The Practitioner aims to share with the student body the professional experiences of those in the field through a series of interviews and profiles. This year, SAC chose to highlight leaders who have implemented a socially responsible agenda in their public health work, or other work disciplines. Through the interviews, SAC hopes to provide students with a glimpse into the practical arena of these leaders in public health and social responsibility that so often remains unexplored prior to entering the field.
The interviews are in the following order:
Marsha Lillie Blanton, DrPH - Henry J. Kaiser Family Foundation
Majora Carter - Sustainable South Bronx
Dr. Karl Lauterbach - University of Cologne, Germany
Dr. Bruce Cohen - Massachusetts Department of Public Health and Sarah Johnson - Management Sciences for Health
Dr. Marsha Lillie-Blanton is a vice-president of the Henry J. Kaiser Family Foundation where she directs the Foundation’s policy research on access to care for vulnerable populations. She also holds an adjunct faculty position in the Department of Health Policy and Management of the Johns Hopkins University Bloomberg School of Public Health. Her research and policy interests are in the areas of substance abuse, racial/ethnic minority health, and HIV/AIDS. Dr. Lillie-Blanton has over 15 years of work experience in health policy research and management positions. She has authored and co-authored numerous articles, book chapters, and reports on health care access and financing issues for vulnerable populations.
Interviewed by Rena Greifinger
Please name two leaders that have been influential in shaping your view on leadership.
The two people that I think about most are Barbara Jordan [a Texas Congresswoman] and David Satcher [the 16th Surgeon General of the United States]. Barbara Jordan is a fearless leader. I watched her rise from her humble beginnings and stand up for her beliefs in Congress and fight for inclusiveness. To this day, she is a model of who I see myself wanting to emulate. David Satcher is a different kind of leader but with similar attributes to Barbara, a visionary, with courage and his own convictions. She was in the background, addressing race and class divisions. He elevated public dialogue and discussion, so we were no longer ignoring it and making it more visible in public health. When I saw that we were setting separate goals for whites and minority populations, it was unheard of to me that we could set such dual standards. David Satcher sought opportunity and seized upon it. In his work to eliminate health disparities, address mental and reproductive health, he is someone who I think stands for his principles and fights for them.
Please describe a defining moment that brought you to public health practice.
I don’t think there is a moment. If anything, I would say, because of my background, I have always been a part of social activism and social movement for change. Whether practicing in a health department or community center, it was never something I had to shift toward. For me, it was an understanding of the connection between science and practice. Activism, without being informed with an understanding of the landscape you are working on or an ability to track your goals is something I didn’t understand in early years. In the four to five years between college and graduate school, I found out I needed something in between science and practice.
What do you find to be critical to leading an organization that champions health?
In my presentation, I talked a lot about vision. I think that is absolutely critical. Someone that can think forward and chart a course. The ability to build partnerships. Even if you have a sense of where you want to go, it is unlikely you will get there by yourself. Building linkages with partners, either organizations or individuals, who can help realize that vision, is key. Lastly, I would say that having tools for measuring results—those tools could be surveys or communicating with the public, certainly in public health, data collection and surveillance systems where you can monitor outcomes—are critical to the organization you are working in.
What are some challenges you encountered in trying to bring larger social agenda to your organization?
In my current position, it is how do you help the public understand complicated and sensitive issues that can include and shape their health. That is the challenge we face. The real day-to-day challenges that people face in their lives with different means in communication. People need to be able to understand those issues, embrace them and act upon them. That is an ongoing process. In my work now, we use all different kinds of venues. The written documents from fact sheets to reports to analyses published on the Web. We also try to be creative, using the broader media. We work with news organizations and television producers, trying to make sure that people are accurately communicating messages about health and health policy issues. Now, we think about how to reach the broader public with information you think they need to act upon. How do you find ways to communicate to audiences in the languages they understand? Language for teenagers may be delivered through music or television advertising. If we are talking to seniors, we work through organizations that they respect. These would include health providers, vision groups, nurses, and professional venues where people are already engaged. Our society now is compartmentalized, with people using communication channels that depend on their interests. Trying to find those channels and communicate through them is more effective than shouting from the rooftops.
There is a sense from the public health practice community that much more research exists than is being used to improve health. What do you think is the best strategy for resolving this disconnect?
