Jan Malcolm wasn't afraid to be the heavy during the pandemic — urging people for months to reduce COVID-19 risks through mask-wearing, social-distancing and vaccination.
Not much has changed for her in retirement.
Minnesota's former health commissioner next week will give one of her first public addresses since stepping down, with an emphasis on the importance of post-pandemic lessons — even if people are ready to forget about COVID-19 now that the federal public health emergency has ended.
"We're all just beyond tired," she said. "I can certainly understand the desire on the part of policymakers and organizational leaders to just kind of want to close the door and move on and not dwell on the difficulties of the last few years. That would not only be a terribly lost opportunity, but really dangerous."
Malcolm's focus will be less on Minnesota's emergency response and more on the chronic disease levels in its population and the fragmented health system that left the state vulnerable in the first place. Her April 19 address is part of the first Whole Person Health Summit organized by the University of St. Thomas in St. Paul.
"Every single inequity that we know about and every single gap or dysfunction in the health care system ... was just exacerbated hugely by the pandemic," Malcolm said.
The summit is well-timed, because the pandemic revealed the consequences of poorer overall health and the need for solutions, said MayKao Hang, founding dean of St. Thomas' Morrison Family College of Health. COVID-19 death and complication rates were elevated among the same minority and low-income communities in Minnesota that can't afford the healthy foods and activities that help boost physical, social, mental and spiritual health.
"We saw that magnified over the course of the pandemic with what I would say were the fault lines of society showing," Hang said.
Adult obesity in Minnesota increased from 15% in 1999 to more than 30% in 2020 at the outset of the pandemic, according to federal heath surveys. The obesity rate then rose above 32% in 2021, despite some people's resolve to use downtime during the pandemic to improve their health.
"Some people, God bless them, got fit while working at home and learned how to cook and life is good," Malcolm said. "Others of us just sat at our computers for 18 hours a day and ruined our own health. And then there's the stress of course and just kind of the collective trauma — that's not an inappropriate word for what a lot of people experienced in so many ways."
While Minnesota's obesity rate is below the national average, it still set up the state for a harsher pandemic toll. Only 2,500 of Minnesota's roughly 15,000 COVID-19 deaths involved people younger than 65, but the majority had obesity or related conditions such as diabetes or hypertension listed on their death certificates as complicating factors.
Low-income Minnesotans were at particular risk, because they worked in service-oriented jobs that couldn't be done remotely and had higher rates of pre-existing health problems. Minnesota's obesity rate was 40% for adults with household incomes of less than $15,000 per year in 2021, but only 21% for adults with household incomes above $200,000.
Malcolm said one problem is that medical providers have historically been paid to treat the consequences of obesity and other health problems, rather than to prevent them. Insurers are gradually rewarding providers for keeping patients healthier and reducing medical costs, but Malcolm said community efforts are needed to help people afford healthy lifestyles that prevent problems in the first place.
Minnesota's Statewide Health Improvement Partnership has funded thousands of efforts to improve health, such as farmers markets in neighborhoods that lack access to fresh, low-cost healthy foods. But Malcolm said successes are hard to duplicate because there aren't additional sources of funding to expand them.
"We have all this good innovation and good work that never comes to scale because it's not really supported," she said.
Malcolm retired in January after a second term as health commissioner, having previously served under Gov. Jesse Ventura.
She said she needed the time after her very visible leadership of Minnesota's pandemic response, and to grieve the loss of her mother and spouse. But she is picking up volunteer roles, serving on the advisory board for the Morrison college, and wants to use the pandemic's lessons to improve the state's health and readiness if another one happens.
"I'm probably the last person everybody wants to hear from, kind of insisting that we can't just move on," she said, "but I think there are some urgent issues. And we've clearly seen the kind of interconnection between things" that result in better or worse health.