Lillian Shirley, MPH, MPA, is director of the Multnomah County Health Department in Oregon and recently began her term as president of the National Association of County and City Health Officials. She is known as a leader and innovator at both the county and state level who helps collaborate with community partners to address health. We asked her about her work, the challenges and opportunities facing public health and her goals for the year ahead.
Why did you choose to work in the field of public health?
While working as a labor and delivery nurse, I was asked to assist the Public Health Communicable disease program with communication and support for the Southeast Asian refugee community. They asked me because prior to going to nursing school, I worked in a non-profit providing medical relief to these countries. I was hooked immediately on the practice of public health. The compelling mission, the quality of commitment of all the people working in public health, the interdisciplinary nature of the workforce, and the connection to community, are all factors that still contribute to my allegiance and loyalty to the field of public health.
Congratulations on the start of your recent term as president of NACCHO. How do you hope to impact the work of local public health in the coming year?
The passage of the Affordable Care Act is a landmark achievement in health policy. One of my top priorities is to increase the visibility of the role of public health that is embedded in the ACA with our policy-makers in Washington, D.C. On the other hand, I hope to work with local public health practitioners in navigating what this landmark legislation means for us and articulating how it is that public health work and the National Prevention Strategy are key to achieving the overall goals of the ACA.
You have said that in this tough economic climate, when faced with declining resources and acknowledging such a decline may be a long-term challenge, that focusing on prevention is key. How can health departments focus on prevention while facing cutbacks?
It is a time when we have to revisit our assumptions about the ‘how’ of accomplishing our mission. If we keep our focus on our goals and the outcomes we want for our community rather than the activities we are performing, it can open us up to identifying the upstream prevention strategies that we need to implement in our delivery of care. Each local public health department needs to analyze their own organizational models and services, however, we have the tools of the Accreditation Standards and the National Prevention Strategy and the Priority Areas for Improvement in Quality in Public Health to guide us and provide a framework for doing system change work.
You have been praised for protecting the core obligations of a public health agency. Can you share how that was possible, discussing the importance of adhering to the public health department’s “mission” of tackling the root causes of poor health?
Again here it is imperative for us to keep our focus on what we are trying to achieve. What is the end result of all our activities in our agencies? Each sector of the governmental public health system, federal, state and local, really has a covenant of sorts with the community to protect, assure and promote health. While there are many important public health interventions and prevention measures being carried out by our partners, we need to discern which role is appropriate for us and where we can have the most impact. For example, there are many programs and ideas we can bring to bear to address the greatest threats to health in our community, but we are the sector that can make use of regulatory tools around tobacco use, menu labeling, and food safety to protect our community and foster healthy outcomes. In clinical care, we can point out the barriers that lead to disparities in outcomes and identify the upstream causes that partners in our community need to address, whether they are the medical care system, the planning bureaus or our non-profit agency partners.
Do you feel it is still a challenge for the public health community to make the case for the health impacts of climate change? Should we be doing more in this arena?
It is a challenge and for many different reasons. One of the most significant is resource commitment to the issue. However, one way we can do more within our current public health practice is to describe our work in a more systematic frame. Across this nation, public health agencies have been on the front lines of severe weather events. These take the form of responding to emergencies like the tornado in Joplin, Mo., the floods in the Midwest and South, the heat emergencies and drought in other parts of the country, among others. California is now doing surveillance for Dengue Fever. We can provide a public health frame around protection and health promotion that identifies the consequences of these events without being trapped in ideological debates.
You are a long-time member of APHA. How is this membership valuable to you as a public health leader?
Absolutely. APHA, in its many dimensions, allows the public health community to come together from academic, practice and affiliate settings to share information, and debate the great issues before us in an environment where I can count on the values and principles that underlie these conversations. My own participation has evolved and changed from my years as a public health student, a public health nurse, a new manager and on the executive level, but at each stage in my own career, APHA has provided a place for me to grow my own understanding of the role public health must play in achieving “Healthy People in Healthy Communities.”
Video courtesy Robert Wood Johnson Foundation