Episode #472 Undoing Decades Of Harm, With David Margolius, MD
- 1 hour ago
- 4 min read
On This Episode Of The Public Health Epidemiology Conversations (PHEC) Podcast
When Marketing Becomes a Public Health Crisis
Cleveland's smoking rate once topped 35 percent among adults, more than double the national average at the time. That number did not happen by accident. Dr. David Margolius explains how tobacco companies specifically targeted Black neighborhoods, low income communities, and youth with free menthol cigarettes once smoking rates began declining nationally. Dr. Huntley and Dr. Margolius dig into how naming that history publicly became the first step toward changing it.
From Exam Room to City Hall
Dr. Margolius spent years as a primary care physician in Cleveland neighborhoods hit hardest by the foreclosure crisis and systemic racism. He kept having the same conversations with patients about smoking, housing, and the stress of poverty. That pattern led him to Cleveland's Department of Public Health, where he now leads a team of over 150 people covering everything from restaurant inspections to lead abatement.
Building Coalitions That Actually Move Numbers
In just a few years, Cleveland's smoking rate dropped from 35 percent to 19 percent, and childhood lead poisoning rates fell from 18 percent to about 13 percent. Dr. Margolius walks through the coalition building, policy changes, and community partnerships that made that progress possible, and why he believes public health can no longer afford to stay invisible.
Why This Conversation Matters Beyond Cleveland
Whether you work in a city health department, a nonprofit, or a completely different community, this conversation offers a blueprint for approaching entrenched health disparities: understand the history, build partnerships beyond your own team, and stay visible about the difference your work is making.
About Our Guest
David Margolius, MD
Dr. David Margolius serves as the Director of Public Health for the City of Cleveland. In August 2022, he became the city's first physician Public Health Director in over 40 years, bringing a perspective shaped by years of caring for patients, leading teams, and addressing root causes of health disparities.
A Cleveland native raised in Shaker Heights, Dr. Margolius returned home after medical training to dedicate his career to improving the health of Cleveland residents. Before joining the City of Cleveland, he spent seven years at MetroHealth System as a primary care physician and administrator, including serving as Division Director of Internal Medicine.
Dr. Margolius earned his undergraduate and Doctor of Medicine degrees from Brown University. He completed his residency in internal medicine at the University of California, San Francisco, where he served as Chief Resident of Quality Improvement and Patient Safety. Today, he leads Cleveland's public health efforts with a vision of building the nation's most responsive, trusted, and impactful local health department.
Listen To This Episode Of The Public Health Epidemiology Conversations (PHEC) Podcast
Conversation Highlights
Structural racism shaped Cleveland's smoking crisis.
As national smoking rates declined, tobacco companies deliberately shifted their marketing toward poverty markets, Black communities, and youth, using tactics like free menthol cigarette giveaways that are now documented in the tobacco master settlement records.
Coalition building drove real, measurable results.
By reviving the Breathe Free Cleveland coalition and partnering with organizations like the Campaign for Tobacco Free Kids and the Northeast Ohio Coalition for Black Health, Cleveland cut its smoking rate from 35 percent to 19 percent in a matter of years.
Lead poisoning in Cleveland stems from housing, not water.
Unlike Flint, Cleveland's lead crisis comes from deteriorating lead paint in century old homes that have long been denied home improvement loans due to redlining, not from the water supply.
Renewed investment is changing outcomes for kids.
Through new home construction, demolition of unsalvageable properties, home improvements, and a rental inspection law, Cleveland's childhood lead poisoning rate dropped from 18 percent to about 13 percent in just a few years.
Clinical experience translates directly into public health leadership.
Dr. Margolius's years as a primary care physician gave him firsthand insight into the repeated challenges patients faced around smoking, housing, and poverty, insight that now shapes his approach to citywide policy.
Public health can no longer afford to be invisible.
Dr. Margolius argues that showing communities tangible results, not just working quietly upstream, is essential to building trust and support for public health work.
Local progress can inspire action anywhere.
Dr. Margolius's message to other communities facing similar disparities is straightforward: if meaningful change is possible in Cleveland, it is possible anywhere.
"We can push back. And that's one of the things that we've been trying to do." — Dr. David Margolius
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This episode includes an After the Mic bonus conversation available only to PHEC Podcast Community members.
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Public Health Consulting
DrCHHuntley LLC is a public health consulting firm that specializes in epidemiology consulting, supporting large nonprofit organizations in South Carolina, North Carolina, Georgia, Mississippi, and Florida that serve Black, Indigenous, and People of Color (BIPOC). We also provide nationwide public health consulting and epidemiology consulting support to BIPOC organizations across the United States.
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