Public Health Practice
The "How" of successful public health programs
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The "How" of successful public health programs
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Politics has been called the art of the possible, and running a public health program can be accurately described in the same way.
In January of 2002, with the embers of the World Trade Center still burning, I was sworn in as New York City Health Commissioner. (In an archaic tradition, the cost of this was 15 cents, payable to the City Clerk.)
I had been running public health tuberculosis programs for more than a decade, but this was a much larger responsibility – one of the largest public health departments in the United States, with 6,000 staff and a budget of $1.6 billion per year. In May 2009, I was sworn in as Director of the US Centers for Disease Control and Prevention (no 15 cent fee that time). Based on 15 years of experience I * ten things I wish I had known before I held these two positions.
Get and disseminate good data. Data are the lifeblood of public health. With rapid information
flow, being first, credible, and correct is both increasingly challenging and increasingly important.
Do the hard stuff first. Success requires identifying aligned interests of partners, stakeholders, and the political and administrative leadership of a jurisdiction.
Find, fight, and win winnable battles. Look for important issues that are in the sweet spot – neither foregone conclusions, nor hopeless tilting at windmills. Don't expect to win them all – if you are, you're not choosing challenging enough issues.
Support and hire great people. Early in my career one of my mentors gave me the great advice that my job was to hire great people then to protect them from the ... flowing down from above.
Manage communicable diseases and environmental health. These are core public health issues, and if a health agency isn't able to keep them well managed, it will not be able to succeed at other key initiatives.
Do not cede the clinical realm. There's too large of a chasm between public health and clinical care. We need synergy. Public health can improve clinical care, and clinical care is essential for many public health goals.
Learn and manage the budget cycle. At the most basic level, the job of a health director is to get as large a budget as possible, and spend it as well as possible. There are seasons for budget initiatives, and cycles (emergencies, elections, etc.) when it becomes possible to obtain additional resources. Every well-conceptualized, well-written proposal eventually gets funded.
Manage the context. Effective communication with the public, political leaders, administrative directors, clinicians, and many others is importnat. Being able to state clearly and simply what a problem and a solution is makes implementing that solution much more feasible. Managing the context requires active engagement with communities in order to understand their values and perceptions.
Never surprise your boss. Most health officers are appointed by elected officials; in a good working relationship, elected officials will defer to the health officer on scientific and technical issues. Conversely, the health officer must not only respect that elected officials have the final say on policy issues but also recognize that they face pressures often invisible to the health officer. Providing advance warning of events or breaking news is essential to maintain a relationship of mutual respect and trust.
Follow core principles. These were highlighted by Dr. Walter Dowdle of the CDC:
Be a diligent steward of the funds entrusted to your agency.
Provide an environment for intellectual and personal growth and integrity.
Base all public health decisions on the highest quality scientific data, openly and objectively derived.
Place the benefits to society above the benefits to the institution.
Treat all persons with dignity, honesty, and respect.
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