E14: From Outbreaks To Equity- Commisioner of Health Dr. Manisha Juthani

A single typhoid fever case in New York City set a young physician on a path that now shapes health policy for an entire state. We sit down with Dr. Manisha Juthani, Connecticut’s Commissioner of Public Health, to trace the unlikely route from outbreak sleuthing and COVID press briefings to a statewide strategy that blends infectious disease vigilance with relentless pursuit of equity.

We dig into the partnership between the Department of Public Health and the Mashantucket Pequot Tribal Nation, exploring how mass vaccination, shared infrastructure, and government-to-government collaboration built momentum that continues today. Dr. Juthani explains why a top health ranking can mask deep disparities, and how the state plans to reduce gaps in heart disease, cancer, diabetes, and dementia through community-driven prevention, better access in rural and rural-adjacent areas, and a stronger public health workforce. She outlines new training pipelines, the Rural Health Transformation Grant with tribal set-asides, and long-term postings aimed at stabilizing care where it’s needed most.

We also tackle the fragile foundation beneath public health—heavy reliance on federal funding—and the push to unify DPH communications so people hear consistent, memorable messages across cancer screenings, tobacco cessation, and vaccination. From modernizing drinking water systems to protecting herd immunity—Connecticut reached 98.7% measles vaccination among kindergartners—Dr. Juthani makes the case that preparedness and chronic disease work must advance together. The result is a clear, practical playbook for building trust, closing gaps, and staying ready for whatever arrives next.

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Transcript

SPEAKER_00 0:03

Hello, Dr. Jutani. Welcome.

SPEAKER_01 0:05

Thanks for having me.

SPEAKER_00 0:07

It's a pleasure having you. I've seen your and uh felt your work throughout Connecticut for the last so many years, and it's great to actually get a chance to speak with you in person, uh, virtually, of course. Hopefully, we'll have you visit Mash and Tucket Pequard Tribal Nation one of these days.

SPEAKER_01 0:24

I would love to do that.

From Typhoid Case To Public Health Calling

SPEAKER_00 0:26

Excellent. So, Dr. Jutani, uh you have an illustrious career. What uh Pequad Healthcare, you know, just as a quick background, is the Tribe's healthcare arm. And uh we really pride in working closely with uh both local, regional, and state partners in uh advancing health. And uh, you know, you're clearly one of the role models for many in public health. So if you wouldn't mind uh starting with sharing your own personal journey into public health, how did you end up being the commissioner at the state of Connecticut?

COVID Pressers And Becoming Commissioner

SPEAKER_01 1:00

Well, thanks for that question. You know, my journey really goes back to the roots of my interest in medicine, and I'll start with a brief anecdote there. When I started medical school, I was always intrigued by infectious diseases, prevention, and I ended up deciding to do internal medicine residency and did an assistant chief residency. And during that time period, I was a third-year resident at Cornell, and we had a case of an 18-year-old student, college student, who had not traveled anywhere who presented with typhoid fever. And it was unusual to have somebody who had never traveled anywhere in New York City to develop this. And the case was reported to the New York City Health Department, and in their investigation, they identified other cases that had occurred in the surrounding New York area, and they ended up tracking it all back to a fast food restaurant in Queens where one of the restaurant workers was not using proper hand hygiene, had been chronically colonized with salmonella typhy, and ended up infecting many people in the New York City area. And that was the most fascinating thing to me to see that intersection of infectious diseases and public health. I went on to then subspecialize in infectious diseases fellowship, uh, which I did at Yale. And that's when I first came to Connecticut in 2002 and ran the fellowship program, did research, and it was during the COVID-19 pandemic when I was first tasked with helping our hospital get up to speed and be able to help care for all the COVID patients that were coming in. And in the second wave of the pandemic, when indoor dining had been reopened and we were seeing more cases, and I was seeing patients who never left their home but whose family members had gone to restaurants and bars were now becoming my patients. And in the context of that, I signed on to a letter complaining to the governor about having indoor dining open. He then proceeded to ask to meet with all of us who had signed this letter, and eight of us had the opportunity to meet with him. And from there, he liked the stories that I shared, asked me to join a press conference on COVID-19 that he was holding three times a week. And six months later, they asked me to be the commissioner of the health department. And so it is a very surreptitious and not planned road to public health. But I tell you the first story because it really shows and showcases why my interest in public health and my interest in infectious diseases go back to the very roots of my time in medicine. Yeah. And 25 years later, I am commissioner of the health department.

