May 23 2011
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Faces of Public Health: A Q&A with Linda Rae Murray, President of the American Public Health Association

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Faces of Public Health is a recurring editorial series on NewPublicHealth featuring individuals working on the front lines of public health and helping keep people healthy and safe. Today's profile is Linda Rae Murray, president of the American Public Health Association.

Graduations are taking place this month at schools of public health across the country. Last week, Linda Rae Murray, M.D., M.P.H., chief medical officer of the Cook County Health Department in Illinois, and current president of the American Public Health Association, gave the commencement speech at the Mailman School of Public Health of Columbia University. NewPublicHealth spoke to Dr. Murray about the students she met and what many are likely to find when they begin working in the field.

NPH: What were some of the key things you said in your commencement speech?

Dr. Murray: Well, I really focused on two issues. One is that public health is intimately, inextricably melded with social justice. And social justice is really the frame around which public health needs to function in our country. I think that reflects the feeling of the Mailman School of Public Health. They have developed an oath for public health workers and social justice is right there in that oath. The second thing I said is that we've had a tradition in public health of saying that if we do our job then we're invisible. I really reject that approach. We have to insist that we're not invisible. We have to be visible--we have to speak out on issues that concern the health of the public. For example--school budgets. When local government cuts of school budgets raises the class size, we need to be saying, "this is going to produce X number more cases of diabetes and X number more obese kids.” So it really means that we have to step forward in issues of labor management, school budgets, transportation--the whole range of things that really address the social determinants.

NPH: How specifically does cutting the school budget impact the health of students?

Murray: Well, we know a few things are likely to happen if we cut the school budgets. First, we know the earliest and quickest things for the cuts are recess, gym, extra-curricular activities and sports. So right away, we're decreasing exercise, for example. Secondly, we know that there's a clear relationship between people who are poorly educated in terms of lifestyle decisions that they're able to make. So, we know there's a relationship between education and health behaviors and opportunities that people with less education don’t have.

NPH: How is entering public health as a profession different now than when you entered the field?

Dr. Murray: Well, I think that right now we're in a position where governmental public health has really been cut to the bone. It's almost as though we're destroying the seed stock of our field. So, in 2010, 18,000 public health workers in local health departments experienced furloughing and 40 percent of the local health departments have had lay-offs or hiring freezes where they can't rehire people that retire. So governmental public health particularly is under attack and it is the core of public health. And when the governmental programs are cut back and governmental departments are cut back we really limit our ability to have good public health infrastructure and emergency preparedness response, and it also prevents us from speaking out. Another example I used in the speech to the Columbia students was from the H1N1 pandemic. We told people to cover their coughs, wash their hands, and stay home from work if they were sick, and most workers in this country don't have paid sick days. And what we should have been saying as public health people is, "If we want to have a modern country and we want to be able to respond to flu pandemics, we have to have legislated paid sick days"--which would help with a whole range of things--not just flu pandemics. So, it's that kind of ability to link what we do to people's lives that is so critical.

NPH: What do you think confronts a newly graduated student when they enter the professional field of public health that they need to learn from scratch?

Murray: Well, the first thing they have to learn is what we taught them in school isn't really true. That is to say, policy is not determined by evidence. So they have to learn the "hard knocks" politics of public health. I think the second thing is--and it varies from school to school as some schools are doing a much better job at this--they have to learn how to work with the community groups. You know, not the professionals who are in the community groups, the real people in the real streets. It doesn't matter if you have all the fliers that you want. I'm going to tell you--60 year old black people--it's really hard to convince them to get the flu shot. So understanding that and learning about what that means and how to talk to people--how to relate to people. And the third thing unfortunately, I think is a problem of our public health schools. They have to really learn how to work with other professionals--social services, urban planning, rural health--a wider variety of professionals than they usually get exposed to--not just public health. Many of our schools are pretty good about public health officials but you gotta learn how to work with the local surgeon; you have to learn how to work with the local park district, education, transportation and labor departments.

NPH: What were some of the questions the students asked you?

Dr. Murray: I was fortunate to be able to have a lunch time with faculty and students and we really talked about what things in public health make us most passionate and how do you stay active in other issues that matter to you when you start working? How do they stay active in issues and things that concern them, even while they have a job to go to? So we talked a lot about involving themselves in activities at their church or in their neighborhood that may be disconnected from their actual 9-5.

NPH: What was their reasoning behind that question?

Murray: First of all, they want to stay active. They felt that public health people needed to be more active because we have a lot of information--and they spend a lot of time asking questions about how things were connected. So we talked together about how public health was really the glue between all of these different sectors, that one thing that public health brought was a multi-faceted view. So we could see a connection between what the transportation department did and what the sanitation department did. So they really wanted to know how to do that, and they felt that many jobs that they would get--not just in government but outside of government--if you're working on an HIV grant for example, that grant may not allow you to do some work in other public health areas you’re interested in. But we talked about how it was possible to bring your knowledge about public health even outside the job. That there might be time periods where your job requires you to do something very specific but that doesn't mean you have to give up your passion.

NPH: What are some innovations that you've brought to APHA in the time since you became President?

Dr. Murray: The thing that I am most interested in is trying to find ways to increase our advocacy role--and especially our advocacy role at state and local levels. We're trying to experiment through some grants we've gotten and have more regional meetings and find ways to energize our membership at a state and local level.

NPH: What kinds of things would you like to see happen as a result of greater advocacy by APHA?

Dr. Murray: I think to the extent that we can actually mobilize people who are not public health professionals--the church community, school communities, etc.--to work on local projects, whether it's getting vending machines out of their schools or working on getting more farmers markets in poor communities. I know our state affiliates--we have an active group working on food access issues and it really leverages a whole range of community activists and community groups to address food nutrition and food security in an intelligent way.

NPH: So with so many students graduating into the field, what do you say to a student starting off today? What do you want them to keep first and foremost in their minds as they enter the field of Public Health in America?

Dr. Murray: The main thing I would ask them to keep in mind is, you're young in your career--don't think you're going to stay in your first job--whatever it may be. Don't be afraid to try new areas and new problems that you haven't maybe dealt with before. The second thing is, stay in touch with your colleagues. Whether it's through APHA or any of other public health organization, be active and involved in organizations that care about public health because that really keeps you fresh. It will help your career and it keeps you active.

>> Read more Faces of Public Health features here.

>> Read previous NewPublicHealth.org Q&As with newsmakers and difference makers in public health.

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