The New Public Health Generation: When I Grow Up, I Want To Be a Public Health Hero

I earned a master’s in public health (MPH) with a concentration in Behavioral Science and Health Education. Right out of school, I accepted the ASPPH Philanthropy Fellowship at the de Beaumont Foundation. One of the best parts of the fellowship has been meeting some of nation’s true “public health heroes.”

On my second day, I met Karen DeSalvo, who developed Public Health 3.0, which charts the future course of governmental public health in the United States. My second week, I met health commissioners from the nation’s 30 largest, most urban cities. At the APHA annual meeting, I was introduced to Jonathan Fielding, former health commissioner of Los Angeles, founder of UCLA’s public health school, and renowned author and public health thought leader. Just the other week I met the current Surgeon General, Dr. Jerome Adams, who is bringing nontraditional partners like business into the practice of public health. These are the gatekeepers to contemporary public health work and the future of the professional health field. I aspire to a career that builds on their work. However, all of these leaders hold medical degrees. I started to wonder if I made the right choice when I picked an MPH instead of an MD?

Health directors are often legally required to be a licensed physician. Looking back into the history of public health, this made sense. The causes of disease and disability were infectious, transmitted by bugs and bacteria and remedied by advances in medicine and epidemiology. However, today’s health directors need to know more than disease pathology. The leading causes of death are complicated chronic conditions that result from lifestyle and environment, and whose prevention requires new schools of knowledge. Health commissioners need to know about public transportation, access to healthy food, and clean air, none of which are covered in traditional medical training. Take, for example, a recent Lancet article that found that air pollution was responsible for 16% of all premature deaths worldwide (about 9 million). It’s not a medical approach that’s needed, but a systems approach working to build partnerships and pass policies that improve air quality. So, if the problems have changed, why do so many cities, counties, and states require still require a medical license?

Is my future in public health capped? Is my professional growth stunted already despite my passion and professional degree?  I began to search for other heroes who didn’t hold clinical degrees and found Colleen Bridger, the health commissioner of San Antonio. As a fellow non-clinical public health practitioner, I called her to learn more about her experiences and her career path.

Colleen Bridger, MPH, PhD, was appointed as health director of San Antonio in March of 2017. Before May 9, 2015, she wasn’t qualified for the job because the San Antonio city charter required that the city’s health director be a licensed physician. But, a public referendum in May 2015  eliminated this requirement. Dr. Bridger recalled being asked what she brought to the table as a public health professional without any clinical expertise. Her answer: she is able to look at the whole picture, understanding and solving health problems from the systems level, using a myriad of tools including policy. In this answer, Dr. Bridger highlighted what I’ve learned, the skills I gained without any clinical experience.

Dr. Bridger gained this system’s level perspective throughout her training in international development and public health, completing a PhD in health systems research and a dissertation in teen pregnancy prevention. Earlier this January, Dr. Bridger applied these skills when she led an effort to pass T21, which is one of the most effective methods of reducing tobacco use and its negative population health consequences, by raising the legal purchasing age to 21. I studied policies like T21; this is the type of work I want to do! I loved talking to Dr. Bridger because I relate to her. She started her career as a bilingual social worker and developed a passion for working and with vulnerable communities. There are a lot of stories like hers among young public health workers.

Dr. Bridger is excited about millennials entering the public health workforce because she says we are “natural systems thinkers”. At a time when zip code is the strongest predictor of health status, system thinkers are needed to create healthy communities. A drive for social change motivates a lot of young people like me to get into public health. I was 1 of 20,000 public health graduates in 2016, of which less than 1 of 10 intended to pursue a medical degree. There are more young workers pursing public health degrees than ever before. We need constructive, upwardly mobile career paths in governmental health agencies in order to become the next generation of “heroes” in public health.

The public health workforce is a team of public health professionals, policymakers, doctors, activists, and researchers of all backgrounds. As Dr. Bridger puts it, “there is something in it for everybody”. However, the MD requirement is a structural barrier that could prevent me, and others like me, from leading in the field. Policy needs to catch up with a changing workforce and changing health landscape by shedding the MD requirement for health agency directors. I still wonder if I made the right choice when I decided against pursuing medical school. But when I reflect on the progressive changes proposed by Public Health 3.0 and talk to public health heroes like Colleen Bridger, I am confident enough in my public health training to someday consider the health director position myself.

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This year I am blogging about my experience as a fellow and what it means for the millennial generation to join and change the public health landscape. I will grapple with the changing public health workforce, interview leaders in and out of the field, and discuss the future of public health as my generation sees it. Follow along!

New Voices: Millennial Health Professionals and the Future of Cross-Sector Partnerships

This article has been cross-posted on the Practical Playbook blog

Health and healthcare have been discussed and debated at the national level throughout 2017. None of the problems are new: healthcare costs are unmanageably high, the system of care is fragmented, and natural disasters and emergent crises rule the headlines. However, there is a promising and growing movement that is transforming health by integrating public health, primary care, and health care more broadly. Cross-sector partnerships are at the center of this movement.

Primary care understands patient needs and quality service provision. Public health understands what healthy communities need to thrive. When combined, the individual and community perspectives inform a health system that treats and prevents diseases. The Practical Playbook released a textbook, The Practical Playbook: Public Health and Primary Care Together, that accelerates, informs, and empowers this movement by disseminating the tools of successful cross-sector partnerships to the health workforce.