I think it is longstanding. First and foremost, people in leadership in those fields need to communicate more. At the government level, whether from NIH to healthcare policy and research who are working with Public Health leaders, they have to better communicate at the top levels. And then that is only part of it. From the ranks, there is almost a dismissiveness on the part of both parties. I don’t want to say the problem is in one sector or the other. How we use the information and knowledge in both directions is important. Researchers communicate in their own language, not one that lends itself easily to practitioners. NIH is trying to do more translations. Still, this is a small part of what they do. The translation is not just about Public Health but also clinical care. The process is one that needs better connections, resources, and funding. On the Public Health side, learning has got to be something we facilitate, encourage, and reward. Organizations have to value it and allow people to develop knowledge and skills. The nature of it is that we often don’t have resources and time to allow people to have that exchange. If we want to break the disconnect, we are going to have to allow researchers and practitioners to have better interactions.
What lessons could public health take from the private sector to improve its reach or scope?
I don’t have much experience in the private sector. Most of it has been nonprofit. I can tell you what I have observed: seeking out and listening to customer feedback. I don’t say that when they ask they always listen, but they at least seek it. Look at the airline industry. The consumer feedback process is something that is routine. In Public Health, I would say we tend to assume that we know what to do and tend to think we know what is needed. We need to reach out more systematically and begin to understand what the community wants. We need to know what the public’s priorities are and how they perceive what we are doing. This may help to move the process along further. Public Health has somewhat of an identity crisis—mainly, who we are in the health field. So trying to be more systematic in identifying who we are and seeking input is important.
What advice would you share with graduate students returning to careers in public health?
What is most important is that you find a position that reflects your passion and your commitment, whatever that is. That will vary for people. If possible, find something that you really care about and focus. Reach back and bring someone along with you. It is easy to move forward and forget about the next generation. As you move along, remember there are those who may need a helping hand or a mentor along the way.
Majora Carter founded Sustainable South Bronx in 2001 after writing a $1.25M Federal Transportation grant to design the South Bronx Greenway with 11 miles of bike and pedestrian paths connecting neighborhoods to the rivers and to each—securing over $20M to begin construction in 2008. Her vision, drive, and tenacity earned her a MacArthur Genius Grant, a place on New York Governor Eliot Spitzer's Energy and Environment Transition Team, the Clinton Global Initiative’s Poverty Alleviation Panel, NYU’s Martin Luther King, Jr. Award for Humanitarian Service, and the National Audubon Society’s Rachel Carson Award. She started 2007 as one of Newsweek’s
“25 To Watch,” was named one of “50 Most Influential Women in NYC” by the New York Post that summer, and ended the year as one of Essence Magazine’s “25 Most Influential African Americans”.
Interviewed by Liesl Bradford
Please name two leaders that have been influential in shaping your view on leadership.
Dr. Martin Luther King, Jr. because he coupled moral imperative with economic common sense. He did not rely on the righteousness of his beliefs to move people towards change, but included—especially near the end of his life—the pressing economic necessity of a functioning economy that did not assume social, civil, or spiritual neglect as part of the equation. And also Sojourner Truth because…well, read her “Ain’t I a Woman” speech and you’ll understand.
Please describe a defining moment that brought you to public health practice.
In the late 1990s, New York City’s then Mayor Rudolf Giuliani was attempting to bring over one third of all NYC’s municipal waste to our tiny part of the city. The South Bronx was already handling 40% of the commercial waste, and hosted the largest food distribution center in the world with over 50,000 diesel trucks trips through our neighborhoods per week. Giuliani’s plans would have greatly exacerbated the already high asthma rates in the South Bronx. The increased trucking would have made the streets even less safe for outdoor physical activity; coupled with poor air quality, the obesity rise would have been even greater had he been successful. He was defeated in large part because we were able to mobilize parents—not by asking them to be “environmentalists,” but by pointing to the connection between their children’s respiratory diseases and the trucking and bad smells in the area. They were fighting for their children’s lives, they were beautiful, and together we were invincible. “America’s Mayor” was bad enough; thank God he didn’t become America’s President!
What do you find to be critical to leading an organization that champions health?
