Faces of Public Health: Mary Selecky Looks Back
Washington State Secretary of Health Mary Selecky has announced her retirement from state service. Selecky has served under three governors since her initial appointment as acting secretary in October 1998. She also served two terms as president of the Association of State and Territorial Health Officials, served on the board of the National Association of County and City Health Officials and is a past president of the Washington State Association of Local Public Health Officials. In 2010, Selecky received the American Medical Association's Nathan Davis Award for Outstanding Government Service.
NewPublicHealth Health spoke with Mary Selecky about her public health career and accomplishments.
NewPublicHealth: Your tenure has spanned many public health game changers. What stands out to you as the greatest triumphs and greatest threats in Washington State?
Mary Selecky: In terms of greatest triumphs, a key one is that we took on the issue of tobacco use in Washington State. Tobacco would be at the top of my list because of the health impact it has had and because it really is something that can be prevented by getting the right information out to people. It has taken us decades for the public to get it that smoking kills.
We had an announcement about tobacco yesterday, in fact. Among our 10th-graders, 9.5 percent used a cigarette in the last 30 days, and our rate has dropped from two years ago, even though across the nation the rate has flattened. So we’re doing something right. We’re a smoke-free state—not just tobacco-free but smoke free. And that really has the most profound influence on people’s health.
On the other hand, tobacco is also our greatest threat, because the tobacco companies continue to spend more than $140 million in this state to get you to use their product or to switch products, and we know they’ve moved to point-of-sale marketing. If you go into the smaller stores particularly, you’re greeted by all these tobaccos posters on the windows, inside the shop and on the counter. Those kinds of things are going on every single day—and every year there’s a new crop of 10th-graders. So it disturbs me that so many of our states have reduced tobacco prevention programs and that, as a result, nationally we’re not making much headway.
NPH: And when you look back at your career, what other successes are you especially proud of?
Selecky: Another accomplishment I’d like to note would be our immunization rates. This is my 15th year in this position and we started at a pretty good place in terms of vaccination rates, but then there was a lot of media attention devoted to what turned out to be not very good science about thimerosal—a preservative in some vaccines—and a linkage to autism. Then individual vaccines were linked to autism. We now know that the science was bad, but it really had an impact on immunization rates in Washington State for our kids under age 3. We have worked very hard over this last decade with our provider community—because more than 90 percent of childhood immunizations are given in the private sector—to make sure that providers are equipped to deal with the misinformation that parents come in with. If you can make sure that children are vaccinated against childhood diseases, you really have made a difference in the health of the population. [Editor’s note: According to the U.S. Centers for Disease Control and Prevention, vaccine exemptions dropped from 6.2 percent in the 2009-2010 school year to 4.7 in the 2011-2012 year. The Seattle Times.]
And a third accomplishment I’d mention, and it has really taken all of us in the public health department to do this, is that even in these tough economic times we’ve worked to make sure that we’ve got a public health system—local, state and federal—so that when bad things happen, it’s seamless in terms of information and moving into action. Whether it was last year’s whooping cough epidemic in Washington State or the scare of a potential anthrax threat in 2001, I’m very proud of the fact that we’ve got a public health system that understands and respects each other here in Washington State.
NPH: In what ways do you think your training prepared you for your job, and what did you have to learn on the job?
Selecky: Well, clearly, the investment Robert Wood Johnson Foundation has made in the State Health Leadership Initiative has made a profound difference. I was in the inaugural class in 1999. Little did we know how important that week at Harvard would be—the opportunity to have a mentor, the opportunity to get to know your colleagues and work through issues together. We were from different walks of life, different parts of the country, but it has served us well. In terms of the on-the-job, you’ve got to know your own authorizing environment, what is essential for your governor’s priorities, how to work collaboratively with other state agencies to get something done because health certainly doesn’t do it alone. And there’s always going to be an issue of the day and you have to quickly move in and out of issues when you’re in a job like I’m in.
NPH: How has collaboration helped you achieve many of your public health goals for the state?
Selecky: I think the relationship between the state public health department and local departments in our state is unique in terms of how well we work together. We have individual roles, but we have a common mission, which is to protect and improve the health of the people in our state. We have been working together from the days when I was at the local agency level. We have been working on the Public Health Improvement Partnership, which is directed by the legislature to guide and strengthen the governmental public health system in Washington State. I recently chaired my last Partnership meeting and I realized that from the time setting the Partnership in motion was signed in 1995 I’ve been engaged the whole time. Partners include the School of Public Health at the University of Washington; tribal partners through the American Indian Health Commission; and state and local public health. My co-chair is from a local health department, and really it’s about how we hold each other accountable because we need each other. I cannot do my job at the state level without the engagement of local public health and they depend on us to be there for a resource they don’t have, such as a laboratory. So it really is about a system.
NPH: You had to contain a whooping cough outbreak last year. What do other states need to know about containing an outbreak?
Selecky: I think there are several things. Number one, relentless communication with the public, taking every opportunity you get, whether it’s print media or it’s radio or television media or social media. We took every opportunity. That, to me, was absolutely essentially. And we pooled together all the parts of the department that have anything to do with this kind of disease outbreak, and it actually involved more people than we thought. And we moved into an incident command for this epidemic. That’s a tool we didn’t have prior to September 11, 2001 and now has become part of the fabric of how we respond to critical things happening.
Another critical thing was understanding that we needed some help and requesting CDC epidemiology aid. They sent to Washington State a team of people who knew the most about whooping cough and were able to review our data, interview at the local level to sort out what was going on. So, really, this was an all-hands-on-deck kind of response. We had more than 4,900 confirmed cases of whooping cough last year. We normally have 500.
NPH: What are your top strategies you think every public health director should have in their back pocket?
- You’ve got to understand risk communication and take every chance you get to take a risk communication class or get coaching, because it will be your communication that helps you succeed.
- You cannot go into this kind of work and think that politics is bad. You may not like the way it plays out sometimes, but we are in governmental roles. I have a great respect for the institutions and the orderly transfer of government, of leadership that we get as governors change, for example. You’ve got to understand the authorizing environment because many of our health officials don’t come in from government.
- You have to gain the trust of the public because one day you say the water is not safe to drink and you want them to believe you and then five days later, you go back and say now the water is safe to drink and they need to believe you.
- Welcome every opportunity to speak with the media because that becomes your mouthpiece for the public, and sometimes we shy away from that.
- Surround yourself with people who are smarter than you are. Use their wise advice, but remember that you are the leader.
- Don’t be afraid to try something new. Push the envelope.