Let's Talk Cincy: Health Commissioner Dr. Grant Mussman discusses a wide range of health issues

THIS IS LET'S TALK CINCY PRESENTED BY WESTERN AND SOUTHERN FINANCIAL GROUP. PUT OUR FINANCIAL STRENGTH BEHIND YOU. HELLO EVERYONE. I'M CURTIS FULLER AND WELCOME TO LET'S TALK CINCY TODAY A SPECIAL PROGRAM BECAUSE WE'RE GOING TO TALK ABOUT YOUR HEALTH AND THE HEALTH OF GREATER CINCINNATI. AND WITH ME IS THE HEALTH COMMISSIONER FOR THE CITY OF CINCINNATI, GRANT MUSSMAN AND GRANT. FIRST OF ALL, THANK YOU FOR BEING HERE TODAY. THANK YOU FOR HAVING ME. LET'S TALK A LITTLE BIT ABOUT SOME OF THE TOP ISSUES FACING THE CITY OF CINCINNATI. WITH RESPECT TO HEALTH. YOU KNOW, THERE'S SO MANY THAT THE CINCINNATI HEALTH DEPARTMENT AND ALL THE LOCAL HEALTH DEPARTMENTS IN THE STATE DEAL WITH IT CAN BE VERY HARD TO ENCAPSULATE AND TO REALLY THINK ABOUT AND WHAT WE'VE TRIED TO DO RECENTLY. ONE WAY OF THINKING ABOUT IT IS LOOKING AT WHAT IS LIFE EXPECTANCY IN DIFFERENT SPOTS IN CINCINNATI, WE'VE KNOWN FOR SOME TIME THAT THERE IS A DIFFERENCE BETWEEN NEIGHBORHOODS IN CINCINNATI, SOME NEIGHBORHOODS HAVE LOWER LIFE EXPECTANCY AND SOME HAVE HIGHER LIFE EXPECTANCY. JUST BY VIRTUE OF THE ZIP CODE OR THE NEIGHBORHOOD. AND IT'S 25 YEARS, YEARS IS THE IS THE DIFFERENCE. AND WHAT WE DIDN'T APPRECIATE IT UNTIL FAIRLY RECENTLY WAS HOW UNUSUAL THAT IS. THAT'S ACTUALLY AMONG THE WORST IN THE COUNTRY. AND WHEN WE FOUND THAT OUT, WE BEGAN LOOKING AT THE DATA THAT WE HAVE, WHICH IS OUR VITAL STATISTICS DATA TO SEE WHAT ARE THE THINGS THAT DRIVE THAT. AND WHEN WE UNPACK THAT DATA FOR YOU CAN LOOK AT OPIOID OVERDOSE DEATHS AND DEATHS FROM CARDIOVASCULAR DISEASE AND DEATHS FROM INFANT MORTALITY ARE WHERE WE'RE SEEING THOSE BIGGEST DISPARITIES, THOSE BIGGEST DRIVERS OF THAT LIFE EXPECTANCY DIFFERENCE. THAT'S A TROUBLING STAT, BECAUSE TO THINK THAT YOU COULD LIVE ON ONE, ONE SIDE OF TOWN AND ANOTHER SIDE OF TOWN, AND THERE WOULD BE A 25 YEAR DIFFERENCE IN LIFE EXPECTANCY, THAT'S THAT'S REALLY SAD THAT THERE'S THAT TYPE OF DISPARITY. IT IS, UM, IT SO MANY THINGS GO INTO LIFE EXPECTANCY THAT WE DON'T KNOW WHAT THE CAUSE OF THAT IS. SO IT'S GOING TO TAKE A LOT OF WORK AND A LOT OF EFFORT TO ADDRESS THESE MEIGS. BUT THERE ARE GROUPS OUT THERE WHO HAVE DEVELOPED WAYS OF LOOKING AT IT. AND INFANT MORTALITY IS A GREAT EXAMPLE. THERE'S AN ORGANIZATION CALLED CRADLE CINCINNATI, AND THEY'VE TAKEN A MULTIDISCIPLINARY APPROACH. THEY'VE THEY'VE STARTED WITH VITAL STATISTICS. THEY'VE BROUGHT IN DOCTORS. THEY'VE BROUGHT IN CAREGIVERS OF DIFFERENT