SPEAKER_00 4:02

What a what a wonderful journey. Um, and obviously it reminded me of Jon Snow in London and the Broad Street pump, right? Uh, the the famous, infamous outbreak of cholera and how you know the roots of public health have always been linked to infectious disease, even if we have more non-communicable diseases uh taking more attention these days. So thank you for sharing that journey, Dr. Jutani. And it and I was as I was reviewing and preparing for this interview, it struck me that you know our paths crossed briefly, perhaps. Um, I joined New York Weil Cornell in 2002. Uh, just when I think you joined Yale for your fellowship, I came from Connecticut to uh Paisent House, Upper East Side, to do my pulmonary critical care with Ron Kristal and my co-fellow was Dana Zapetti. You may have even heard or seen her.

SPEAKER_01 4:59

We were great friends and we were residents together. She was my intern at one point. So uh yes, our roads cla crossed just as I was coming to Connecticut, you were going to New York.

Partnerships With Tribal Nations

SPEAKER_00 5:12

Incredible. Wonderful story. And uh Connecticut is very fortunate to have you in that critical role uh through the pandemic. And uh, you know, obviously during the pandemic, the Mashantucket Pequot tribe um did its part to be a good steward, good partner. Um so we work closely with both Ledge Light Health District and also Uncas Health District, but more so at the state uh DPH level, uh Dr. Deidre Gifford, um, you know, uh we forged a working relationship, government to government, and we had one of the largest mass vaccination sites at the uh resort right here in Mashantucket. So we continue to, you know, look for opportunities to collaborate, to bring Connecticut. And by the way, congratulations. Under your watch, Connecticut was named the fourth healthiest state just recently. So uh obviously the game is on. How might we get to number one now, Dr. Jutani?

Fourth Healthiest State, Unequal Outcomes

SPEAKER_01 6:12

Well, you know, thank you for bringing up so many of the ways that we've partnered to date, but I really see our partnership needing to only grow going forward. And there's several reasons for that. You know, as you mentioned earlier, infectious diseases are the root of all public health interventions. That's where it starts, because those diseases are usually acute, they can be deadly, they are what determine the speed with which a disease can move through a community, whether it be through clean drinking water, whether it through through whether it be through a communicable disease like COVID-19, and we so appreciate the collaboration in sort of what you shared on the max vaccination clinics.

SPEAKER_00 6:57

Yeah.

Chronic Disease Burden And Equity

SPEAKER_01 6:58

But as we but as we look forward, you know, I do worry about a slip back in our prevention efforts in infectious diseases, especially right now when we talk about funding cuts, when we talk about changes in vaccination guidelines. But one of the things that we know is that many of our chronic diseases do have a high prevalence in our tribal nations. Yes. And although we are the fourth healthiest state in the country, and I am proud of that, but one of the things that I really do struggle with is that for all the benefits that we have as a relatively wealthy state and a relatively healthy state, our disparities within the state are quite stark and quite dramatic. And this is where I look to continue partnering with the tribes because I do think we have more work that we can do here. If we think about some of the most deadly diseases that impact adults, whether it be heart disease, cancer, diabetes, and other metabolic diseases, Alzheimer's diseases, and other dementias, these four things occupy so much of the healthcare delivery system. And certainly our tribal members do have high incidence rates of each of these diseases. And so I do see great opportunity for us to collaborate further to be able to help reduce those disparities within our state and make our fourth healthiest state status more equitable throughout the state.

Building The Public Health Workforce

SPEAKER_00 8:41

Completely agree with you. And uh, you know, at the tribal nation, similar to many other organizations and uh, you know, um jurisdictions, we face a challenge around, you know, staffing as well, uh recruiting, retaining talent, especially in public health. How do you see the current state and the future of public health workforce in Connecticut?

Rural Health Transformation Grant

SPEAKER_01 9:05

We are definitely challenged in this way. We had an infusion of funds with the public health infrastructure grant a few years back, and that would enabled us to help push funding out into our local health departments and districts who were able to use those funds to hire up additional staff. We've been able to put a lot of that funding into our educational systems throughout the state, whether it be in the community college level to increase the pipeline of workforce into public health, whether it be in professions such as sanitarians, others ensuring clean drinking water, or whether it be in people getting masters in public health and degrees that can help them be epidemiologists and other higher level data scientists. So I do think we've done some things over the last several years that will continue for another couple of years through an infusion of funding from the federal government. Now, one of the Go ahead, please. One of the other things that we just found out that we are receiving funding for is the Rural Health Transformation Grant. And I do think that our tribal nation will benefit from that because there are specific set-asides within that grant that are going to support specifically public health, health care, workforce in the tribal nation. So I'm hopeful that there will be some infusion of support and funding from there. I also think that part of that grant, what we are looking to do is also increase spots for practitioners who will work in areas of the state that are rural, and they have to make a five-year commitment to doing that. So it's not going to solve everything. Right. But it at least it is some sort of infusion to be able to help support getting people into work in some of the more rural areas of the state and then sustain that work there.