Being a leader of an organization that champion’s dignity, and pretty much everything else will fall into place.
How does your organization communicate health priorities to the public?
We try to make physical activity fun. For instance, we do an annual race called the Hunts Point Hustle 5k and the all the artwork involved with promoting the event has a silhouette of 2 people doing the Hustle. This is a more inviting way to get involved than something that strictly says “running” for a predominantly Latino and Black American community that does not have a strong contemporary culture of physical exercise, but is very familiar with dancing.
There is a sense from the public health practice community that much more research exists than is being used to improve health. What do you think is the best strategy for resolving this disconnect?
I totally agree! The results are in, and surprise—poor people have more health problems. I don’t want to hear about another study being conducted, unless we are studying the effectiveness of solutions that have been developed, often out of desperation. Some of this is due to academics who are looking for something to research, but have not been exposed to some of the existing solutions to public health problems, so they end up studying the same old things over and over again. I think the really valuable public health research would be in tracking the cost benefit analysis of saving on the front end, and the deleterious effects those short-sighted decision have down the line, with a huge price tag attached at each step of the way. How would those price tags be different if we spent more on the front end with green infrastructure such as beautifully designed, walkable communities with lots of parks and greenways with locally owned businesses dotted along the way? Communities that encourage physical activity, neighborliness, and community pride? I think the public health people, the environmentalists, and the economists need to join up their research so that we can take that collective balance sheet to the folks who decide how money gets spent.
What advice would you share with graduate students returning to careers in public health?
Advocate lifestyle adjustments over medications for your patients and the teams you find yourself working on. Yoga, meditation, getting out of the subway or bus one or two stops ahead of your destination so that you can get some extra walking in; these are some really great pieces of advice that if delivered in the right way will go a long way.
What lessons could public health take from the private sector, to improve its reach or scope?
Meet your customers where they are. Don’t assume that they hold their own personal health in the same regard that an educated public health professional might. Poor people suffer above all else from a lack of dignity in their daily lives – 24/7 – and that adds up to some pretty poor decision making if viewed from the outside. If there is a simple, cost- effective way to do something, do it. Address the root issues and don’t go for the “end of the pipe” solution, which is more characteristic of government. Like, instead of properly funding education and cultivating good entry-level jobs, we build more jails instead. Asthma clinics in American cities can be said to serve a purpose, but addressing the disease vectors that make those clinics necessary in the first place is a smarter and more cost-effective approach.
Interviewed by Natasha Khouri
Are there one or two leaders that were especially influential in shaping your view of leadership?
I would think of two people, both at Harvard School of Public Health. The first person I have in mind is Marc Roberts, who through many discussions developed an integrated approach to health policy decision making that I, by and large, practice. He was very skillful in showing that policy work gets done if the discussion gets translates into politics, economics, and the social sciences. The integrated approach for which he always stood was very influential to me.
Second, Amartya Sen, an economist, was very influential in shaping our views: there cannot be good economics without good justice and economics is a value enterprise, through and through.
I’m sure students will find that encouraging since so many are able to interact with Professor Roberts as well. Next I want to ask you about your work at the forefront of advocating for a major change in the German health insurance system, namely, the Bürgerversicherung. What would you say were the challenges that you encountered in trying to bring this larger social agenda to Germany?
Germany, as a matter of fact, has a two-tiered health care system. There is the public system which is a solidarity-financed system with contribution rates that are income related. This is a system with a universal benefit package which is paid over-proportionately by those that have higher incomes. It’s a fair system in my opinion. But in parallel, we have a private system which takes 10% of the population and can basically pick the patients they want to insure. They do not have to take anyone, but they can take those who qualify. You qualify for the private system if you have at least double the average income or work as a public servant. It is also a system where there is risk selection and premiums according to risk. Basically the private system takes the rich and healthy while the public system has to take everyone else.
This is unfair payment-wise, but more importantly it is also unfair in terms of how the care is provided. It turns out to be the case that the private system pays hospitals and physicians higher rates than the public system—it can afford to do so because it insures wealthier and healthier people. This implies that the privately insured enjoy better quality of care. There are many top specialists that work for private patients exclusively—they do not see any public patients.
