Jan Malcolm reflects on tenure as health commissioner

Health Commissioner Jan Malcolm has been at the helm of the Minnesota Department of Health for a total of nine years under three different administrations.

For a third of that time, she led the state through an unprecedented pandemic.

Malcolm is one of several key members of Gov. Tim Walz’s cabinet that announced they will step aside on Wednesday. She says she plans to retire after a long career in public service.

Malcolm spoke with MPR News reporter Catharine Richert about her tenure and future plans.

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Use the audio player above to listen to the full conversation.

Why are you leaving MDH now?

Malcolm: The short answer to that is, at the end of a term and the beginning of a governor’s next term is the right time to turn over to new leadership. I didn't frankly imagine that I would have been in the job as long as I have, but with a pandemic, having come when it did, I was committed to staying through the first term, at the very least. Not that we're finished with the pandemic we're in much better shape and I think have solid plans going forward for continuing to manage the challenge.

How would you describe the department that you came into four years ago and the department that you are now leaving?

Malcolm: That’s a really good question. I mean, the Minnesota Department of Health is one of the finest state health departments in the nation, and our local public health agencies and the relationship that we have between state and local, it really is one of the strongest public health systems in the country. So I was thrilled to be able to come back.

And when I came back, it was sort of in a crisis around elder care concerns and some regulatory reforms needed in that end. So there was kind of stress in the department when I arrived about that particular issue. We worked really hard, we made some big improvements.

And then along came the pandemic. So there's no way to sugarcoat it. I mean, health care workers and public health workers have just been through a really, really difficult several years. So I think we're all really proud of the work we did for Minnesota and the results that we achieved, not perfect to be sure, but I think time will show that our performance fared really well, among other states. But there's definitely a lot of burnout and ongoing trauma, frankly, among the health care and public health workforce. So that is something we all need to work to fix.

I wanted to ask you about that. How did you keep your staff going through all this? And how did you keep yourself going through all of this?

Malcolm: You know, the honest answer, it was just the incredible depth of the mission commitment that public health folks have. At one point 80 percent of the entire health department was redeployed in some way to help with this response. And it was their commitment to doing the work that needed to be done that really sustained all of us through.

So on top of all the stress of managing through this pandemic and leading the state, there were lawmakers who wanted to fire you in the midst of doing that job. since you're on your way out and honesty is on the table. Did you ever think of just leaving?

Malcolm: No, I didn’t. It was it's just one of the sad things about the whole experience that it unfortunately did, you know, kind of become influenced by ideological differences. And I regret that I have always prided myself on having respectful and good, productive working relationships with legislative leaders in both parties in the health arena. And we kept doing good work, despite some of those tensions.

I will say I really do appreciate the legislative leaders I've had the privilege of working with. But yeah, that was, you know, having it become political, and personal. Just added to the difficulty of it and the injury that kind of happened and will take a little time to recover.

One predominant theme that I know I’m going to be thinking about for years to come when I look back on this period of my life, was just sort of that push and pull between keeping people safe and reopening businesses and schools and restaurants, all very important. I’m wondering, did you anticipate that there would be so much consternation around that question, even among members of the Walz administration? And are you happy with how your department was able to strike that balance?

Malcolm: Oh another great question. First, we have to absolutely acknowledge that the mitigation efforts — that was of necessity — were very broad attempt to limit transmission. That those had downsides to businesses and to kids learning in person. And nobody should minimize that those were real losses too.

What was unfortunate was the debating over the evidence. You know, this study says masks are dangerous, this study says there is no impact to restricting, you know, gathering sizes, and there were no common facts. So, yeah, I thought both at the state level, and I was with some local public health colleagues over the last few days and very personally for them living in their oftentimes very small communities.

Seeing the negative impacts of the business closures and so forth was really difficult. And I think there was from the governor's perspective. He always sort of stressed that his job was to try to have the best balance possible between protecting health and protecting well-being in the larger sense. I think the governor deserves a lot of credit for having gotten the balance pretty right, I think in terms of how our state fared on health metrics, but also on economic metrics. Which, again, it's not to diminish or minimize the negative impacts that so many felt, I hope we learn a lot of lessons from this.

So public health leaders spend a lifetime prepping for something like this. What surprised you about this real life pandemic, that you've had to lead the state through, compared to what you thought it would be like?

Richert: Managing outbreaks and managing public health emergencies is a core part of what we do in public health. And we're really good at most things that are sort of contained, you know, geographically or population-wise, or in time. You know, we have strong emergency preparedness plans and those plans just were not nearly sufficient for something of this duration and this scale globally.

I mean, this has never happened before that there's been an outbreak of this size, this long, across the whole world. At the same time. Even the 1918 flu pandemic was a rolling one, in any area. It was several months, not three years. But I think there's just a tremendous amount to learn from this that I really hope we will take seriously and build some more resilience into our public health system and our health care system to be able to deal with challenges that are larger.