KINDS. AND BUT REALLY, THEY WENT INTO THE NEIGHBORHOODS AND TALKED TO PEOPLE, TO MOTHERS AND EXPECTANT MOTHERS TO SEE HOW THEY COULD START ADDRESSING, UH, THE THAT DIFFERENCE AND WHAT WE'VE SEEN WITH INFANT MORTALITY IS THAT 15 YEARS AGO, THAT WAS THE NUMBER ONE CAUSE. AND AND THAT HAS STEADILY DECREASED. IT'S STILL HIGH IN CINCINNATI. IT'S STILL WAY TOO HIGH. BUT THAT HAS COME DOWN A LOT. AND THAT'S THE KIND OF DATA DIFFICULT LONG SLOG IT TAKES TO ADDRESS SOME OF THESE THINGS. AND I SHOULD SAY THIS ISN'T THE FIRST TIME I'VE HEARD ABOUT THE DISPARITIES. THIS IS SOMETHING THAT'S BEEN ON THE RADAR DISPARITY OF NEIGHBORHOODS BY, YOU KNOW, ZIP CODES. SO IT'S SOMETHING THAT'S BEEN PUT OUT THERE. I'VE DONE SEVERAL STORIES. I GUESS WHAT'S TROUBLING IS THAT WHEN YOU SAY THAT 25 YEAR DIFFERENCE, IT DOESN'T APPEAR AS THOUGH IN, YOU KNOW, THE PAST TEN, 15 YEARS THAT THAT'S DROPPED AT ALL. IT REALLY DOESN'T LOOK LIKE IT HAS THE FIRST DATA. WE HAVE ABOUT THE NEIGHBORHOOD DIFFERENCES. THAT ANALYSIS WAS DONE BY THE HEALTH DEPARTMENT IN 2009, AND WE DID IT AGAIN IN 2015. AND THAT DIFFERENCE SEEMS TO HAVE PERSISTED IN AND OUR MORE RECENT DATA. WE HAVEN'T DONE IT. THAT'S THAT'S VERY TIME INTENSIVE, AND WE HAVEN'T DONE QUITE AS THOROUGH OF AN ANALYSIS RIGHT NOW. BUT WHAT WE LOOK AT RIGHT NOW WITH THE YEARS OF LIFE LOST OUT OF THE NEIGHBORHOODS, IT LOOKS LIKE IT IT REALLY HASN'T BUDGED. CAN YOU, UH, OFF THE TOP OF YOUR HEAD, GIVE SOME EXAMPLES OF NEIGHBORHOOD HOODS ON THE UP SIDE? NEIGHBORHOOD HOODS ON THE DOWN SIDE, OFF THE TOP OF MY HEAD. UM, I, I CAN THINK OF 1 OR 2, BUT I ON OUR WEBSITE ACTUALLY IS A LIST. SO IF YOU GO TO THE CINCINNATI HEALTH DEPARTMENT WEBSITE, WE HAVE AN INTERACTIVE DASHBOARD WHERE FOLKS CAN PUT IN YOUR ZIP CODE. YES. YEAH. WELL, IT'S NOT ZIP CODE. YOU YOU DON'T PUT IN YOUR ZIP CODE. WE HAVE THERE'S A UM, IT JUST LISTS THE NEIGHBORHOODS AND YOU CAN LOOK AT COMMON CAUSES OF DEATH, AND YOU CAN LOOK AT NEIGHBORHOODS AND SEE WHERE THEY STACK. WOW. WOW. ALL RIGHT. WE'RE GOING TO TAKE A BREAK AND COME BACK AND TALK ABOUT MORE ISSUES FACING CINCINNATI. WITH RESPECT TO YOUR HEALTH. BACK IN THE MOMENT. WELCOME BACK EVERYONE. WELCOME BACK EVERYONE. I AM TALKING TO THE HEALTH COMMISSIONER FOR THE CITY OF CINCINNATI, DOCTOR GRANT MUSSMAN. UM, LET'S LET'S TALK ABOUT AN ISSUE THAT HAS SURFACED RECENTLY. MEASLES, OF ALL THINGS. YEAH. I DID NOT EXPECT MEASLES TO BE A BIG ISSUE IN MY CAREER HERE. WHEN I WAS STUDYING TO BE A PHYSICIAN, BUT IT HAS COME BACK. WE'VE HAD MULTIPLE OUTBREAKS SINCE, UH, OVER