I have argued that a system which reserves the best trained physicians and specialists for a minority in the population, which enjoys the best health and income to begin with, is not fair. This is the key idea to the Bürgerversicherung, which is a kind of an “all-citizens” insurance system where all physicians work for all patients and are paid the same fees for all patients. There should be quality bonuses—it is not a single payer system. There should be competition among sickness funds [insurers], but there should not be discrimination between the public and private systems.
Since the 10% who are currently in the private system are the most politically influential people, they resisted the idea. Almost all of the professors, 50% of the members of Parliament, and almost 90% of top business people in Germany are insured in the private system. So the private system is defended by the most influential groups because they enjoy privileges at even lower expenses. Since they are not liable for the poor, they pay for themselves only. This is where the resistance came in.
In Professor Joseph Newhouse’s economics course we recently read a study you co-authored from the Institute of Health Economics and Clinical Epidemiology at the University of Köln, on the dramatic disparities in waiting times for public versus private patients to see specialists. These ideas are extremely relevant in the American experience as well. I wonder if there are take-aways you would share with the Harvard community about your experiences at the center of this health care reform debate and your “lessons-learned” —about how to communicate a vision for change, or the need for change, to the public.
My experience is that, first of all, it’s most important to have a vision. I can imagine a competitive market system where there are quality bonuses but where there is no risk selection and no difference in the payment scheme between the publicly and privately insured. A vision has to be specific and can not be a general one such as, “better care for everyone.” The opponents will say, “Well, ‘better care for everyone,’ this is exactly what the current system delivers.” You can only succeed in health policy in Germany if your vision is neither too specific nor unspecific. If it is too specific, then your enemies basically pull you down in looking at the least likeable, or least defensible, smaller points and take those for total to show that the whole vision doesn’t work. So, visions have to be more like mid-range missiles which are not too big and not too small. You must be able to communicate your vision in less than 90 seconds. This is the typical time you have on prime-time TV in order to defend your position—it must be “prime-time explainable,” which is 90 seconds or less.
Secondly, I think you need to look to the public as your main ally. The 10% that are the most privileged in our society, including some physicians who benefit from this system, they will only move if the rest of the population—which does not recognize that the system isn’t working well for them—become aware of the problem. Making the public aware of the problem and changing the perspective from which the problem is seen is most important.
To make your message into a sound-bite and to be able to relate it to the public’s interest—this is excellent advice, I think, for communicating in many scenarios.
You are also a researcher. I think the public health community sometimes has the sense that there is more research existing than is being used to improve health. What is the strategy for resolving this disconnect? When you were able to bridge this gap, what parts of health research were you able to integrate, and why was it not all integrated?
I always undertook research with a view of what type of a study will be important for the current health policy public debate. Secondly, I became very early on involved in advising politicians. Politicians need reliable researchers from the public health community. I basically started as an advisor on the board to the Germany Ministry of Health and a couple years later became a politician myself. Advising the government and doing studies that are policy-relevant, but to do those in the best possible quality so that you build up a quality reputation, is rewarding. The quality issue is very critical because in the German setting, physicians will always argue, if a study is policy-relevant, and also if they do not like the results, then the study is flawed and low quality. They may argue, “the numbers are wrong, the study is flawed, this can not work,” and so forth. Therefore to deliver high quality research is very important as a self-defense mechanism in that setting.
What advice would you share with graduate students who are preparing to return to careers in public health?
I think that careers in public service that are relevant to policy or even part of politics are very fulfilling. It is astonishing how many good studies, how much of our best knowledge, is never put into practice. If public health policy makers were able to fill that void, this would be a huge service for the public. To become exposed to policymaking and politics early on in a public health career, I think, is most relevant. One of the biggest impacts that public health researchers can have is when they collaborate with policymakers or become policymakers themselves.
Dr. Bruce Cohen is the Director of the Division of Research and Epidemiology for the Bureau of Health Information and Statistics in the Massachusetts Department of Public Health. He has adjunct appointments at Tufts Medical School, University of Massachusetts School of Public Health, and Boston University School of Public Health. Dr. Cohen is also active in his community: he is an elected Town Meeting member in Brookline, a member of the Public Health Advisory Committee, serves on the board of the Brookline-Quezalguaque Sister City Partnership as a member of the Nicaragua Health Committee, and is currently the President of Friends of Brookline Public Health.
