individual physicians and patient community members to take action.

The antibiotic piece is more about a larger, more systematic approach to access to generic medications. But most of my work is about things that individuals scan do.

ConvergenceRI: Can you give me an example of feeling seen and heard?
RANNEY: For me, it is not so much about personally being seen and heard, it is about the ideas having an impact. I struggle with that terminology.

I don’t care whether it is “me” personally, [what is important is] things like seeing the tracking of PPE shortages on a nationwide basis. We no longer have to have it done by the nonprofit that I was part of. It would be things like seeing changes in access to school nurses to masks, because of work that I was part of, or did. Those are the things that matter to me.

ConvergenceRI: When it comes to digital health, what do you see as the greatest barriers? Is it patient access? Is it the platforms, such as EPIC? Is it the time-consuming nature of recoding the patient data? Is it the emphasis on billing?
RANNEY: Great question. I think it is a couple of things. The first is patient access. Many of the folks who could have the greatest potential benefit from digital health are left out of the process of design and dissemination of the tools.

So, I think it is incumbent upon those of us working in the field to make sure that we are creating tools in ways that can be used by the average Rhode Islander or the average American, or the average person across the globe.

So, that is considering and being mindful of the need for access for broadband and high-speed WiFi. It is about making sure that our programs work on phones that may not be the latest iPhones. It is about making sure that it is accessible to folks who have lower literacy levels, or who may not be English-speaking.

I think that is the first big barrier. The second one is that, for better or for worse, digital health is still largely a for-profit business. And, so, many of the programs that are out there are things that are nice to have, not things that we need to have.

Because the populations that need additional support and access are often ones that have less capacity to pay out of pocket for those services.

Whether it is around digital or mental health apps, or direct to consumer reproductive health supports, many of those programs are designed for people with disposable income, which we know is not true of many, many Americans.

ConvergenceRI: At the unveiling of the R.I. Life Index, I was struck by the leadership role being played by women in health care. I don’t know whether you saw my story about that or not…
RANNEY: I didn’t. I would love to read it, if you could send it to me,

ConvergenceRI: I would be happy to; I will send it through Kate. One of the headlines was quoting Beth Macy, when she said: “Women get shit done, just saying.” [See links below to ConvergenceRI stories.]
RANNEY: [Laughter]

ConvergenceRI: What is the best way to amplify the role of women in terms of corporate decision-making?
RANNEY: Oh, wow. I don’t know a single best way. I will say the most important thing is for women to be in the room. I would extend that beyond women to also include folks who come from racial and ethnic minorities and backgrounds.

And, the most important thing is that there is more than one of us in the room. That is the first step. And so, the best way to amplify our voices is to have it there.

Let me say that I think it s “a” way to amplify; I don’t know if it is the best way.

ConvergenceRI: Have you sat down and talked with Attorney General Peter Neronha to discuss a joint collaboration on public health and gun violence? What would you say to him?
RANNEY: Certainly not recently. But he has been a strong advocate for public health in general. He has been doing tremendous work around paying attention to landlords who are not mitigating lead paint in their apartments and housing complexes. You know that lead is a major driver of learning loss; it can be a driver of aggression, it hurts kids’ long-term development.

And, so, he has already shown himself to be a strong supporter of using law, when appropriate, for public health. When we look at the challenges that we face on a state level, we are fortunately one of the states with the lowest levels of gun deaths in the country. That is partly due to our policies. It is partly due to enforcement of the policies.

Which is also partly due to creating laws that put an emphasis on things like safer storage.

And so, to me, he has a role to play in terms of setting, defending and enforcing the polices that are on the books, whether it’s around domestic violence, making sure that folks that have been convicted of domestic violence or have personal restraining orders don’t have access to firearms, or whether it’s around preventing access to illegal firearms on the street. And, I know he is active in both of those areas already.

But again, it’s also supporting that community norm, which is the counterpart to any policy that is out there, and sometimes is way more powerful than putting a new law in place.

ConvergenceRI: If you could change the delivery of emergency medicine in Rhode Island, what steps would you recommend taking?
RANNEY: [laughter]

ConvergenceRI: I am asking you really easy questions to answer. [laughter}
RANNEY: You’re hitting me with all these gimmes, you know? [laughter]

I think the first thing is that we need adequate staffing. Emergency departments across the state are suffering from inadequate numbers of nurses, and physicians, and techs, and security guards, not just in the emergency department, but also across the health care system.

And, when there are problems in one part of the health care system, it all trickles down to the emergency department. We are the provider of first or last resort, when people can’t get care elsewhere.

And when the hospitals or the nursing homes are too full, it then overflows into emergency medicine.

The first and biggest thing is to ensure that you have a health care facility that is adequately staffed.

The second part would be around avoiding the emergency department, and thinking outside of the box, in collaboration with state officials, insurers, but also community groups, about ways that we can provide care for patients. Certainly the emergency department is wonderful at diagnosing problems relatively quickly, but then it is also linking people to services, so that they don’t need to be hospitalized.

And, I think that there is a moment now for some strong collaboration around improving that type of access.

You know, really [creating] a partnership between local nonprofits, health insurers, and in-depth specialists.

It’s about thinking about public health and health care as being part of the same spectrum.

And, that we’re going to be able to keep people out of the emergency department or out of the hospital more easily if they have access to housing, if they have access to mental health treatment, if there are adequate numbers of home health care aides who can help folks safely stay at home instead of heading to hospitals.

ConvergenceRI: I had mentioned Dr. Jill Maron to you. She is interested in actually sharing the results of the data from her national clinical trials for her saliva assays. Would you be willing to participate on a panel of experts to respond to the data?
RANNEY: Possibly, I would like to learn more about it.

ConvergenceRI: Have you migrated your messaging to Mastodon and Post following your disruptions to Twitter?
RANNEY: I am active on Post. I have an account on Mastodon, but find it a little complex to use. And, I do still use Twitter, but less so than I was, even a month ago.

ConvergenceRI: Have you considered running for political office.?
RANNEY: Right now, I am very happy in my position at Brown.

ConvergenceRI: I did see that there was a program being done jointly with the School of Public Health about advocacy and running for office this month.
RANNEY: Part of our goal is to train people who can go and have an impact on the world in a variety of ways, whether it is through political office, through nonprofit or for-profit leadership, or through programs like working with communications professionals and journalists, like you.

ConvergenceRI: Last question. How do you cope with the stress of the job to prevent burnout?
RANNEY: Two things. One is that I have a tremendous network of colleagues, both locally and nationally, whom I feel really fortunate to be able to both work with, but also turn to. We have all got each other’s …. We’re all there to support each other’s long-term missions, that can help solve problems, that can help provide [support] when I need a break, but who can also help me create a path forward when [the work] is exhausting.

The other thing is that I have a great family. My husband and my two kids and both of my parents are all here in Rhode Island. They are probably the biggest part of my happiness and resilence.