SPEAKER_00 11:09

Agreed. And I think you know that that focus on um reducing disparity that you mentioned earlier is clearly going to help the entire citizenry of Connecticut. When we design a product or a service that is more inclusive and meant to serve the unmet needs, the rest of us also benefit from that.

SPEAKER_01 11:30

So I can always echo that.

Small State, Real Rural Barriers

SPEAKER_00 11:34

And at MPTN, we were uh we were very fortunate to have a plan in place um before the rural health transformation program became a reality, so that we were able to collaborate with uh our state partners and present uh a model, so to speak, of Mashantucket uh rural health. And it'll be an interesting, you know, real-world deployment of uh you know human resource, human capital that is enabled by technology, uh, so that we can bring more services, uh better access to care in certainly the tribal nation, but also in communities that are rural or rural adjacent. Um and as you as you know, there's severe pressure on uh you know the state Medicaid participants and beneficiaries, both access points and such. So we look forward to actually you know working closely with uh our partners of the state to bringing that model that hopefully is much more sustainable in the long run.

SPEAKER_01 12:39

Yeah, and I think that we are a relatively small state geographically, and so to your point, any investment that you make in one area is going to support many more people in that area. And that has been one of the challenges, actually, even in a state like Connecticut, is that because we are not as big as some of the other states and other areas of the country, it is often perceived that we don't have that many rural areas, but in fact we do. And the needs are the same. And yes, it may be that a hospital is within an hour's distance and maybe not three hours distance by drive, but that doesn't mean that for any person who is in distress, an hour is a long way to go.

National Challenges And Funding Fragility

SPEAKER_00 13:28

Agreed. And also, I want to congratulate you on your uh appointment recently as the president of the HASTO. Congratulations. And in in your new role, uh, as you have compared notes uh uh across the nation with your other colleagues, have you found any significant, you know, unusual challenge that Connecticut faces, or is it a universal pain that all states are going through?

Unifying DPH Messaging And Strategy

SPEAKER_01 13:57

Every state has its own flavor of challenges based on the politics of your state, the geography of the state, the constituents in your state, the local issues that may be challenging to the health department. But the thing that is so interesting in the four years that I've been in this job going on my fifth year, and then having been elected president of the Association of State and Territorial Health Officials, ASTO, is how much we actually all have in common. We all face the same challenges, the first and foremost of which is that as a United States of America, we do not have universal health care. If you keep that as your underlying core problem that we have, what that creates is pockets of people that do not have access to health care or preventative health. And then when you don't have access to preventative health, you have a patchwork of public health, which is supposed to provide that public, that preventative health in many situations throughout this country that has largely been funded by the federal government. 80% federal funding, 20% state dollars. And those 20% of state dollars are very, very discreetly marked so that we have state money to purchase vaccines to prevent certain cancers, breast, cervical, colon, and that's only for underserved, underinsured, and uninsured individuals. Um, provide certain safety nets uh for patients with HIV or prevention of HIV, STDs, tuberculosis, hepatitis B or A, for example, in outbreak settings. But beyond that, we don't have any state investment in public health, and we're dependent on the federal government for that. And so when you have fluctuations in prioritization of public health at the federal level, that really puts you in a very, very vulnerable position on doing important work on so many of the other topics that we talk about. All of our clean drinking water is funded through the federal government. All of our disease prevention efforts, other than the ones I've described, are funded by the federal government. Any of our chronic disease prevention efforts on heart disease, you know, other cancer-related work, diabetes, Alzheimer's, all funded through the federal government. So you think about the vulnerability that all states have, we actually have much more in common on our vulnerabilities and our priorities than we have differing.

SPEAKER_00 16:45

I see. That's certainly the balance between uh federal trust responsibility versus self-sufficiency and uh being almost sustainable. Uh, that's always a tension there, at least for the tribal nations. And we we continue our journey in exercising tribal sovereignty to um you know build capacity locally so that we still rely on and expect federal trust and treaty obligation to be met and fulfilled, but at the same time, put into place systems that uh are not critically endangered or or you know at risk if uh policy may have to change from time to time. It doesn't matter, right? So I I completely uh share your uh you know thoughts and concern there. So as you look forward to the next five years of Commissioner Giutani, what what's what are some of the big hairy aspirational goals that you have for Connecticut public health?