Millennials entering the health field can learn from the Practical Playbook. This younger generation is technology savvy, creative, and passionate about creating change. They are not afraid to think outside of the box and adapt quickly to new rules and strategies. The marriage between health care and public health is an exciting challenge that this workforce is ready to take on with a fresh perspective. Institutions of higher education need to prepare students of all disciplines with tools of collaboration and the ability to work together in community, clinical, and governmental settings. If these new health professionals are the future of the health field, then they must be folded into the movement of cross-sector partnerships and an integrated health system.

New Voices Essay Contest

Accordingly, the Practical Playbook is inviting students and recent graduates of any health discipline to add their voice to the movement and discuss what they see as the future of cross-sector partnerships and the collaboration of health care (especially primary care) and public health. Submissions can take form of short-essays and answer one of the following questions:

1. Given the currently fragmented relationship between public health and health care, and the goals of Public Health 3.0 and the Practical Playbook, what do you see as you and your discipline’s role in bridging the gap and transforming the health system?

2. How can professionals in your discipline create and sustain cross-sector partnerships, rather than working exclusively within discipline? (Cross-sector partnership example: a hospital working with a local housing development organization on improving indoor asthma conditions.)

Students and recent graduates of any health-related professional program are invited to respond, including: public health, medicine, nursing, psychology, dentistry, social work, and health-focused programs in business, law, etc. The top submissions will be chosen for publication in the second edition of the Practical Playbook textbook. Submissions not chosen for the textbook will be considered for publication on the Practical Playbook blog.

Other guidelines for submission:

  • A PDF or Word document of 750 words or less
  • A cover page with your name, institution, year, program, and how you heard about the Practical Playbook
  • Email to corcoran@debeaumont.org
    • First round due Jan. 20
    • Second round due March 1

The New Public Health Generation: A Sales Pitch for Governmental Public Health

During my fellowship year at the de Beaumont Foundation, I have spent my time discovering the functions, challenges, and value of governmental public health, as well as considering whether health departments are my next career move. I’m the first to admit that working for the government, especially state or local health departments, doesn’t have the exciting, magnetic pull of some of the interesting entry level positions at policy advocacy groups, consulting firms, and innovative non-profits.

Luckily, I had the chance to explore my hesitations about governmental public health with Dr. Mike Fraser, the Executive Director of the Association of State and Territorial Health Officials (ASTHO) . I sat down with him to ask some questions about the field and future workforce trends.

As the Executive Director of ASTHO, Dr. Fraser represents and supports state health officials across the country. My big question for Dr. Fraser was this: “Why, with such an uncertain financial, political future, should millennials join the governmental public health workforce?” Dr. Fraser reframed the question as a matter of responsibility and social good. If we want to live in a society where people are able to live, work, play, and raise families in healthy environments, government is the best entity to bear the responsibility of that ideal. There is no one else. The way Dr. Fraser puts it, government is a natural place for young people who believe in the common good, which is a compelling motivation for millennials like myself.

When I asked about future trends in public health, Dr. Fraser described his work with state health agencies as making the “invisible, visible,” because public departments are the hidden connective tissue that make our communities livable, from disease surveillance and vaccinations, to progressive improvements in transportation, housing, and food access. We eat, travel, and interact with other people every day without considering the public health departments that make our lives healthy and safe. Dr. Fraser’s, and ASTHO’s, role is to strengthen the voice of governmental public health and change the public perception of health.  Ideally, when people think about ‘health’, they will think less about pills and procedures and more about all the things that make us truly healthy: clean air, economic opportunities, access to healthy foods, safe outdoor space, and more. These are the things that governmental public health takes responsibility for creating, the invisible work that should become visible so that public health has the credibility and investment to do our job. Taking this perspective, I am excited to potentially join agencies that take more responsibility for making people’s lives better.

There is work to be done in public health in America and millennials have the energy, ingenuity, and passion to do it. However, governmental public health has a reputation for bureaucracy, low-paying jobs, and slow hiring processes that discourage young workers. Nevertheless, these less-than-appealing qualities can be mitigated by the powerful draw that meaningful work with a large social impact has on young workers.

Based on my time at the de Beaumont Foundation, and my conversation with Dr. Fraser, I have a sales pitch. Millennials should work in governmental public health agencies because they:

  • Are increasingly strategic in tackling public health problems at their roots and rebalancing the scales of prevention vs. treatment
  • Are working more with other sectors, both cross-jurisdictional in government and with the business, nonprofit, and philanthropy sectors
  • Need passionate people working on the inside
  • Are a place for people who believe in the common good and are passionate about social change and healthy communities

Dr. Fraser mentioned outright that he doesn’t believe in labeling the different generations, due to inaccurate stereotypes. He thinks that a person’s interests and passions come from their lived experiences- and I couldn’t agree more. My own experiences have shown me that the country needs a stronger, vocal, and visible governmental public health, which means that governmental public health needs more young professionals to join up. I haven’t quite made up my mind if I will end up in governmental public health, but I am much more interested than before.

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This year I am blogging about my experience as a fellow and what it means for the millennial generation to join and change the public health landscape. I will grapple with the changing public health workforce, interview leaders in and out of the field, and discuss the future of public health as my generation sees it. Follow along!