Jonathan Fielding: NewPublicHealth Q&A
Jonathan Fielding, MD, MPH, MBA, County Health Officer and director of the Los Angeles County Department of Public Health, responsible for all public health functions including surveillance and control of both communicable and chronic diseases, was the morning plenary speaker at the NACCHO’s Annual Meeting today. He challenged the thousands of local health officials meeting here to keep their attention on the most vulnerable in their communities and to realize how much policies can impact improved population health.
“The greatest changes will come not from tweaking programs but from getting new policies introduced,” said Fielding. To help policy-makers make those changes, he said, many public health departments may need to add expertise in areas such as policy analysis and economics. He also urged health leaders to embrace the health-in-all-policies approach.
NewPublicHealth spoke with Dr. Fielding about his vision for public health.
NewPublicHealth: What changes do we need at the local level to improve population health?
Dr. Fielding: We all have to be advocates for the underlying social determinants of health. We need to think about education, poverty, the tax structure, mobility, social conventions and at the same time focus on our natural environment such as climate change and the built environment. And that includes the environment we find ourselves in with regard to marketing and advertising such as vending machines and billboards. And we need to enact policy and not just programs. In Los Angeles we are putting in a great deal of emphasis on policy by working with decision makers and other partners.
And we have to convince the funders at all levels of how essential core public health is to the quality of life we have now and how we aspire to improve it, to reduce the burden of risks and injury. Public health can’t do what it does if it keeps getting cut, and cut and further cut.
We also need to combine and enhance relationships so that the core capabilities we know are so critical in public health are broadly disseminated regardless of whether a health department is in a metropolitan area, a rural area or on an Indian reservation.
NPH: Big cities such as Los Angeles can offer model practices for smaller communities. What are some model practices to highlight in L.A.?
Dr. Fielding: Our system of grading restaurants, started in 1998, has become a model, which includes providing incentives, and as a result we’ve reduced hospitalizations for severe foodborne illnesses.
Another is that many of our cities were early adopters of comprehensive smoking control programs including reduction of exposure to involuntary smoke, quit lines and mass and social media campaigns—those are reasons why our rate of smoking has gone down substantially.
Work that we’ve done in community transformation grants to try to get policies to improve health is another example. We have 88 cities and over 100 policies adopted by local city councils with regard to reducing smoking such as not allowing it in multi-unit housing complexes.
We’ve worked to change food served throughout the country, to reduce high-fat, high-sugar foods in the vending machines, and changed what the county serves in most of its facilities.
NPH: How important are partners to the future of public health?
Dr. Fielding: It’s indispensible to have strong partners. For example with our Community Transformation Grants, most of the money went out to our partners. And even, or especially, when we don’t have additional money, so many organizations that have overlapping or very similar missions can work together to achieve goals. We have worked with faith-based communities to try to reach out to their parishioners to and improve the vaccination rates for flu and other diseases; we’re working with groups to put in place more screenings for HIV. We have had lots of different partners and often the best fit is working in combination.
NPH: You recently donated millions of dollars to the UCLA School of Public Health which now bears yours and your wife’s name. What are some hopes you have for the school in the future?
Dr. Fielding: Well, the money, of course, is to be used at the discretion of the dean, but some things I hope will happen include more attention to distance learning, not just for the degree programs, but to keep graduates involved throughout their careers. And I hope they will try to get all the school’s graduates to mentor the students as they leave the school and embark on careers. I also hope the school will have an even stronger global reach than it does now, for what we can teach and also for what we can learn. And, finally, I hope that every public health student that goes to UCLA will have experience with actual practice to better understand core public health.