Rowitz On Leadership

The field of public health in the United States is changing as you read this blog posting. The profession of public health was very organization focused in the past. It was perceived through the lens of a governmental public health agency that not only concentrated its activities on clinical services into the 1990s but also talked of prevention and a population-based focus. Being healthy is not a silo-based activity. It requires not only the involvement of each person, it involves the support , collaboration, and involvement of many other people and organizations. I believe health promotion is a leadership issue always with an eye on future behavior. Over the last several decades, we have set health goals for the Nation for each decade. A new decade appears and we seem to start all over again with a new set of goals and expectations. For every step forward, we seem to take two steps backward. Unexpected health crises, a new pandemic, or a new problem to be addressed seems to shift our health priorities. Each type of event becomes tied to a specific health profession or health organizational silo. For example, the events of September 11, 2001 seemed to be a public health crisis and much money was allocated to build public health infrastructure through the advocacy of a preparedness approach to emergencies and other public health crises . And yet, subtle and not so subtle shifts occurred in which emergency preparedness and response seemed to become the domain of law enforcement and fire departments with public health often appearing to take a back seat.

Whether we want to admit it or not, It is not only the public health professions and their organizations that define public health. Public health is defined by the economic climate of the country, politics, economics, culture, and the possibility of global pandemics. In addition, today’s health issues also define what public health agencies are supposed to be doing today. It is also true that these contemporary issues help define our field although we sometimes drop the ball and some other profession or organization picks it up. For example, violence has been seen as a public health issue and yet we did not know how to address this issue. Public health leaders often let law enforcement, schools and other organizations pick up our dropped ball.

The field of public health is expanding in the face of health reform by governmental officials at the federal and state level. Funded public health workforce and leadership development programs are being asked to consider the training of health professionals in preventive medicine, HIV health professions , emergency preparedness, maternal and child health professionals, and community health center administrators. The argument being made is that people working in health and community clinical areas are beginning to carry out public health work at the population-based community level. This expansion of the purview of public health means that we need to reevaluate our training, research, service, community engagement activities and leadership activities in this ever changing public health environment. We need to create alliances and other mechanisms for the discussion of these issues. It will be necessary for governmental health professionals to talk to academic and public health practice leaders in concert with their professional organizations to aid in the redefining of public health in a rational manner. Business and citizen involvement may also be necessary. Our decisions today will have an impact on the future of public health for many years to come.