Advancing the Agenda for a Healthier Population in New Hampshire

    • October 18, 2010

After earning his medical degree from the National University of Colombia in Bogotá in 1986, José Their Montero, MD, worked in the jungles of Colombia to meet his social service requirement. This work involved a mix of patient care and public health projects such as organizing a tuberculosis program and a diarrhea prevention campaign. In one town, he was the only doctor.

Montero had planned to become a plastic surgeon, but after seeing "that people had so many needs," he decided to focus on public health. He spent the next few years completing his medical training in family medicine, health communication and preventive medicine in both Colombia and the United States, at the University of Texas and the University of Alabama at Birmingham. He then held various positions in public health in Colombia for nearly 10 years. He was director of health promotion and disease prevention for the Colombian health ministry and an adviser to the Social Security Institute and a local health system in Bogotá.

Montero moved to the United States to work in public health, joining the New Hampshire Department of Health and Human Services as chief of the Bureau of Communicable Disease Control in the Division of Public Health Services in 1999. Six years later, he was promoted to state epidemiologist. In 2008, he became the division's director.

Building political savvy and efficiency. Being the state's top public health official is both incredibly interesting, says Montero, and very challenging-though an expert in public health, he needed to learn how to navigate the political environment to be able to improve the health of the public in New Hampshire. "The state has a strong libertarian mantra-trying to create programs to tell people not to do things in public health doesn't work here," Montero explains. "We need to be creative and engage the community in grassroots efforts to create change."

Participating in the Robert Wood Johnson Foundation (RWJF) State Health Leadership Initiative is helping Montero build political savvy and learn to work more efficiently. The program's five-day leadership retreat at the Kennedy School of Government at Harvard, as well as his interactions with other state health officials there, have enabled him to build key skills and to gain "fresh ways to look at some things," he says.

Montero is using his program network to increase his leadership capacity.

"The program creates a network of people you can call any time. Having people across the country who are dealing with similar things has been great," he says.

Focusing on Chronic Disease Care and Prevention. Integrating the funding and management of the state's chronic disease programs and positioning the Division of Public Health to play a key role in health care reform are two of Montero's priorities. Traditionally, each of the state's programs for chronic diseases (e.g., cancer and heart disease) has been funded and run separately. Montero wants to increase operational efficiency and look at the outcomes in an integrated way. By putting together the maternal and child health and tobacco programs, for example, the division can see how many pregnant women get smoking cessation services and how many quit. A group is reviewing other programs to develop common outcomes.

Montero also wants to develop best practices for health promotion statewide, and to work with health care providers to help prevent chronic diseases and promote health. The health promotion fund in health care reform legislation, with its focus on preventive care, provides this opportunity.

"Public health is in an historical position to advance the agenda of a healthier population," says Montero.

Participants in the RWJF program also receive funds for customized technical assistance. Montero plans to use his for training his senior management team, perhaps in health care reform.

Improving Health Care for Children. In 2010, Montero was named Public Citizen of the Year by the NH Pediatric Society, the New Hampshire chapter of the American Academy of Pediatrics, for his work on vaccination. "We have a fully universal vaccination program, with all vaccines paid for all populations in the state under age 18," says Montero, who worked with the society to build support for the legislation that funded this program. He also worked with the society to improve newborn screening and obtain funding for maternal and child health care programs.

Montero also received the 2009 Friend of Public Health award from New Hampshire Public Health Association for his efforts to make public health more visible and credible statewide by working with the legislature and the media. He is an adjunct assistant professor at the University of New Hampshire's School of Health and Human Services and Dartmouth Medical School's department of community and family medicine.

RWJF Perspective: The State Health Leadership Initiative seeks to make state public health systems more effective by accelerating the leadership capacity of new state health officials. Because of the diverse demands of the job, few people have the necessary mix of policy, political and scientific knowledge plus experience. The initiative provides training, mentoring and other tailored support.

"Strategic leadership skills are critical to state public health officials' ability to achieve their goals of improving the health of people in their states. This requires knowledge, networks, access to evidence, ability to form partnerships, skills in performance management resource allocation and, most important, knowing how to navigate the very political environment of the state executive branch," said Pamela G. Russo, MD, MPH, a senior program officer on RWJF's Public Health Team.

"The State Health Leadership Initiative enables new state health officials to rapidly connect with networks of current and former state health officials, get intensive case-based training on leadership, have the help of the national organization to move policy change at both the state and national levels and work as strategically as possible with the resources available to them."