THE LAST, LAST, UM, LAST FEW YEARS. AND RECENTLY WE'VE HAD AN OUTBREAK IN OHIO. SO WE'VE HAD SOME EXPOSURES IN THE CITY OF CINCINNATI, WHICH THANKFULLY NO ONE HAS GOTTEN SICK FROM YET IN CINCINNATI. AND I THINK IT IN THE CASES AROUND GREATER CINCINNATI, UH, THIS WAS FROM SOMEONE WHO TRAVELED TO CINCINNATI. IS THAT. YEAH. YEAH. THAT'S RIGHT. AND IT DOESN'T TAKE MUCH. MEASLES IS INCREDIBLY INFECTIOUS. IT IS TEN TIMES MORE INFECTIOUS THAN COVID. SO IT IS PROBABLY THE MOST INFECTIOUS OR ONE OF THE MOST INFECTIOUS THINGS OUT THERE IS. AS I UNDERSTAND IT. AND I THINK MANY PEOPLE THOUGHT, WELL, WE'LL LIKE YOU. YOU SAID YOU PROBABLY WON'T SEE MEASLES. WHAT'S CAUSING THIS, UH, RESURFACING OF MEASLES? WELL, THE THE GREAT NEWS IS MOST PEOPLE ARE IMMUNIZED FOR FOR MEASLES IN THE THE IMMUNITY IS IS LIFELONG LONG. AND IT'S IT'S A VERY EFFECTIVE KYIV VACCINE. MOST PEOPLE GET IT AROUND ONE YEAR OF LIFE. AND AT FOUR YEARS OF LIFE IN THE UNITED STATES AND SO TO KEEP MEASLES OUT OF THE POPULATION, THOUGH, BECAUSE IT'S SO INFECTIOUS, YOU NEED EXTREMELY HIGH IMMUNIZATION RATES ON THE ORDER OF 95% OR SO. AND I SHOULD SAY, I'M NOT AN INFECTIOUS DISEASE DOCTOR. SO I'M NOT INCREDIBLY WELL VERSED IN THOSE NUMBERS. BUT IT'S IT'S APPROXIMATELY THAT. SO SO IF THERE ARE RECENTLY AND ACTUALLY NOT SO RECENTLY, YOU KNOW, GETTING AN IMMUNIZATION IS IN INVASIVE. THERE'S A NEEDLE. IT GOES INTO YOUR ARM. AND THERE'S HAS ALWAYS BEEN A FEW FOLKS WHO HAVE BEEN HESITANT. AND WHEN SOME OF THESE DISEASES THAT WE HAVEN'T SEEN IN A WHILE ARE GONE FOR A WHILE, THEN PEOPLE CAN QUESTION WHETHER OR NOT IT'S IMPORTANT TO BE IMMUNIZED. AND THEN IF YOU HAVE BODIES OF PEOPLE WHO AREN'T IMMUNIZED, THEN THAT CREATES A PLACE WHERE SOMEONE CAN BRING IN MEASLES INTO THE COMMUNITY AND THEN IT CAN SPREAD. YEAH. AND WE'VE SEEN AN ANTI I THINK YOU ALLUDED TO THAT. THE ANTI-VAX. UH MOVEMENT FOR LACK OF BETTER WORDS. AND THAT'S PROBABLY I WOULD THINK CONTRIBUTED TO SOME OF THIS. WELL IT CERTAINLY CONTRIBUTED. THERE'S FOLKS WHO HAVE UH RELIGIOUS OBJECTIONS. YOU KNOW, THERE'S, THERE'S PEOPLE WHO ARE IN COMMUNITIES THAT THAT MIGHT, UH, THAT MIGHT HAVE SOME INJECTION, SOME OBJECTIONS TO IT. UM, AND ALSO, YOU KNOW, WE FORGET IS A IS A COMMUNITY. SEE HOW SICK YOU CAN GET FROM IT FOR MEASLES. WE THINK OF IT AS A CHILDHOOD ILLNESS. YOU GET SPOTS AND THEN AND THEN YOU GET OVER IT. BUT ACTUALLY IT'S IT HAS A VERY HIGH COMPLICATION RATE. UM, YOU KNOW, 1 IN 1000 FOLKS WILL HAVE COMPLICATIONS THAT IT CAN INCLUDE ENCEPHALITIS, WHICH IS A AFFECTING THE BRAIN. THAT