The Board of Directors of the de Beaumont Foundation has appointed Brian C. Castrucci, MA, as the Foundation’s Chief Executive Officer. After six years as Chief Program and Strategy Officer, Brian has been serving as Acting CEO since March 1, 2018. He has led the creation and implementation of many of the de Beaumont Foundation’s signature initiatives, including CityHealth, Practical Playbook, the BUILD Health Challenge, and the Public Health Workforce Interests and Needs Survey.
“Brian’s vision, creativity, and hands-on experience as a public health leader have been critical to the Foundation’s progress over the past six years,” said James Sprague, MD, chairman of the Board of Directors. “The Board has full confidence in him, and under his leadership, we know the Foundation will continue to expand its impact in improving public health nationally.”
“I’m thrilled to have the opportunity to lead the de Beaumont Foundation in this new role,” Castrucci said. “I look forward to working with our Board, our partners, and our grantees to build on our momentum and explore new possibilities to improve communities and people’s lives.”
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.
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!
by Brian C. Castrucci
There have always been politicians who believed that government could be more efficient and impactful if operated more like a business. While often debated throughout the history of civilized government, the same conclusion is always reached – government really can’t run like a business. One has a profit mindset; the other has a people mindset. But that doesn’t mean there aren’t things government can learn from business.
Whether you’re assembling cars, designing clothes, or preventing diabetes, you have to manage a budget; set and work towards goals; thinks strategically; and write, execute, and monitor contracts. This is what businesses are great at and precisely what’s missing in government.
Running a $500 Million “Business” without Business Skills?
When I worked in governmental public health agencies, I managed budgets of up to $500 million and staffs that exceeded 100 employees. I did this without any formal training in business or budgeting. Sure, I had the public health skills needed to understand what communities needed to be healthy, but I had limited qualifications to lead a large team, manage multi-million dollar budgets, or craft city- and state-wide RFPs that awarded millions in government contracts. Looking back, it’s alarming that my responsibilities included so many tasks for which I had no training or expertise.
My experience is far from unique. In a 2014 survey of the state governmental public health agency workforce, financial skills were identified as important by roughly three-quarters of the workforce, but many reported having no better than beginner level skills in this area. I look back on my time in public service with gratitude for the leaders and mentors who guided me through my many management quandaries. When those quandaries got the best of me, I had the opportunity to learn from my failures. Others weren’t nearly lucky. The cost of the skill-gap is the loss of hardworking, dedicated people, who were put in the position of doing something for which they were not trained.
Business Skills Are Essential, Even When Profit Isn’t
Governmental public health workers want to make a difference; they’ve opted for a career of “mission over margin.” But, we can’t continue to ignore this major workforce development need. Business skills need to be recognized as a core competency in effectively managing public health programs. We must have the specialized skills necessary to improve the public’s health, like epidemiology, maternal and child health, and preparedness, but we also need to develop critical strategic skills – like budgeting, contracting, and management – that amplify our reach, effectiveness, and impact. This reality is being recognized by some of the nation’s top public health educators. Through a partnership between the Department of Public Health Sciences in the Miller School of Medicine and the School of Business Administration, the University of Miami (UM) will launch an online, asynchronous certificate program called Building Expertise in Administration and Management (BEAM) in May 2018. BEAM will be offered through UM’s Schools of Business and Medicine and will be tailored to the unique needs of program managers working in governmental public health agencies at the state and local levels. This certificate joins the Northwest Center for Public Health Practice’s Public Health Management Certificate, a distance and in-person hybrid focused on planning, organizing, budgeting, and analyzing performance.
These programs alone cannot meet the overwhelming need to develop business skills in the governmental public health workforce. Schools and programs of public health must find a way to develop this skill set in the workforce of the future, while federal funders – primarily the Centers for Disease Control and Prevention and Health Resources and Services Administration – need to identify and align funds to support this as a major training objective for the nation’s public health workforce.
When a business fails, the products and services they produced are no longer available. But, if a demand exists for that product or service, the gap will be filled. We hardly miss Blockbuster, Eastern Airlines, or Compaq, and we can be sure that even as Mattel faces financial uncertainty, there is no fear of a world without Barbies. But when governmental public health fails, there’s no one there to fill the void. Critical services aren’t delivered; communities are less prepared for health emergencies; and the risk of disease outbreaks increases. Accuse me of being overly dramatic, but our lives are literally on the line.
If that’s not a reason to start prioritizing business skills in the governmental public health workforce, I don’t know what is.
This post first appeared in the Huffington Post.
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 firstname.lastname@example.org
- First round due Jan. 20
- Second round due March 1