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10 Things Every Health Official Should Know

Speaker: Dr. Thomas Frieden
Source: Office for State Tribal, Local, and Territorial Support
Running Time: 00:12:05
Release Date: 09/20/2011


First, I want to talk with you about 10 things that every health official should know.

First, get good data. Data is the lifeblood of public health. This is what enables you to determine what the major problems are, what can be done about them, and whether your programs are succeeding. It's data that gives your health department a unique ability to influence policy and practice in your area.

Second, prioritize and do the hard stuff first. In the first months and the first year of your term, you have a degree of freedom that you will never have again. You can get stuff done that you might not be able to get done in the future. You can take measures that may take several years to come to fruition. You can address challenges that may have been neglected for a long time, so it's very important that you decide what you want to get done and move quickly to get those things done.

Third, fight and win winnable battles, and we'll go over later this morning six that CDC has identified. You can think of those six or others in your area, but figure out what you can do to make a difference. Figure out areas where specific action by the health department can lead to significant health improvements and can serve as a rallying cry for your staff and those who support public health in your area and can serve to demonstrate to voters, to politicians, to your leaders and those to whom you report the value of your agency.

Fourth, hire great people and protect them so they can do their job. Hiring great people is the single most important thing that you must do. When I was hired by Mayor Bloomberg, he called us all together, all of the commissioners of all of the agencies, and he said, "Only hire people who are smarter than you. Otherwise, you're not making good use of your resources." And then he told all of us, "It's your agency. Don't screw it up." And that kind of approach to management is extremely important. You can't be day-in and day-out where the decisions need to be made. You need to be able to rely on people to understand the issues, to take autonomous action, to involve you when they need to involve you.

Ultimately, no matter how hard you work, no matter how fast you work, most of the work of your organization is going to be done by the people who work for you, and therefore you need to ensure that you empower them, that you protect them from the challenges coming down from above and from outside, and that you support them and their ability to get their job done. That will enable you to succeed.

And also remember that it's not just about hiring. 80%, 90% plus of the people who work in your agency when you join will still be there when you leave, so motivating people to do an even better job, identifying the stars and promoting them, finding the people who know the system and can get it done is all incredibly important. It's very difficult to get to know systems of any public health organization, so finding people who understand those systems and can move quickly is essential to being able to succeed.

Address communicable diseases and environmental health, or you won't be able to address anything else. Communicable diseases remain very important challenges to us, and environmental health remains something that people are both very concerned about and that causes significant health problems. In and of themselves, they're very important, but in addition, they have the potential to be the only issues you deal with, so if you're not able to identify and rapidly stop an outbreak or address lead poisoning or air quality with a sensible and effective set of policies and practices, that may become the only thing that the press and the public and your staff are dealing with on a day-in and day-out basis.

You want to be able to address the entire panoply of public health issues -- communicable, non-communicable, heart attacks, strokes, diabetes, as well as communicable diseases, HIV, TB, environmental health threats, particularly air quality and others, and lead poisoning, asthma. All of these things are important, but if you don't manage the areas of communicable disease and environmental health, that may be the only thing you end up addressing. Don't cede the clinical realm. Many public health agencies are tempted to think that health care is complex and difficult and expensive and much of what happens in the healthcare system doesn't have a direct relevance to public health, but, in fact, understanding and being able to improve clinical care is essential to just about every aspect of public health.

Whether it's communicable disease control and getting doctors to test for HIV and to report communicable diseases rapidly and to treat according to the nationally recommended standards or in environmental health, getting clinicians to manage asthma well and report and address lead poisoning and other concerns, or in diabetes, increasing the number of services available to prevent and effectively treat diabetes, or, crucially important, the prevention of heart attack and stroke -- the leading preventable causes of death and disparity in this country -- and much more that we can do to help people with high blood pressure, high cholesterol, have it under control.

Don't cede the clinical realm, because it's essential both to your ability to get your job done in reducing avoidable illness, injury, disability, and death, and it's crucial to your being part of what is probably the single-most challenging issue that all of us have to deal with -- the importance of providing better-quality care for less money.

Seven, learn the budget cycle. There is a natural rhythm to the budget in most jurisdictions, and it's very important to understand it. When will there be initial proposals for the new budget, both in terms of what may be cut and what potentially may be added, understand when the hearings will be, when review will be, when passage will be, when budgets will become effective. This is very important, and it will guide a lot of your planning processes. A lot of work goes on in planning. Often in the government, our budget is our plan, so think about that process and think about ways to manage it, both within the health department, within the government, as well as outside with groups that care about public health. Manage the context. The context determines your degree of freedom to operate. A lot of that means messaging things clearly. The headlines you see here are about artificial trans fat. Artificial trans fat is partially hydrogenated vegetable oil. It is a product that was introduced into the food supply several decades ago and done so with all good intentions. But with time, we came to understand that artificial trans fat is even more harmful than saturated fat. It raises bad cholesterol, it lowers good cholesterol, and it increases your risk of having a heart attack. Now, most people have no idea what artificial trans fat is. They don't know what it is. They don't know that it's in their food, and they don't know that it could kill them. So when one jurisdiction tried and successfully implemented a trans-fat elimination program for restaurants and other food-service establishments, it was very careful to message this well. Artificial trans fat is an industrially produced substance added to your food without your knowledge or consent that could kill you. Now, when messaged in that way, in fact even the food industry made no attempt to counter the elimination of artificial trans fat. They just asked very reasonably for a transition time to eliminate it. Eliminating artificial trans fat didn't increase the cost. It didn't make things taste worse. It didn't make it impossible to make anything, but it did take time for industry to eliminate it. But managing the context means making sure, especially the first time an issue is in the public's eye, that it's framed accurately.

Communication is key, and the context is something that you need to work to manage. Never surprise your boss. Very important that if something is going to happen, your boss hears about it from you before reading about it in the newspaper or hearing about it in the news. Understand that those to whom you report have a broader portfolio and a broader understanding of what the challenges and issues of the days are, and so understanding how things are going to get conveyed, when they're going to get conveyed, very important to work with your leaders to ensure that you are in synchrony.

Follow these five key principles laid out by Walter Dowdle, who was the deputy director of CDC. First, be a diligent steward of the funds entrusted to your agency. The dollars that we have are precious, they're hard-earned taxpayer dollars, and we need to make sure that every penny we spend is well-spent.

Second, provide an environment for intellectual and personal growth and integrity. The way you treat your staff is crucially important. They are your most important resource.

Third, base all public health decisions on the highest quality scientific data, openly and objectively derived. Basing decisions on data is our core principle in public health.

Fourth, place the benefits to society above the benefits to the institution. We are part of society, and ultimately, we will all be best off if we focus on that collective responsibility.

And, fifth, treat all people with dignity, honesty, and respect. In addition, there are some practices that would be good to follow. you can know what's really happening. We're here for you. Help us help you. Find one thing that you will make core to your term. And, unfortunately, all of us need to learn to do more with less. These are challenging times to run any public health agency, but that makes it even more important that you base your decisions on data, that you work strategically, that you focus. If it wasn't such a difficult time, it would still be a privilege to run a public health agency, but in these times, it's both a privilege and an enormous responsibility.

Good luck, and we look forward to working with you to help you succeed.

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