MIGHT NOT SOUND A LOT, BUT, YOU KNOW, THERE'S. 300,000 PEOPLE IN CINCINNATI OR SO. SO THAT'S THAT'S A LOT OF PEOPLE WITH WITH THAT. AND, YOU KNOW, FIVE OUT OF A THOUSAND, UH, CAN EVEN GET A VERY SEVERE FORM THAT CAN BE, UH, THAT CAN BE FATAL. SO I THINK YOU GET EVERYONE'S ATTENTION WHEN YOU SAY IT'S TEN TIMES. OH, YEAH, WORSE THAN COVID. YEAH, YEAH. ALL RIGHT. WE'RE GOING TO TAKE ANOTHER BREAK AND THEN COME BACK AND TALK MORE HEALTH WITH DOCTOR GRANT. MUSKINGUM. BACK NOW WITH DOCTOR GRANT BACK NOW WITH DOCTOR GRANT MUSSMAN. THE CINCINNATI HEALTH COMMISSIONER. I COULD HAVE STARTED AT THIS POINT, AND I SHOULD HAVE TO JUST GIVE A LITTLE BACKGROUND ABOUT THE CINCINNATI HEALTH DEPARTMENT. PEOPLE KNOW THAT IT EXISTS, BUT TALK A LITTLE BIT ABOUT WHAT YOU DO. SURE. ABSOLUTELY. CINCINNATI HAS ONE OF THE OLDEST HEALTH DEPARTMENTS IN THE IN THE STATE. I A LOT OF THE. SO COLUMBUS HAS THEIR OWN CLEVELAND HAS THEIR OWN. MOST OF THE HEALTH DEPARTMENTS ARE ORGANIZED AT THE AT THE COUNTY LEVEL, AND WE'RE A LOCAL HEALTH DEPARTMENT. SO THE CDC CREATES, UH, YOU KNOW, ADVICE AND ADVISORY AND, AND POLICY. UH, PRODUCTS. AND THEN THE, THE STATE, THE STATE DEPARTMENT OF HEALTH, OHIO DEPARTMENT OF HEALTH RUN US OR SETS POLICY FOR OHIO. SO AND THAT'S WHO THE LOCAL HEALTH DEPARTMENTS WORK WITH. WHENEVER SOMETHING SOMETHING IS OCCURRING OR WHO WE FOLLOW FOR POLICY AND WHAT WE DO, WE WE DO A NUMBER OF THINGS. WE. SO FROM A PUBLIC HEALTH SIDE, WE ENSURE THAT RESTAURANTS ARE ARE, UH, SANITIZE WE WE LOOK AT, UM, RETAIL FOOD ESTABLISHMENTS. WE DO THINGS LIKE INSPECTING CLOSED LANDFILLS. WE MAKE SURE THAT IT NOT NOT VERY MANY PEOPLE HAVE, UM, UH, HAVE SEPTIC SYSTEMS IN THE CITY, BUT WE'LL LOOK AT THOSE, TOO. UH, THOSE ARE A BIGGER ISSUE FOR SOME OF OUR FRIENDS IN DIFFERENT COUNTIES. UM, WE ALSO HAVE COMMUNITY HEALTH WORKERS AND A COMMUNITY, UM, PROGRAM THAT DO THINGS LIKE GO INTO, UH, MEET WITH EXPECTANT MOTHERS TO MAKE SURE THAT THEY'RE CONNECTED TO RESOURCES SO THAT THEY, YOU KNOW, TO HELP REDUCE THE INCIDENCE OF PREMATURITY AND MAKE SURE THAT BABIES ARE HEALTHY. UH, WE WE HAVE A EPIDEMIOL ALLERGY DEPARTMENT THAT TRACKS, UH, INFECTIOUS DISEASE AND OTHER PROBLEMS, UH, FROM AN EPIDEMIOLOGIC ALL LOOKING AT DISEASE PROGRESSION SIDE SAINTS. AND WE HAVE A INFECTIOUS DISEASE PROGRAM THAT THEY WORK WITH VERY CLOSELY. AND THEN WE HAVE SOMETHING REALLY UNUSUAL FOR A HEALTH DEPARTMENT. WE HAVE A SET OF CLINICS, UM, OR WE CALL IT'S A FEDERALLY QUALIFIED HEALTH CENTER, IS THE PROGRAM THAT WE OPERATE UNDER TO TO HAVE CLINICS. AND