Tobacco Cessation And Community Relevance

Water Infrastructure And Trust

Guarding Immunization And Herd Immunity

SPEAKER_01 17:48

So one I would say is that right now we are in a period of transition. We don't know exactly where we're heading. However, whenever you have transition like that, you also have opportunity. And part of what I'm looking to do is see if we can streamline what we're doing, do it more coordinated, do it in a more systematic way, so that even within DPH, we don't have a lot of different siloed work, which happens because we are funded through these grant mechanisms. And so what we're looking to do is really create a unified voice of DPH, with especially on the side of communications and engagement with the community, that people know who DPH is, that when you see messaging coming out of DPH, it's not this one program or that one program or some other small program, that you get a consistent message coming out of the department. And that has taken a lot of work actually to centralize some of those efforts. So we hired a chief marketing officer and a larger communications staff. And as an example, I talked about all the different types of cancer prevention messaging that we may put out there. Well, we'd like to really have that be not just breast cancer prevention with a certain theme and colon cancer prevention with another theme. Really, it's about cancer prevention more broadly and really message accordingly so people can remember all these different things and screenings that they should be doing over the course of a year, over the course of a lifetime. Another example of that, and something that we're very focused on, is tobacco cessation. And I know this is something particularly that I've been looking at very closely because I look at smoking rates within our state, and particularly in the tribal nation, there are higher numbers there. And when I think about What are we going to do as a state to make sure we're actually getting our messaging to the right people who need it? We need to make sure that our messages are relevant and appropriate to the community that needs to hear it most. And so we have funding through the Tobacco Health Trust Fund. This is funding that was given to the state as part of a settlement with the tobacco companies. And there is money put aside for interventions in the community, but also for interventions into things like the quit line, which people can call and get engaged with to really go on a path to being able to quit. And this is a resource that is available to residents, and we're trying to make it more and more accessible so that people know about it and can actually try to tap into it. When I look at other areas, you know, I really want to make sure that we continue to utilize funding that we received through what was called the bipartisan infrastructure law that was passed under President Biden and so much funding putting into improving our drinking water systems throughout the state. And there are many areas, rural parts of our state, where there is just old infrastructure. And I really want to see that we're able to roll all that out so that for people who are using public water supply, turning on the water is something they can really trust and know that they can drink it safely. That is really a fundamental foundation of a developed society. And in the United States of America, we should be able to have that everywhere. I can't control that everywhere, but certainly trying to make that a reality for all of Connecticut is an example of something that we'd like to do. And then lastly, I would just say that I'm really working very hard to make sure that we don't backslide in our infection prevention interventions. We have been this year the most highly vaccinated state in the country as it relates to measles for kindergartners entering school. And we've had a rate of 98.7%. We had our first measles case in December of 2025. It was the first time in four years. It was a child who had traveled internationally, and we had no other cases in the state. That speaks to the fact that herd immunity works, and that we are very fortunate that we have high immunization rates in our state. So a lot of what we're doing on the infection prevention side is just making sure that we don't lose people who have understood the value of these prevention efforts and may be scared or confused or uncertain what to do with the messaging that they're hearing right now. Because if we can continue those efforts, we can really focus on the chronic diseases, which have gotten a lot of attention recently. But unfortunately, when the infectious diseases come back, you don't have time to deal with the chronic diseases because the infectious diseases tend to be more immediate, acute, and immediately life-threatening.

Preparedness, Lessons, And Closing Thanks

SPEAKER_00 23:20

Cannot agree with you more. It's not a matter of if, it's more a matter of when we'll have the next big pandemic. And uh, you know, um hopefully as a nation we have learned some lessons uh from the last one so that we are better prepared uh in both early detection, uh prevention, mitigation uh strategies, and then uh you know, building a community immunity through judicious use of uh uh immunization. So thank you again for your exemplary work, Dr. Jutani. And uh we stand ready to partner with uh the DPH here at MPTN. Thank you for your time.

SPEAKER_01 24:00

Thank you so much for having me, and I look forward to our continued partnership.

SPEAKER_00 24:05

Appreciate it. Have a great day.

SPEAKER_01 24:06

Okay, thank you, you too.