What’s Your Take: Michael Fraser, ASTHO

What’s Your Take is an interview series with interesting individuals – leaders, practitioners, academics, policy makers – whose work touches on public health, philanthropy, or related topics.

Name: Michael Fraser, PhD CAE FCPP
Organization: Association of State and Territorial Health Officials (ASTHO)
Title: Executive Director

How did you become interested in public health?

I came to public health through academic work in sociology and graduate school research looking at the social determinants of health from a sociological versus public health perspective.  Sociologists have been working on health equity and social determinants for decades – and it is good to see public health making that connection too!  My doctoral dissertation committee had faculty from both sociology and public health and that got me hooked on the public health and the need to look at both the clinical and the community factors that contribute to health and wellness.  My first job in Washington was at the National Association of County and City Health Officials (NACCHO).  While I didn’t know much about governmental public health, those first few years at NACCHO really opened my eyes to the many ways that public health agencies protect and promote health nationwide. So, I became interested in public health both as a student and then as an advocate for public health agencies. While I do not have an MPH, I think my journey underscores the many ways that we find our way into public health and bring diverse training and experience to the our public health work.  That diversity is what makes public health so interesting, important, and instrumental as well look to address health equity and promote optimal health for all.

Tell us about one organizational partner you’ve had and how you’ve worked together. Extra credit if they’re in another sector!

Our ASTHO’s President’s Challenge focuses on public health approaches to substance misuse and addiction.  I recently had the chance to meet with the National Association of Attorneys General and learn more about how Attorneys General and law enforcement agencies have approached the topic.  There is a lot to do with this sector to understand how law enforcement and legal minds think about substance misuse and its antecedents.  I was surprised to see a great deal of interest in thinking about addiction in different ways, including the destigmatization of addiction and moving upstream to prevent substance misuse.  It was refreshing to know that our Attorneys General colleagues are eager to learn more about the work of public health and how public health connects to their priorities in the states.

Another area where I think there is tremendous opportunity is the public health connection to the health care delivery system.  New federal legislation to move health care delivery from “volume” to “value” means that public health agencies are positioned to add value to health care systems in new and exciting ways.  The term that is used in many health care delivery circles is “population health” – that to me is just public health described in a slightly different way.  There is increased recognition and understanding by the delivery system that health outcomes are influenced not only by what happens in the exam room but also by what happens outside the exam room and in the community.  Working with health care delivery partners, public health agencies can not only contribute to improving health outcomes but also save states money as we move “upstream” to prevent illness and address the social determinants of health.  I think the future of public health will require us to better understand the health care delivery system and the ways that public health can work together with health care partners to improve health outcomes in a much more coordinated clinical and community approach.

What’s the biggest opportunity you see for impact in your work?

Our work at ASTHO has many opportunities for impact.  We are privileged to work with all states, territories, and freely-associated state members.  Our direct connection to the governmental agencies responsible for the public’s health in these 59 jurisdictions gives us access to health leaders nationwide and the opportunity to impact policy and practice across the country.  As we develop public health leadership, share best practices, promote learning between states, advocate for public health improvement and investments in core public health services, ASTHO is well positioned to have direct influence and impact on health status nationwide. Our work prepares and supports state and territorial health agencies to do great things!

What’s the number one thing public health can improve on?

We talk to ourselves too much and wring our hands because “no one understands us.”  We have to stop engaging only those we know in conversations about health and reach out farther to make connections to new partners in the public health system.  This means truly practicing what we preach when it comes to “health in all policies.”  Instead of getting others to think like us, we have to think like others and walk a mile in their shoes.  Why would housing agencies want to work with us?  Why would health care delivery systems want to work with us?  Do we know their language, do we understand their incentives and pain points?  Do we know enough about them to help them solve their problems while also advancing our public health priorities?  I think this is the crucial challenge for public health – how to move beyond conversations with each other and widen the circle to understand the perspectives and experience of others that might also have an impact on health.

The statements above are shared as written by the interview subject. They do not necessarily reflect the views of the de Beaumont Foundation.

Grantee Spotlight: The Health Impact Project

 

Health impact assessments (HIAs) gauge the impact that a policy, program, or law could have on a population’s health. HIAs have been applied to a range of decisions including those addressing transportation, housing, social and economic policy, natural resources and energy, and education. They aim to provide policymakers with information and recommendations informed by qualitative and quantitative data from multiple sources, including input from community members and other stakeholders, in order to improve decision-making.

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, was established in 2009 to promote and support the use of health impact assessment  in the United States. To date, the project has invested more than $20 million in advancing the field –funding more than 100 assessments, supporting training for more than 1,300 individuals, and serving as a convener for practitioners.

Part of the de Beaumont Foundation’s mission is to strengthen the public health system. With that in mind, in 2014 the Foundation partnered with the Health Impact Project to encourage urban health departments to perform HIAs–Boston, Chicago, and Maricopa County (Phoenix) were funded to conduct HIAs in their respective cities.

Boston chose to focus specifically on a measure that would propose changes to the city’s living wage ordinance. Evidence shows that there is a direct tie between income and health outcomes, and the work in Boston demonstrates the impact that raising wages can have on individuals and their families.

In 2016, Boston’s Mayor lauded the Boston Public Health Commission’s health impact assessment, saying, “This Health Impact Assessment is another step in the process we’re taking to make all of our city’s labor and wage laws work for our residents. I thank all of our partners and the Boston Public Health Commission for their work on this report and look forward to our important work ahead to provide our residents with the tools and services they need to become financially empowered.” Read the full report.

Chicago examined a particular decision about the built environment. There is a two-mile corridor in the city that is currently overgrown and vacant; this team looked at the impact of a proposed greenway trail and urban agriculture zone on the local community. The result was the Eastside Greenway Health Impact Assessment, which provided practical recommendations for using the proposed greenway to address fear of crime, the need for public exercise areas, and social cohesion in underserved neighborhoods.

Maricopa County, AZ took a slightly different approach. In this video, produced by the Maricopa County Department of Public Health, the participants of this HIA talk about the benefits of a shared-use agreement with the local public school system. As described by the Maricopa County Department of Health, a shared-use agreement can be defined as “opening school buildings and grounds during non-school hours for community use.” This will allow community members to access and use school-owned property for things like exercising, community gardening, and other activities that can lead to better health. Read the full report or executive summary.

HIAs are one tool in the toolbox. For these three communities, the process has been a powerful mechanism for informing decision-makers and engaging community members. It will be interesting to see if the skills learned by the local public health practitioners will translate into wider use of health impact assessments in these three urban areas, and serve as a model for other jurisdictions.

Politics and Public Health—Engaging the Third Rail

In the September/October issue of the Journal of Public Health Management & Practice, de Beaumont Foundation President & CEO, Ed Hunter, outlines the importance of constructive engagement between public health and political systems, and suggests ground rules that can help bridge the current divide. To read the complete commentary, click here.

There’s A Hole In The Boat. Let’s Buy Buckets?

Chief Program & Strategy Officer, Brian Castrucci, discusses the need to fix the balance between health and healthcare in his latest blog There’s A Hole In The Boat. Let’s Buy Buckets? To read the complete piece on Huffington Post, click here.