WE SEE ABOUT 40,000 PATIENTS A YEAR. WE'VE GOT SIX COMMUNITY LOCATIONS. WE'VE GOT 13 SCHOOL BASED HEALTH CENTERS, AND WE HAVE DENTAL SERVICES IS UH, UM, ADULT MEDICINE, PEDIATRICS, WOMEN'S HEALTH. AND THIS WOULD BE FOR VISION. THIS WOULD BE BE FOR FOLKS WHO MIGHT NOT HAVE ANY KIND OF INSURANCE. OR WOULD THEY NEED SOME KIND OF INSURANCE? UH, WELL, IT'S ANYBODY OKAY. BUT BUT WE FOCUS ON FOLKS WHO HAVE PUBLIC INSURANCE. OKAY. WHO OR WHO ARE UNINSURED AND HAVE DIFFICULTY FINDING ACCESS TO CARE. WOW. I WANT TO GO BACK TO THE TO THE RESTAURANTS BECAUSE I THINK PEOPLE CAN RELATE TO THAT. YOU KNOW, WHERE EVERYONE EATS OUT HOW HOW OFTEN ARE THOSE INSPECTIONS DONE? AND ARE THEY RANDOM? UH, WE DO THEM EVERY YEAR, SO RESTAURANTS NEED TO BE INSPECTED AND CERTIFIED ANNUALLY. UM, IT'S A IT'S A HIGH VOLUME PROGRAM. WOW. UM, I ALSO WANT TO GO BACK TO JUST THE HEALTH OF THE NEIGHBORHOOD. YOU AND I WERE TALKING ABOUT. UH, YOU KNOW, SOME NEIGHBORHOODS DON'T HAVE ACCESS TO, LIKE, A GROCERY STORE. WE. IT'S AMAZING THAT WE'RE SAYING THAT IN THE YEAR 2024, THAT A NEIGHBORHOOD MIGHT NOT HAVE A FULL SERVICE GROCERY STORE, BUT THAT IS GOING TO IMPACT THAT TOP LINE THAT WE TALKED ABOUT EARLIER IN TERMS OF LIFE EXPECTANCY. YEAH, WE KNOW THAT FOOD INSECURITY, UH, CONTRIBUTES ROOTS TO A LOT OF CHRONIC DISEASES AS MEDICINE. NOW IN THE UNITED STATES, MOST OF OF WHAT YOU DEAL WITH IS A IS A PHYSICIAN HAS TURNED INTO CHRONIC DISEASES. THAT'S NOT NEW. IT'S IT'S BEEN DECADES IN THE MAKING AND FOOD INSECURITY CONTRIBUTES TO, UH, PREMATURITY WHICH CONTRIBUTES TO INFANT MORTALITY, UH, CARDIOVASCULAR DISEASE, DIABETES, ALL THOSE DIETARY CHOICES. I WANT TO SHARE WITH YOU SOMETHING THAT I KNOW YOU'RE FAMILIAR WITH. THIS CAME OUT FROM THE AMERICAN LUNG ASSOCIATION, CINCINNATI RANKS 22ND MOST POLLUTED CITY IN THE UNITED STATES. YOU KNOW, THEY SAY IF YOU GET A GOOD HEADLINE, IT'LL GRAB PEOPLE'S ATTENTION. WELL, OBVIOUSLY THAT GRABBED MY ATTENTION. THE 22ND MOST POLLUTED. WHAT'S WHAT'S LEADING TO SOMETHING LIKE THAT? YEAH. SO I THINK I THINK WE'RE REALLY STARTING TO COME BACK TO ACTUALLY OUR HEALTH DEPARTMENT FOR A LONG TIME HAS LOOKED AT AIR POLLUTANTS AS, UH, AND I THINK THERE'S A LOT OF THAT BECAME CLEANER, UH, HEALTH DEPARTMENTS DID LESS OF THAT. BUT WE'RE REALLY STARTING TO COME BACK TO THE QUALITY OF OUR AIR AND HOW IT AFFECTS HEALTH. AND IT CAN DRIVE A LOT OF DISEASES. PNEUMONIA, ASTHMA, LUNG CANCER, THE, UM, AND AND WHO KNOWS WHAT ALL ELSE. ONE OF THE THINGS WE'RE LOOKING AT CLOSELY IS PARTICULATES. SO JUST REALLY SMALL