Faces of Public Health: John Auerbach, Commissioner of the Massachusetts Department of Health

Jun 6, 2011, 4:51 PM, Posted by NewPublicHealth

Each year the Association of State and Territorial Health Officers (ASTHO) establishes a Presidential Challenge that becomes a focus for public health efforts on a particular public health issue at state health departments across the country. The challenge set by John Auerbach, M.D--the current ASTHO president as well as Commissioner of the Massachusetts Department of Public Health--is reducing health disparities and achieving healthy equity in the United States.

NewPublicHealth recently spoke with Commissioner Auerbach about the initiative’s activities and goals.

NPH: Tell us a little bit about some of the work you’ve done toward reducing disparities and inequities as health commissioner, even before you became president of ASTHO.

John Auerbach: Sure. We didn’t have a line item, we still don’t have a line item, that says “eliminate racial and ethnic health disparities.” So we wanted to start by doing things that could be done inexpensively but had the potential for positive outcomes. So one place we started was doing detailed data analysis. And we thought that was important as a way to start because what we believe about racial and ethnic disparities is that they’re driven by the data. They’re not driven by our sense of social justice or our beliefs that it is a good social program based upon our sense of fairness. We really actually do believe that. We think that public health needs to justify its prioritization by being able to say, this isn’t just a gut instinct that we have that people are not treated fairly.

We rely on data, and, if questioned, we’ll show you exactly why this needs to be a priority. So we did a complicated data analysis that looked at a lot of different populations in an attempt to say, is race and ethnicity really a central lens through which we can examine disparities? And what we’ve found in doing that analysis was that in the vast majority of health indicators that we measured, we could see disturbing and significantly large gaps in terms of pre-mature death and poor health outcomes. And we analyzed that and then we published it in a way that focused in entirely on that subject matter rather than the way it’s been done historically.

So the data allowed us to approach legislators, policy makers, community agencies, foundations, and say, we think there’s a strong foundation for building this work.

NPH: And what were your next steps?

John Auerbach: We then, trying not to spend too much money, decided that we would apply the lens of data to each of the different program areas that we have to examine the race and ethnicity of the target populations in their particular health arena and make sure that they were appropriately aligning the resources for those programs to the populations at this proportionate risk. We said hey, you’ve got a public information campaign on asthma and it’s not targeted towards black and Latino residents of the state--even though the childhood asthma rates are much higher among those populations. It’s not a good idea to do a general population asthma campaign when we see that level of disparity. Let’s think about something more targeted. So we did that again and again and again where the data suggested that it was necessary.

NPH: You are coming up on six months since the President’s Challenge and inequities and disparities were launched. Have you received any feedback from the states?

John Auerbach: I have. I’ve heard from a number of states that they have developed innovative approaches to dealing with disparities using the information and the collaborative approach that we developed through ASTHO.

So, for example, in Virginia, they’re doing some very good work around disparities looking at key health indicators and focusing their attention on campaigns that specifically address those issues.

There are several other states--Virginia just came to mind because I was talking with them earlier--but a number of states, for example, with large Native American populations, who have talked about strengthening those efforts as well. There are some campaigns that are now being developed around premature birth in the southern states where they are crafting those programs with a mindfulness to the racial and ethnic disparities.

NPH: Once the year is over, what will keep the focus on this issue?

John Auerbach: I am hopeful and really quite confident that we’re beginning to see some significant changes in the way that public health operates in regard to prioritizing racial and ethnic disparities. Certainly, the work that’s been done at the Federal level, the release of the Federal report (PDF) on the elimination of disparities that just came out, combined with the Center for Disease Control’s first time ever-comprehensive report on disparities that was released a few months ago, is so significant. Combined with organizations like ASTHO, APHA [the American Public Health Association] and NACCHO [the National Association of County and City Health Officials], all saying this needs to be part of our mission is so significant. It needs to be not simply one campaign that we might be involved in for a year and then we move on, but it really needs to be part of who we are as an organization. And ASTHO has written into its core activities, as part of its strategic mission, a continued high-level focus on the elimination of racial and ethnic disparities. We don’t think it’s something that should be focused on in short-term. It needs to be focused on consistently long-term-and in a coordinated way at all levels of both the public and private sector.

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