We know that COVID is not over. But I'm wondering, what do you think is the biggest public health challenge facing the state as you leave?

Malcolm: Yes, COVID is not over. There are still four to 500 people every day in Minnesota in the hospital really sick with COVID. There are probably 20,000 people are in the state right now who are infected and hopefully having mild experiences.

But we don't even begin to know yet the ramifications of long COVID. So even COVID itself, I think is going to be a concern going forward. But the pandemic has also exacerbated so many other health conditions. You know, so many chronic conditions have gotten worse, because people haven't gotten the maintenance care and the screening and the management services that they've needed.

And things like mental health concerns have just continued. And substance abuse concerns have just continued to go up and up. So I think work on the behavioral health side, and work to try to get back to “OK, so where have we seen the biggest negative changes in health risk factors and chronic conditions?” and really direct some efforts to getting people caught up with needed services is really important.

So will you have a successor eventually? What’s your advice to them?

Malcolm: Wow. I mean, my advice is, this really is one of the premier state health departments and state local systems in the country. And we need to take these learnings and invest in strengthening that system. And I would say, you know, because of the pressures of the last few years, there is healing needed, that needs to be, you know, taken seriously that folks need time and need support to get back up to full speed.

And working to rebuild the workforce on the healthcare side and on the public health side. We've lost a lot of people.

You hinted at this earlier, but are you done working or is there another professional chapter ahead of you here?

What I envision is, you know, continuing to serve as a volunteer, and an advocate, but my intention is that this is it. For big full time jobs. I will be a happy volunteer going forward.

So it’s the day after your last day. What are you doing? What beach are you on?

No, I don't have any big vacations planned, but definitely, you know, some trips to see friends around the country. And I would imagine there are some naps, some naps and some catching up on streaming shows that I've missed.

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Audio transcript

CATHY WURZER: There will be a number of new people who will help Governor Tim Walz run state government in his second term. Several key members of Walz's cabinet are stepping aside, including Minnesota's Health Commissioner Jan Malcolm. After a long and distinguished career in public service, Malcolm is retiring. She became a familiar voice throughout the pandemic with daily calls updating the public during lockdown. She spoke with MPR News reporter Catherine Richert about her tenure and her future plans.

CATHERINE RICHERT: Commissioner Jan Malcolm has been at the helm of the Minnesota Department of Health for a total of nine years under three different administrations. And for a third of that time, she led the state through an unprecedented pandemic. Thank you so much for being with us today, Commissioner.

JAN MALCOLM: My pleasure. Thank you, Catherine.

CATHERINE RICHERT: Why are you leaving MDH now?

JAN MALCOLM: Well, the short answer to that is at the end of a term and the beginning of a governor's next term is the right time to turn over to new leadership. I didn't frankly imagine that I would have been in the job as long as I have this stretch.

But with the pandemic having come when it did, I was committed to staying through the first term at the very least. Not that we're finished with the pandemic, but we're in a much better shape, and I think have solid plans going forward for continuing to manage the challenge.

CATHERINE RICHERT: So how would you describe the department that you came into four years ago and the department that you are now leaving?

JAN MALCOLM: Wow. That's a really good question. I mean, the Minnesota Department of Health is one of the finest state health departments in the nation, and our local public health agencies and the relationship that we have between state and local-- it really is one of the strongest public health systems in the country, so I was thrilled to be able to come back.

And when I came back, it was sort of in a crisis around elder care concerns and some regulatory reforms needed in that end, so there was kind of stress in the department when I arrived about that particular issue. We worked really hard. We made some big improvements, and then along came the pandemic.

So there's no way to sugarcoat it. I mean, health care workers and public health workers have just been through a really, really difficult several years. So I think we are all really proud of the work we did for Minnesota and the results that we achieved-- not perfect to be sure, but I think time will show that our performance fared really well among other states.

But there's definitely a lot of burnout and ongoing trauma, frankly, among the health care and public health workforce, so that is something we all need to work to fix.

CATHERINE RICHERT: I wanted to ask you about that. How did you keep your staff going through all this, and how did you keep yourself going through all of this?

JAN MALCOLM: The honest answer is just that the incredible depth of the mission commitment that public health folks have. At one point, 80% of the entire health department was redeployed in some way to help with this response, and it was their commitment to doing the work that needed to be done that really sustained all of us through.

CATHERINE RICHERT: So on top of all the stress of managing through this pandemic and leading the state, there were lawmakers who wanted to fire you in the midst of doing that job. Since you're on your way out and honesty is on the table, did you ever think of just leaving?

JAN MALCOLM: No, I didn't. It's just one of the sad things about the whole experience that it unfortunately did kind of become influenced by ideological differences, and I regret that. I have always prided myself on having respectful and good productive working relationships with legislative leaders in of both parties in the health arena, and we kept doing good work despite some of those tensions.

I will say I really do appreciate the legislative leaders I've had the privilege of working with. But yeah, that was-- having it become political and personal just added to the difficulty of it and the injury that kind of happened and will take a little time to recover.