PARTICLES FROM, YOU KNOW, DIRTY EXHAUST OR OR IT'S TYPE OF POLLUTION. AND WE ARE IN THE MIDDLE OF A PROGRAM WORKING WITH THE UNIVERSITY CITY OF CINCINNATI TO SET UP AIR QUALITY MONITORING AROUND THE CITY. AND, AND LOOK AT PARTICULATES. YEAH, THAT'S, THAT'S THAT WILL BE GOOD. AND TO IT'LL BE INTERESTING TO SEE AND I WOULD HOPE THAT THIS WOULD THESE NUMBERS WOULD CHANGE. BUT THAT'S THAT'S AGAIN CONCERNING. UH NO QUICK FIX BUT VERY CONCERNING. ALL RIGHT. WE'RE GOING TO TAKE ANOTHER BREAK AND THEN WRAP THINGS UP WITH DOCTOR BRANDT. MUSSMAN. WELL COME BACK. WELL COME BACK. A FASCINATING CONVERSATION WITH THE HEALTH COMMISSIONER OF CINCINNATI, DOCTOR GRANT MUSSMAN. THERE ARE SO MANY ISSUES. UH, OBVIOUSLY ONLY ONE THAT WE DON'T WANT TO LEAVE OUT IS, UH, STDS. AND AND SOMETIMES I THINK PEOPLE THINK THESE THINGS GO AWAY, BUT THEY REALLY DON'T. AND THERE'S A CHALLENGE THAT I KNOW YOU'RE CONFRONTED WITH ALL THE TIME. TALK ABOUT WHERE WE ARE AS A CITY WITH ADDRESSING ISSUES OF STDS. YEAH. SO IT CAN BE CHALLENGING BECAUSE IT'S IT'S HARD. YOU KNOW, ONE OF THE FUNDAMENTAL PROBLEMS WILLIAMS IS, UH, STIGMA AROUND IT AND ACCESS TO CARE AND ALL A LOT OF SOCIAL THINGS GO IN THERE AS WELL. UM, UH, IT CAN BE, UH, YOU KNOW, DRUG USE IS AN EXAMPLE, UH, THAT YEAH. SO MANY THINGS. YEAH. IT'S REALLY SO MANY THINGS. IT'S A THE COMPLEXITY OF IT. UH, YOU KNOW, FORTUNATELY THERE'S A, A DRUG TASK FORCE AND I WOULD IMAGINE THAT YOU'RE WORKING WITH THEM TO, TO ADDRESS THE HEALTH CONCERNS HERE LOCALLY. YEAH. SO WE, WE DO WORK WITH THE, WITH THE DRUG TASK FORCE. UM, MY COLLEAGUE IN THE COUNTY, GREG KESTERMAN, IS MUCH MORE INVOLVED THAN WE HAVE BEEN. AND WE TEND TO WORK WITH HAMILTON COUNTY A LOT ON IT. UH, BECAUSE THEY, UH, THEY HAVE HAD SOME GRANT FUNDING AND SOME EXPERTISE THAT WE HAVEN'T HAD. AND SO WE COLLABORATE, UH, A LOT WITH BOTH THE COUNTY AND WITH THE DRUG TASK FORCE. AND I WAS GOING TO ASK, YOU KNOW, I KNOW EVERYONE KNOWS ABOUT THE CDC. AND THEN WE HAVE OUR STATE HEALTH DEPARTMENT. DOES IT REALLY RUN THAT COURSE? YOU KNOW, CDC, STATE HEALTH DOWN TO THE COUNTY LEVEL, DOWN TO THE CITY LEVEL? IS THAT THE. YEAH, YEAH, I THINK WE SAW THAT WITH COVID A LOT. THE CDC CAN, YOU KNOW, WOULD PUT OUT, UH, GUIDELINES AND INTERPRETATION AND IMPLEMENTATION OF THAT. WE SAW VARIATION DIFFERENCES BETWEEN HOW DIFFERENT STATES WERE APPROACHING THAT. AND THAT'S BECAUSE IT'S REALLY THERE'S NO OBLIGATION TO FOLLOW THE CDC GUIDELINES. UH, WELL, I'M NOT A LAWYER. I DON'T I DON'T KNOW. YEAH. OKAY. BUT NORMALLY HE IS PRACTICAL TO FOLLOW