Oct 13 2011
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ASTHO 2011: Q&A With Paul Jarris

 Paul_Jarris Dr. Paul Jarris, Association of State and Territorial Health Officials

The annual meeting of the Association of State and Territorial Health Officials (ASTHO) begins next week in Portland, Oregon, bringing together chief health officials and other key public health leaders to talk about public health issues in the U.S. NewPublicHealth will be on the ground throughout the meeting covering workshops, sessions and keynote speeches, as well as speaking with program speakers and conference attendees. Follow the coverage here.

In advance of the conference, NewPublicHealth spoke with Paul Jarris, M.D., ASTHO’s executive director, about the meeting’s priorities and goals.

NewPublicHealth: About how many new state health officers are there this year?

Dr. Jarris: I’d say by January we’ll have 32 new health officials. So it was a major turnover. We count 59 members including the US territory, so 32 new officials are quite a few.

NPH: What is different for them than the post might have been five or ten years ago, and are there any particular strengths you can cite that they might be bringing to the job this year?

Dr. Jarris: As a whole it’s a very impressive group of people. Some of them are clearly giants that walked the earth in the fields they came from, and so as hard as it is to see a health official leave, we’re always impressed with the people coming in. For example, Bob Moser in Kansas was a solo family doctor running the health system for three counties. He was a local health official. And for years, he was the only doctor in the hospital delivering all the babies, running the ER, running the ICU. He actually had to treat his father when his father was having a major heart attack. And so he brings all that experience from rural health now to become the Secretary of the Kansas Department of Health.

Compared to five years ago, I think the level of professionalism is probably rising fairly consistently in terms of the background and the degrees people have. The other major change though is five years ago it may have felt as if the budgets were tight, but it was still a period of growth for us and right now it’s clearly a period of contraction in all aspects of government, but in public health in particular.

NPH: Do you think the new state health officials are aware of the depths of the budget crunch?

Dr. Jarris: I think people have a notion, but I don’t think they can fully understand the impact it will have on them. Most people go in honored that they’ve been chosen and selected. They go in because they want a platform to make large-scale change in improving health, and I think that’s what motivates them, a real sense of mission. They clearly have to be risk takers because they’re all employees at-will and can be walked out the door in an instant, often not knowing where the truck came from that hit them because of something political. So it tends to be really a risk-taking, mission-driven, really idealistic group of people. No one can be prepared for these jobs fully – dealing with the media, dealing with, in some cases, tens of thousands of employees dealing with budgets that are hundreds of millions to billions of dollars, and on top of that, being an expert in public health.

NPH: Is budget the key issue for state health officials right now?

Dr. Jarris: Yes, what people are trying to figure out is how can they continue to protect the health of people and promote the health of the people in this cutting mode. What is it that is absolutely core that cannot be cut at any cost versus what are those things, although they’re painful, that can be cut? To use preparedness, which is one many people understand, we saw so many responses this summer – tornados in Alabama or in Missouri; flooding and hurricanes in places like Vermont, Pennsylvania and New York; wildfires in Texas. Public health is continually called to respond, and yet in our future we’re looking at the continually declining funding for emergency preparedness response and notions that perhaps that funding will be cut so severely that it will be put out on a competitive basis rather than every state getting it. And so health officials are asking how are we going to protect the American people and the health of the public if these cuts eliminate our capacity to have infrastructure and staff and trained professionals to respond?

NPH: Given that, do you find that relationships are formed at the annual meeting that helps as they continue in their job?

Dr. Jarris: Clearly, and that’s something we also really foster through the Robert Wood Johnson State Health Leadership Initiative. We do a lot of work to help new officials. So we’ll call them sometimes even before they’re in office. I’ll go out and make a site visit, in their environment when they take office. We’ll send them to the [Harvard] Kennedy School of Government for a week; we offer them a mentorship; we have grant funding for personal and professional development; and then we offer them many networking opportunities. We are also on call 24 hours a day, 7 days a week. At the meeting they become very close colleagues, and in many cases, friends.

NPH: The agenda looks great. Are there a few sessions you’d highlight?

Dr. Jarris: Well, I think we’re really pleased at the level of folks that are coming once again to our meeting, and the preparedness session with Heidi Avery, the Deputy National Security Advisor to the President is going to be a very important session to hear from two steps away from the oval office about public health preparedness and response. So that’s going to be incredibly important because we are concerned about how we will continue to protect the American people with the cuts that are ongoing.

We also have a set of both federal and state health officials talking about how to integrate public health and healthcare. We think it’s essential that public health and clinical medicine bridge this divide. And frankly, we also feel that if public health can create greater quality and value and save cost in healthcare, then hopefully public health can share in that 97% of the budget that goes into healthcare.

NPH: What are the key takeaways for the health officials attending the meeting?

Dr. Jarris: We want them to understand that they’re part of a system, they’re not alone. There’s a tremendous set of resources through their colleagues across the country, through the local and federal officials that are their colleagues and through this organization.

Secondly, I think that we want them to understand how important it is not just to do good work but to let that good work be known so that when there is an incident and public health responds, that their members of congress and people in the administration know they’ve done it and done it well and that they appreciate the public health preparedness funding that allowed them to do it.

We, for too long in public health, have felt that good work speaks for itself, and that’s simply not true in this environment. So we really want them to understand not only that they have to work with their local and state governments, but that the vast majority of their money comes from the federal government and it’s at risk and they need to be engaged with us in educating federal officials in the administration and the legislative branch on the necessity for this funding.

A key issue for this year is the Preventative Health and Health Services Block Grant, which was dramatically cut back in the fourth quarter last year, and had the effect essentially of eliminating it. It’s critical because this is 80 to 100 million dollars and it is the only money the states get from the federal government, which they can then apply to statewide priorities. That is something we are going to have to continue to educate people about — how important the Block Grant is in protecting the public’s health because it covers things that simply no other funding covers. For example, many states use it for education and licensing expenses for emergency medical services. Other states use it for water fluoridation. If that money goes away, they’ll have no money to do that.

We want our members to go away understanding how important it is to tell those stories.

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Tags: ASTHO, Public Health Departments, Public and Community Health, Q&A