CATHERINE RICHERT: Yeah. One predominant thing that I know I'm going to be thinking about years to come when I look back on this period of my life was just sort of that push and pull between keeping people safe and reopening businesses and schools and restaurants-- all very important.

I'm wondering, did you anticipate that there would be so much consternation around that question, even among members of the Walz administration? And are you happy with how your department was able to strike that balance?

JAN MALCOLM: Boy, another great question. First, I would say we have to absolutely acknowledge that the mitigation efforts of necessity were very broad attempts to limit transmission-- that those had downsides to businesses and to kids learning in person, and nobody should minimize that those were real losses, too.

What was unfortunate was sort of the debating over the evidence. This study says masks are dangerous, and this study says there is no impact to restricting gathering sizes. And there were no common facts.

Yeah. I mean, I thought both at the state level and-- I was with some local public health colleagues over the last few days-- and very personally for them, living in their oftentimes very small communities, seeing the negative impacts of the business closures and so forth was really difficult.

And I think there was-- from the governor's perspective, I mean, he always sort of stressed that his job was to try to have the best balance possible between protecting health and protecting well-being in the larger sense.

I think the governor deserves a lot of credit for having gotten the balance pretty right, I think, in terms of how our state fared on health metrics, but also on economic metrics-- which, again, is not to diminish or minimize the negative impacts that so many felt. I hope we learn a lot of lessons from this, frankly.

CATHERINE RICHERT: Yeah. So public health leaders spend a lifetime prepping for something like this. What surprised you about this real life pandemic that you had to lead the state through compared to what you thought it would be like?

JAN MALCOLM: Well, yeah, managing outbreaks, managing public health emergencies is a core part of what we do in public health, and we're really, really good at most things that are sort of contained geographically or population wise or in time. We have strong emergency preparedness plans, and those plans just were not nearly sufficient to something of this duration and this scale globally.

I mean, this has never happened before, that there's been an outbreak of this size this long across the whole world at the same time. Even the 1918 flu pandemic was a rolling one. In any area, it was several months, not three years.

But I think there's just a tremendous amount to learn from this that I really hope we will take seriously and build some more resilience into our public health system and our health care system to be able to deal with challenges that are larger.

CATHERINE RICHERT: So we know that COVID is not over. But I am wondering, what do you think is the biggest public health challenge facing the state as you leave?

JAN MALCOLM: Well, I mean, yes. COVID is not over. There are still 400 to 500 people every day in Minnesota in the hospital really sick with COVID. There are probably 20,000 people are in the state right now who are infected and hopefully having mild experiences. But we don't even begin to know yet the ramifications of long COVID.

So even COVID itself, I think, is going to be a concern going forward, but the pandemic is also exacerbated so many other health conditions. So many chronic conditions have gotten worse because people haven't gotten the maintenance care and the screening and the management services that they've needed. And things like mental health concerns have just continued, and substance abuse concerns have just continued to go up and up.

So I think work on the behavioral health side and work to try to get back to-- OK, so where have we seen the biggest negative changes in health risk factors and chronic conditions? And really direct some efforts to getting people caught up with needed services is really important.

CATHERINE RICHERT: Yeah. So you will have a successor eventually. What's your advice to them?

JAN MALCOLM: Well-- wow. I mean, my advice is this really is one of the premier state health departments and state local systems in the country, and we need to take these learnings and invest in strengthening that system. And I would say because of the pressures of the last few years, there is healing needed that needs to be taken seriously, that folks need time and need support to get back up to full speed.

And working to rebuild the workforce is just-- on the health care side and on the public health side, we've lost a lot of people.

CATHERINE RICHERT: Well, you hinted at this earlier, but are you done working or is there another professional chapter ahead of you here?

JAN MALCOLM: Well, what I envision is continuing to serve as a volunteer and an advocate, but my intention is that this is it for big full time jobs. I will be a happy volunteer going forward.

CATHERINE RICHERT: So it's the day after your last day ATM. What are you doing? What beach are you on?

JAN MALCOLM: Yeah. No, I don't have any big vacations planned, but definitely some trips to see friends around the country. And I would imagine there's some naps-- some naps and some catching up on streaming shows that I've missed.

CATHERINE RICHERT: Commissioner Jan Malcolm, thank you so much for being with us. I wish you the best of luck.

JAN MALCOLM: My pleasure. Thanks, Catherine.

CATHY WURZER: I'm telling you. Those naps-- I love that. That was MPR News reporter Catherine Richert talking with Jan Malcolm who is the outgoing Commissioner of the State Department of Public Health.

Also leaving the Walz administration will be Public Safety Commissioner John Harrington and Education Commissioner Heather Mueller. Iron Range Resources and Rehabilitation Commissioner Mark Phillips is also stepping down. The governor has to fill vacancies at the Department of Revenue and Department of Labor and Industry.

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