THOSE GUIDELINES. BASICALLY GENERALLY MAKES A LOT OF SENSE. YEAH, YEAH, YEAH. SO SO IF YOU HAD TO AS WE WRAP THINGS UP, IF YOU HAD TO GIVE ADVICE TO FOLKS, UH, WE KNOW THAT EXERCISE IS IMPORTANT. YOU KNOW, EATING RIGHT. AND IMPORTANT JUST AS A DOCTOR, GIVE SOME SOME FINAL TIPS TO, TO FOLKS JUST TO LIVE A HEALTHIER LIFE. UM, BECAUSE THAT'S IMPORTANT. BOY, THAT IS THAT IS A BIG TOPIC, ISN'T IT? UM, YOU KNOW, IN TERMS OF WHAT'S MODIFIABLE, LIKE, WHAT CAN YOU CHANGE A LOT OF THINGS WE CAN'T CHANGE. SOME PEOPLE HAVE GENETIC PREDISPOSED ADDITIONS TO THINGS LIKE CANCERS OR HEART DISEASE. AND AND YOU CAN'T CHANGE THAT. UH, IT CAN BE DIFFICULT BUILT TO CHANGE DIET BECAUSE A LOT OF THAT IS DRIVEN BY WHAT YOU HAVE ACCESS TO AND WHAT YOU DON'T. AND SOME PEOPLE MAY HAVE TO HAVE A HARDER TIME TO EAT HEALTHIER, BUT CERTAINLY IT'S SOMETHING THAT IT DESERVES. A LOT OF THOUGHT TO, TO THINK ABOUT EATING HEALTHY, A BIG ONE IS SMOKING. SMOKING, UH, IS IS IS BAD FOR YOU. IT TURNS OUT. BUT IT IT CAUSES A LOT OF PROBLEMS. IT CAUSES A LOT OF PROBLEMS WITH HEART DISEASE. IT CAUSES A LOT OF, UM, CAR OTHER CARDIOVASCULAR PROBLEMS BEYOND THE OBVIOUS LUNG DISEASES AND LUNG CANCER AND DIFFICULTY BREATHING. UM, SO MY ADVICE WOULD BE, DON'T SMOKE. TRY TO TRY TO EAT RIGHT AND KEEP MOVING. THE EXERCISE PART SIZES IS REAL COURTIS GOOD. YEAH, YEAH. AND PEOPLE CAN ADD, UM, UH, VISIT THE HEALTH DEPARTMENT OR GO TO THE WEBSITE WHERE THE CITY'S WEBSITE IS. THERE'S SO MUCH INFORMATION ON THERE. SOME OF THE STUDIES THAT WE'VE TALKED ABOUT, IN ADDITION TO SOME OF THESE TIPS THAT YOU'VE YOU'VE GIVEN AS WELL. YEAH, WE WE DO HAVE A LOT OF INFORMATION ON OUR WEBSITE. AND I THINK YOU'RE GOING TO PUT THAT UP. YEAH. UM, THE OTHER THING I WOULD SAY IS IF THERE'S AN INFECTIOUS DISEASE OUT THERE THAT HAS A FATALITY RATE, YOU SHOULD THINK ABOUT GETTING VACCINATED FOR IT. YEAH. BECAUSE THAT'S ANOTHER THING YOU CAN DO THAT'S MODIFIABLE. UH, IN LONG. COVID'S A GREAT EXAMPLE OF THAT. SO UM, WE DON'T LIKE TO THINK ABOUT COVID ANYMORE BECAUSE IT WAS TERRIBLE. UM, BUT BUT PEOPLE ARE STILL GETTING COVID. PEOPLE AND IT'S, IT'S MANY FEWER THAN THERE WERE. THANK GOODNESS. BUT LONG COVID IS STILL A THING OUT THERE. AND THE ONE THING YOU CAN DO THAT'S MODIFIABLE FOR THAT IS GET YOUR COVID VACCINE. YEAH. WELL, THANK YOU VERY MUCH. VERY INTERESTING CONVERSATION. AND I KNOW IT'S BEEN HELPFUL TO A LOT OF PEOPLE. WELL THAT DOES IT FOR THE PROGRAM TODAY. THANKS FOR JOINING US. I'M CURTIS FULLER I'LL SEE YOU NEXT TIME FOR ANOTHER EDITION OF LET'S TALK CINCY.