Leadership Viewpoint: Challenging Ourselves

Lillian Shirley, MPH, MPA, has been the Director of Multnomah County Health Department in Portland, Oregon, since 1999. She served as President of NACCHO* in 2011–12.

How would you describe the current opportunities in public health? 

Public health can leverage our core competencies so that communities will use these to frame what they value and need. Data collection and epidemiology can assist in community protection. These aspects of public health are being requested in a lot of jurisdictions. This work does not have to be done by public health, but we must show our added value by convening and providing epidemiology analysis. 

What do we in public health need to do differently to take advantage of opportunities?

We need to challenge ourselves, look at the big picture, develop systems thinkers, and analyze programs from a perspective of the whole environment. Also, we need to be more flexible in our practice and partnerships to achieve our goals. 

What are existing trends or environmental conditions that could be leveraged to improve population health? 

We have to think in terms of what to leverage. What do we care most about measuring? How do we work more with system impacts and outcomes? Our focus must be on outcomes and not just activities in the implementation of the Affordable Care Act. 

Do you have concerns about the field of public health today? 

We have to look at health equity and access issues. If you look at some of our health outcomes across jurisdictions, they don’t look that bad until you begin to “peel the onion.” Looking across the spectrum, individual outcomes vary. I want to support poor and vulnerable families.  How do we get whole communities and jurisdictions behind goals that support these populations? Our workforce needs will be monumental in the coming decade. Do our curriculums support the preparation of new skills and approaches?

In recent years, you, Carol Moehrle, and John Wiesman have been elected to serve as NACCHO’s President. Why do you think our region has been prominent in this way?

We practice our craft in an environment that allows for experimentation, and we all have had boards that invested in our professional development. We also practice in a region that has a culture of innovation. We are not overwhelmed by numbers, conditions, or disasters. We have been able to focus. 

How might public health become more relevant and effective in communities?

Communication plays a role in making public health relevant. After 9/11, we got up to speed with risk communication. But we also need to get the public health story out, and we are getting better at this. In my department, we hired someone who came from media to help so we can tell our story in a way that folks can hear. 

 A big part of public health leadership is to make sure people who work in public health are healthy and can model healthy behaviors and attitudes. Sometimes we get weighed down and focused on what we can’t do. If we focus on what we can do, that ripples down and creates an environment for positive change.

*National Association of County and City Health Officials (NACCHO)