Public Health Leadership During the COVID-19 Pandemic

The Harvard Business School identifies six characteristics of an effective leader: the ability to influence others, transparency (to an extent), encouraging risk-taking and innovation, integrity, decisiveness, and the ability to balance hard truths with optimism.¹ While there are obvious differences between the private sector and public health, there is much to draw from this distillation.

As the health of the country is ultimately dependent upon the success of our emergency preparedness and response efforts, particularly with regard to infectious disease threats, it is imperative that our public health leaders, at the local, state, and national level, are exceptionally effective. In order to ensure this is the case, they must be equipped with accurate information in real-time, have the support to implement necessary interventions, and have the capability—in the face of chaos—to lead.

Public Health: Leadership Training Required

The need for training and expertise in public health leadership is not a new concept—an Institute of Medicine report calling for greater competency in public health practitioners was published more than 30 years ago²—nor is globalization, nor pandemics. However, in the current environment of explosive social media and critical social issues at a tipping point, it is fair to say that public health leadership has never been more important.

What we are experiencing now with the COVID-19 pandemic is a confluence of concerns:

• The economics of health or the social determinants of health (SDOH), which include adequate nutrition, housing, and transportation—not to mention the impact of lost wages and health insurance
• Mental health challenges, including the toxic stress of racism and health disparities, and the unintended consequences of social isolation
• Physical health, including both the immediate and long-term consequences of SARS-CoV-2 infection, particularly its exacerbation of underlying chronic conditions.

The National Public Health Leadership Network³ established a framework for ensuring well-trained and effective public health leaders. Top among the four core competencies was leadership transformation manifested by

• Visionary leadership
• Sense of mission
• Being an effective change agent

More recently, a study looking at the effectiveness of leadership teams within public health found the competency most relevant to local health department executives was “interaction with interrelated systems.”⁴

What We Need Now from Public Health: Four Leadership Requirements

As the global community waits for an effective treatment and the widespread availability of vaccine, what we need are effective risk reduction strategies and strong public health leadership. Here are four suggestions to get us there.

1. Exceptional Communication. Risk management is predicated upon communication. There has been a dearth of data, a lack of transparency, misinformation, and disinformation throughout the COVID pandemic. Moreover, we do not simply need data, we need understanding. Public health needs to educate (and re-educate) themselves and the public—what we know, what we don’t know, why we don’t know it, and when we think we will. Public health must be the “go to,” existing outside the political landscape, for accurate and trusted information.
2. Partnership and Trust. Public health needs to establish partnerships and build trust with community organizations, the healthcare system, other government agencies, the private sector, and, most importantly, the public, so that when information does become available it will be accepted. Public health needs to anticipate the unanticipated (e.g., the secondary consequences of social distancing including worsening substance use and increased risk of domestic violence).
3. Managing Fear. Fear comes from the unknown; people abhor a vacuum. In the absence of trusted information, people will listen to anyone who speaks loudly. Clear, accurate, timely, and consistent messaging is essential. We need resources to support our community and we must reassure the public that we are listening.
4. Focus on Infrastructure. To be the source of accurate data, we need better data collection systems. The United States has a fragmented data ecosystem lacking interoperability even within the public health and healthcare sectors. We must continue to develop our health IT capabilities and infrastructure and maintain it once this pandemic has resolved. We must continue to expand and strengthen telehealth and care coordination, contact tracing and outreach, vaccine registries, and the integration of the non-traditional sources of SDOH data—all of which depends upon health IT. Pandemics are a recurring part of our global ecosystem, and new pathogens of public health importance will continue to emerge. And what we build now helps to keep us healthy and well.

Public health’s ability to respond swiftly and effectively must be in place before a crisis; developing a response system during a pandemic is like building the plane while you’re flying.

Notes

1. Landry, Lauren. “Six Characteristics of an Effective Leader.” Harvard Business School Online. October 4, 2018. https://online.hbs.edu/blog/post/characteristics-of-an-effective-leader.
2. Institute of Medicine (US) Committee for the Study of the Future of Public Health. The Future of Public Health. Washington (DC): National Academies Press (US); 1988. www.ncbi.nlm.nih.gov/books/NBK218218.
3. Wright K et al. “Competency Development in Public Health Leadership.” American Journal of Public Health. October 10, 2011. https://pubmed.ncbi.nlm.nih.gov/10936996/#affiliation-1.
4. Jadhav, Emmanuel D. et al. “Leadership for Public Health 3.0: A Preliminary Assessment of Competencies for Local Health Department Leaders.” Front Public Health. October 6, 2017. https://pubmed.ncbi.nlm.nih.gov/29085819/.

References

The Centers for Disease Control and Prevention. “Advancing Public Health: The Story of the National Public Health Improvement Initiative.” https://www.cdc.gov/publichealthgateway/docs/nphii/compendium.pdf.

DeSalvo, Karen B. et al. “Public Health 3.0: Time for an Update.” American Journal of Public Health. March 9, 2016. https://ajph.aphapublications.org/doi/10.2105/AJPH.2016.303063.

DeSalvo, Karen B. and Claire Y. Wang. “Public Health 3.0: A New Vision Requiring an Invigorated Workforce.” Pedagogy in Health Promotion. March 11, 2017. https://journals.sagepub.com/doi/10.1177/2373379917697334.

Figueroa, Carah Alyssa et al. “Priorities and challenges for health leadership and workforce management globally: a rapid review.” BMC Health Services Research. April 24, 2019. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4080-7.

Institute of Medicine, Committee on Assuring the Health of the Public in the 21st Century. For the Public’s Health: Investing in a Healthier Future. Washington, DC: National Academies Press (2012). http://www.nap.edu/catalog.php?record_id=13268.

Institute of Medicine (US) Committee for the Study of the Future of Public Health. The Future of Public Health. Washington (DC): National Academies Press (US); 1988. https://www.ncbi.nlm.nih.gov/books/NBK218218/doi:%2010.17226/1091/.

Umble, Karl et al. “The National Public Health Leadership Institute: Evaluation of a Team-Based Approach to Developing Collaborative Public Health Leaders.” American Journal of Public Health. October 2, 2004. https://ajph.aphapublications.org/doi/10.2105/AJPH.2004.047993.

Wiesner, PJ et al. “Taking training seriously: a policy statement on public health training.” Journal of Public Health Management Practice. Fall 1995. https://pubmed.ncbi.nlm.nih.gov/10186644/.

Wright, K et al. “Competency Development in Public Health Leadership.” American Journal of Public Health. August 2000. www.researchgate.net/publication/12383680_Competency_development_in_public_health_leadership.

Yphantides, Nick, Steven Escoboza, and Nick Macchione. “Leadership in Public Health.” Frontiers Public Health. February 26, 2015. https://pubmed.ncbi.nlm.nih.gov/25767792/.

Jenifer Leaf Jaeger (jenifer.jaeger@healthec.com) is the senior medical director, HealthEC.