Judith Monroe: Never Underestimate the Importance and Value of Health Officers Coming Together

Sep 13, 2012, 10:40 AM

Judith Monroe of CDC answers questions at ASTHO 2012 Judith Monroe of CDC answers questions at ASTHO 2012

The Office for State, Tribal, Local and Territorial Support (OSTLTS) at the Centers for Disease Control and Prevention (CDC), was launched in 2009 as a central office dedicated to advancing public health at the state and local levels and identifying both gaps and opportunities for collaboration. Judith Monroe, the office's director, spoke to us last year about challenges facing health departments in a tough time. Recently, at the ASTHO Annual Meeting, we had a chance to catch up with Dr. Monroe to hear what she and her office have been up to since we last spoke in the summer of 2011.

>>Read our earlier Q&A with Dr. Monroe.

NewPublicHealth: The focus of the ASTHO annual meeting this year is on the intersection of health care and public health. What efforts is CDC engaged in right now in that intersection?

Dr. Monroe: We’ve been involved in a number of areas. The IOM report on the integration of primary care and public health, was co-funded by the Health Resources and Services Administration and CDC. And CDC had a seat at the table when ASTHO and the IOM came together to develop the strategic map for the integration. We’re excited about that and we continue to be on those calls.

We have an office here at CDC recently created called the Office of Prevention Through Healthcare that is looking at this intersection and where the gains might be, working with the Centers for Medicare and Medicaid Services very closely. And, in addition, our office—the Office of State, Tribal, Local and Territorial Support—has forged a relationship with all of the primary care residency programs across the nation. That’s dear to my heart because I was a residency program director in family medicine for a number of years. We’ve had a number of educational venues taking the science from CDC and packaging it in a way that the residency programs can use. We’re looking toward some quality improvement projects with the residency programs as well as “playing matchmaker” in many ways, between health departments and residency programs. And, I am the point person here at CDC for our relationships between the American Academy of Family Physicians and the American College of Physicians so we have a lot going on. Those are the biggies, but there are many daily activities taking place as well.

NPH: Thank you for that overview. Since you’ve been at OSTLTS, what are some successes that you’d point to?

Dr. Monroe:   The National Public Health Improvement Initiative (NPHII) has been a big area for our office in terms of improvement, and that’s tied very closely to accreditation, which launched on September 14, 2011. Now here we are a year later and I think on the threshold of the first health departments in the nation being accredited.

The NPHII program was a big success for our office. It took a lot of heavy lifting to get it off the ground and we had the opportunity to launch it, as a five year program, through the Prevention and Public Health Fund. We’re ready to embark on year three, and in the first two years the credit really goes to the folks on the ground at the state, tribal, local and territorial health departments across the nation that have done some really meaningful work in terms of gaining efficiencies in their work and greater effectiveness in their work. We’ve got a whole storyboard of success stories on our website.

And a critical thing we’ve done is to really focus on quality improvement and performance management. We’re seeing more and more people across CDC recognizing the importance as well. And at our office we took on the Public Health Associate Program, which is a program where new CDC employees train in health departments for two years. We’ve grown that program. I think there were only 10 in the first class back in 2007, and this year we brought in a hundred new associates for the incoming class. I’m really proud of the team.

NPH: Tell us, us from your vantage point, about the success you’re seeing from partnerships to improve public health, including partnerships in the business community.

Dr. Monroe: I think we’re seeing more and more of those real examples, and the importance in my mind, is it’s the way we need to do business. If health department leadership is not reaching out to the private sector in their communities, whether that’s at the local level or the state level or at the national level, we’re missing an incredible opportunity to make things happen. When I was back in Indiana [as state health director] I did a lot of work with the private sector. Our governor, Governor Daniels, was very supportive of the public-private activities and initiatives, and so that was ingrained in me.

CDC reaches out to the private sector for a number of things including some of our preparedness efforts. If you look at H1N1, that was a dramatic example of where the private sector really stepped up and helped us such as some of the big pharmacy chains taking delivery of vaccines. I think we clearly are seeing more of that happening because I think again it’s kind of a mindset like performance management and quality improvement. Folks that have grown up and lived in the public sector needed to make a transition in their own minds to accept and embrace working with the private sector.

NPH: All the ASTHO President’s Challenges, since the one you started on physical activity, have had a significant impact across the country in drawing attention to critical public health issues including reducing preventable injuries and health disparities. Are you seeing other improvements in public health linked to actions and initiatives and innovations by state health officers?

Dr. Monroe: That is a terrific question. First of all, I just have to tell you, when I was at the ASTHO meeting last year and I heard the presentation by David Lakey of his president’s challenge I got chills. I was so proud of the work and I was sitting there now as a Fed wishing I had my own jurisdiction to take the charge back to.

I don’t think we can ever underestimate the importance and the value of health officers coming together and being inspired by others, seeing the way forward. We’ve got to remember most health officers don’t have the luxury of really long tenures, which means you’ve got to hit the ground running if you want to have impact. You’ve got to seize the moment, and they need that modeling. They really do need to see the models from those health officers that are a few years into it and that have figured out how to navigate the political waters, the policy, their staff and their partners. It’s complex work but you can have incredible influence if you navigate those waters properly. Personally, I think it matters so much that the health officers are able to convene at the ASTHO annual meeting and really get that inspiration.

This commentary originally appeared on the RWJF New Public Health blog.