Sarah Johnson is Deputy Director of the Center of Leadership and Management (CLM) at Management Sciences for Health (MSH) and a Team Leader in the Center’s Leadership, Management and Sustainability (LMS) Program. As Deputy Director of CLM, Sarah oversees new business development for the Center, participates in other new business development throughout MSH and is actively involved in setting strategic directions for CLM, in conjunction with the CLM director and the other CLM deputies. Ms. Johnson is on the senior management team of the LMS program and serves as the Scale-Up Team Leader. The Scale Up team oversees all of MSH’s virtual management and leadership learning programs and networks and LMS’ management tools and approaches.
Interviewed by Rena Greifinger
Can you name two leaders that have influenced you in shaping your career and your view on leadership?
Bruce: The rabbi in my synagogue was the first person I knew who was active in civil rights. He engaged me to connect with people and think about social equity as part of my day-to-day life. The second leader who influenced me was a woman named Dorothy Rice, who was the Director of the National Center for Health Statistics. She was a mentor of mine and she planted the seed in my mind about connecting data and research to policy and development.
Sarah: I am probably exposing my philosophy of leadership and leadership development by expressing myself this way. I think there are leaders on all levels and some of the people that have influenced me are people who hold positions of leadership. But, people who serve the community in other ways, like community health workers, are the most outstanding examples in my mind of everyday leaders. There were two or three people who influenced me in Public Health in the beginning of my career. My first job in Public Health was to work with the Ministry of Health in Mexico. The people who influenced me were the community health workers who were going out and giving immunizations in a community that, at that time, had the highest incidence of rabies of any city in Latin America. They were on the frontlines everyday.
In the present, someone who influences my thinking and who I hold in high esteem is Dr. Peter Mujemi. He is an Ugandan leader, very well known in the field of HIV/AIDS in Uganda and throughout Eastern and Southern Africa. He happened to sit next to Laura Bush at the State of the Union address when PEPFAR was launched. He is the Director of the Joint Clinical Initiative Research Center in Uganda, and I have had the pleasure of working with him as a consultant to and friend of the organization. I have watched how he and others have transformed the organization from a single, small treatment site in Kampala to a very large organization that is spread out all over the country with six Centers of Excellence and over 50 treatment sites. He was one of the first people to treat Ugandan people living with AIDS.
Leaders exist at all levels. They are not just those that occupy positions of authority. There are so many everyday leaders. The situation today in developing countries cannot be addressed solely by people at the top. The challenges that exist demand that leaders exist at all levels of organization from the grassroots right to the top.
What do you find to be critical to leading an organization that champions health?
Bruce: Creativity and a sense of humor. Humility. Persistence. And faith. All are prerequisites to succeed. Wherever you are and whatever the nature of your organization.
Sarah: What we try to do at Management Sciences for Health, the organization I work with professionally, is to demystify leadership. There are probably thousands of titles of books on leadership. A lot of the books that are written about leadership and management refer to people’s attributes. Those attributes are absolutely essential and are bolstered by good moral values. In demystifying leadership, we talk about what leaders do to produce results. We define leadership as enabling others to identify and address challenges. Leaders at all levels need good leadership and management practices and competencies in addition to good ethics. I consider good leadership as the ability to scan the external and internal environment, focus a team of people on work to be done, align and mobilize people, and get people on board to accomplish a task in unison. Leaders have to inspire. They have to be able to plan, to organize, to implement, monitor, and evaluate. Leadership is developed by people facing challenges.
What lessons we can we learn from the corporate sector, to improve our reach and scope?
Sarah: My entire professional career has been in the public or NGO sector. I have never worked in the private, for-profit sector. Of course, I am encouraged by corporate social responsibility. I think that to solve the public health problems that exist today, everyone needs to participate. There are corporations that want to participate and many of them do. I think that is great. I certainly have come to appreciate that it is not just one sector or another that can solve the public health problems of the world, particularly in developing countries. It takes many. I think there are things that we can learn from the corporate sector. Although not always characterized by good management and leadership, there are frequently some very well managed and led corporations and firms. I think we can learn those practices from them. There is always a lot of antagonism between sectors and I think we need to share with one another for the common good.