Washington State Becomes "Go-To" State for Public Health Best Practices

    • October 18, 2010

Mary C. Selecky has been the top public health official in Washington—a job with an average tenure of three-and-a-half years nationwide—since 1998. One key to her longevity is her ability to stay on top of the issues and to navigate the ever-changing political and policy environment. Another secret to her success has been the experience she gained from the Robert Wood Johnson Foundation (RWJF) State Health Leadership Initiative, which she took part in shortly after taking office.

As secretary of the Washington State Department of Health, Selecky is responsible for 1,500 employees and a biennial budget of nearly $1 billion, an undertaking which she says has been made easier by the RWJF program—"a lifeline to get through the tough times." Selecky was one of 12 members of the initial class of the State Health Leadership Initiative in 1999 or, as she jokingly refers to her colleagues, "The Dirty Dozen." She credits the program's five-day leadership retreat at the Kennedy School of Government at Harvard with helping her learn how to achieve public health goals within the context of her environment. "It really challenges you to look at the bigger picture and get a sense of the political context and authorizing environment," says Selecky.

Learning to See the Big Picture. The safe environment for learning provided by the program was crucial. She still taps into the network of support and expertise she established during the program with her colleagues and the Kennedy School faculty, and she continues to support it as a facilitator and advisory board member.

"These are fishbowl jobs—not much can be hidden. When you get an experience like having a week with colleagues in an environment that's all about helping you learn, it creates a solid foundation for success," Selecky explains. "There's no other place you can let your hair down and connect with someone who's going through the same things you are, and will hear your story."

Each state health official participating in the initiative receives funds for customized technical assistance. Selecky used hers for personal coaching on creating a public presence and public speaking, and also supported communications coaching for her senior management team.

Creating Innovations in Public Health. Under Selecky's leadership, the Washington State Department of Health has become the "go-to" state for public health best practices. For example, the Public Health Accreditation Board used the state's public health standards in developing accreditation standards for health departments nationwide. The Department of Health uses these standards to assess all local public health departments and divisions of the state health department every three years.

Tobacco prevention and control is one of Selecky's priorities. Washington State has one of the nation's lowest adult smoking rates, thanks to work that she led beginning in 1999. Back then, Washington was 20th on the list; today it is third. Between 1999 and 2008, adult smoking dropped 30 percent and youth smoking dropped 50 percent.

Using best practices from the U.S. Centers for Disease Control and Prevention and funding from the tobacco Master Settlement Agreement, the Washington State Department of Health started a program focused on supporting smokers who were ready to quit, keeping kids from starting, and making policy changes. "We made it easy to reach the quitline, which hooked-up people who were insured to helpful resources, and helped those without insurance get nicotine therapy and other help," says Selecky.

The program targeted kids through the radio stations they listened to and at school. It also worked with schools to make them tobacco-free zones and to enforce no-smoking-on-school-grounds policies.

Advocates took advantage of the state's work to push for a smoke-free law. Passed in 2005, this law makes it illegal to smoke in indoor public places and workplaces in the state.

"Tobacco is a compelling story. This is one of those opportunities where I've been here long enough to see the outcome," Selecky says. "One of my colleagues said, 'When you become a state health official, figure out what your priority is and get to work on it, because you don't have a lot of time to make a difference."

As it has turned out, Selecky's longevity in her position has allowed her to see the completion of several other important projects with a national impact-including shellfish industry regulations and new tests for E-coli bacteria. "Several years ago we had a lot of illness across the country from Washington State oysters (and other oysters) affected by bacteria that made people sick. Our staff identified better handling practices. We tested them and they've now been adopted as national standards," she explains.

Improving State Public Health's Effectiveness: Having watched state health officials participate in the RWJF State Health Leadership Initiative since its inception, Selecky can step back and look at the impact of the program. For state health officials who are new to public policy, the program provides quick immersion and the survival skills needed to navigate the public policy world, she says. Selecky also credits the initiative with increasing interactions between state and federal public health agencies and the presence of state health officials at the national policy table.

"The position of state health official pulls you in several directions. You're the manager of a large bureaucratic organization that requires your attention to the direction the agency is going, not the nitty-gritty details," Selecky says. "Having an up-to-date mission, vision and goals is important. They can't just sit on the shelf; you must keep them current in the context of your state, the political environment and the important public health issues of the time."

Leading State and Local Public Health: Selecky helped create the Washington Department of Health, separating it out from being part of an umbrella agency that also handled welfare, Medicaid and juvenile rehabilitation. Before that, Selecky managed the Northeast Tri-County Health District in Colville, Wash., for 20 years. She has a bachelor's degree in history and political science from the University of Pennsylvania.

Selecky is also a clinical associate professor at the University of Washington School of Public Health and Community Medicine. In 2009, she received the Association of Territorial and Health Officials Presidential Meritorious Service Award in recognition of her exemplary leadership.

"To be a state health leader is a privilege," Selecky says.

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 level and work as strategically as possible with the resources available to them."