Leadership Viewpoint: Where Can We Do the Most Good?

John Wiesman, DrPH, MPH, is the incoming Washington Secretary of Health. Wiesman served as Director of Clark County Public Health in Vancouver, Washington, from 2004–2013. He is currently President of NACCHO*.

How would you describe the current opportunities in public health? 

Right now we have a number of important opportunities with health care reform. First, we can increase our partnerships with non-profit hospitals by assisting them with their required community assessments. And for those of us who have multiple hospitals in our jurisdictions, we have an opportunity to take a leadership role in encouraging a single assessment process that has a coordinated health improvement plan. 

Second, we need to take our population health experience to the tables at which accountable care organizations and the triple aim (improved patient experience/outcomes, improved population health, and reducing per capita costs) are being addressed. Our expertise in addressing the social determinants of health is going to be critically important to our health care partners as they focus even more heavily on quality as their payment systems switch from procedures to patient outcomes. 

Third, we have systems and chronic disease prevention knowledge that should influence where hospitals invest their community benefit dollars, as those dollars are freed up from covering bad debt and uncompensated care. 

Fourth, we need to increase our public health informatics resources to fully engage in health information exchanges to mine the data that can improve our knowledge of population health and help in designing prevention efforts to address the issues we find.

We in the field of public health like to do it all. This will not work for today’s environment, and so we need to assess where we can do the most good. Part of defining this is to develop a minimum package of public health services that should be provided in every jurisdiction. This is critical to forming our brand identity, which, if strengthened, should assist us in our policy and legislative efforts. The minimum package must come with appropriate funding and the understanding that the minimum package may not cover all the services a health department will need to provide. 

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

Our systems of providing health care, behavioral health, oral health, population health, human services, and education are fragmented. We need to address this and improve population health by working across institutions and systems. 

Retooling our workforce is something in which we must invest time, talent, and financial resources. Similarly, succession planning must be folded into our workforce development efforts. It is important that we take a leadership pipeline approach in which we support developing frontline staff for their first supervisor position, supervisors for their first job managing managers, and so on. 

When you look at local public health across the country, do you see common pitfalls and issues for the field that are mirrored in many jurisdictions? 

I think this goes to the themes I have already raised: a lack of brand identity, a chasm between public health and medical care systems, and a workforce that needs preparation for new realities. If we address these things, we will be more relevant and effective. 

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