What qualities contribute to effective state health officials (SHOs)? Public health leadership has been analyzed and written about, but few studies have examined the personal characteristics and experiences of state health leaders and what their leadership looks like in the context of their state.
State Health Officials – Career Achievement and Sustainability Evaluation
In partnership with Association of State and Territorial Health Officials (ASTHO) and the de Beaumont Foundation, this project explores the experience of SHOs through interviews, surveys, and research.
By determining the model of a successful SHO, governors and secretaries will have a national resource of state health official historical data to better understand and analyze the qualities and backgrounds of potential candidates, to best prepare them for the job and to avoid career derailment.
Over the next year, the project team will share their findings through a series of presentations, articles, and more.
For more information about ongoing work, please reach out to Valerie Yeager at email@example.com.
Resources and learning tools
The SHO-CASE study has developed a series of pocket guides for users, as well as an infographic that highlights the trends among SHOs.
Current and former state health officials share their individual experiences as health leaders, and provide insights and advice for aspiring SHOs and anyone interested in the role of state health officials or public health leadership.Watch now
Description of the video:
Ed: What does success look like to you as you reflect back on your tenure as a state health director?
John: I think that the biggest indicator of success is being able to point to some sign, some concrete sign that health actually improved as a result of actions that I took, or I took in partnership with other people at the department. Ideally, that's improved health and some indication that people were healthier as a result of our policies or our programs. It may be other surrogate markers that are suggestive of success, but I think that would be the gold standard. I'd settle for a silver standard that had to do with improving awareness, knowledge, perhaps attitudes in some measurable way, that were more supportive of public health or of activities that would promote health.
Hugh: What's your definition of success? What's success in public health for a state health officer?
Nicole: For a state health official, in my view, success means that you're able to bring some of your own skillsets, talents, gifts and abilities to a state public health agency; be able to embed with and add to the expertise that already exists there; and advance that agency to another level prior to leaving. For example, from my perspective, our agency had a real focus on health equity. And my entire career has involved a commitment to eliminating disparities, and achieving health equity, and making sure that there is equitable access to services and care for people. Bringing those together has been a signature goal for me, to be able to make sure that our Health Equity Zones Initiative that the department had already birthed, that I was able to join with and take to the next level in promoting it at the state level, is successful. We want it to be successful. We want it to be sustained. For me, one of the demonstrations of success will be that by the time I leave the Health Equity Zones Initiative it is not only successful, institutionalized, and well-embedded into our state system with sustainable funding for making the difference that it's intended to, going forward.
Ed: What does success look like to you when you reflect back on your term as the director of the state health department in Maryland?
Benjamin: Well, my goals when I was coming in as a state health official—I had come in as being the Deputy, and I moved to being Secretary—I absolutely wanted to make sure that I had ultimately improved the health of the people in Maryland. That was my ultimate goal. We were really excited, because we actually think we achieved it while I was there.
Ed: What in your mind’s eye does success look like when you think back about your term as a State Health Official?"
Devlin: Well, Ed, when I look back on my years as a State Health Official and think about what success looks like, I remember that we chose a few priorities, because there are so many issues in public health that need to be addressed, and that we're working on. But, I decided what were the things that I wanted to be able to say, "During my time, we made a difference on school health; on preparedness, on disparities, and building the public health infrastructure was another priority, and working on Women and Children's issues." So, we had those five broad priority areas and how do we move policy? Were we able to put new programs or shore up existing services? What were the partnerships we developed, and did we have impact in the end through those different strategies?
Hugh: Let’s just start off with your definition of success. What’s a… What is a successful state health, officer?
Engel: Well, I have to look at my environment, which is the state of North Carolina, and, I think, in my state, the Health Director role is, actually, defined in statute, and it has to be a physician licensed in that state. That is, pretty much, it. But, in reality, in my time, I think, the success was a dual role. The Health Director needed to wear the hat of the Surgeon General, that is, the subject matter in the public health science of the state, and the second role, is a leader and manager of a very division, within the department of Health and Human Services, that division being the division of Public Health. So, I think, success was mainly due to wearing those two hats, simultaneously, being that valued, trusted, credible public health scientist, as well as a really good manager leading a very complicated division, and an even more complicated department.
Hugh: What is success?
Halverson: It’s interesting. I’ll answer that question by first telling you a bit of a story. When I first arrived in Arkansas as the State Health Commissioner you may remember it was after the unfortunate and untimely death of Dr. Fay Boozman who was in that role and died in a farm accident. That, in and of itself you know, was a public health issue. When I first came to be in that role, I had a chance to go around to all of our 75 counties and 93 offices. I did that over a year but one of the first trips I made I actually went to a rural part of Arkansas and had a chance to really drive in the neighborhoods in small towns. Usually that meant going on dirt roads. Frequently it meant just trying to get a sense of where people live and what their conditions were that they lived in every day. Inherently, I knew it was different than what I lived at. What I found was and I’ll never get it out of my mind was children playing in a dirty street and there was just something about it. As I talked to people in the community I discovered that many of these kids hadn’t had anything to eat and there really were problems in terms of malnutrition and just not having the sense that they will really have a full meal. Not really having the advantages, I think, that a lot of people. We would all like to say that our kids can grow up and have a carefree life and these kids didn’t. It was interesting to me. It set the stage for what to me is success and that is being able to intervene, to create the conditions under which people really can be healthy. To me, take it another step forward and say it’s really about giving kids hope, right? Not just the kids, but their parents. As we all live together in communities it seems to me that one of the most important things that we could strive for in terms of public health is the success of providing the opportunity for people to have hope that tomorrow will be better than today. That there is reason to believe that because of public health there is a better tomorrow. I’m sorry, maybe it sounds corny. To me, it was a driving force to say, “You know, we can do better than this.” So that has been on my mind along with a number of other things about how I wanted to change the way that we lived, worked, played and worked together as a community.
Hugh: What is your definition of success for a state health officer?
Harmon: I think the first thing is to have a successful relationship with different leadership bodies in the state. The Governor’s Office, the legislature, the local health departments, the non- profits so that you can have a successful agenda with your legislation. Your budget is very important and the different programs. Then with all of that to be able to continue in your job for a reasonable period of time so that you have long enough to bring those programs and initiatives to a successful completion and continuation.
Hugh: As a state health officer, what does success mean? What is a successful state health officer?
Lloyd: Well, times have changed so much, as you know, Hugh. We have a situation now where most of the health officers are at super agencies. I think one of the greatest parts of being a health officer in Connecticut is I reported directly to the governor, which was Tom Meskill and then Ella Grasso. When she died, that was Bill O'Neill.
Hugh: What was success?
Lloyd: Well, we were very successful in many different ways. First of all, we had the first hospice in the United States in Branford. I've been back to see that several times. I remember the day we got a call on the Lyme arthritis. Annie was my secretary. She said, "There's this woman on the line, and she's nearly hysterical because of these large things on her." It was Lyme arthritis, named for Lyme, Connecticut. We were the second state in the United States to have a rate setting commission. That was back in the days of certificate of need. Of course, they don't do that now; they negotiate with health plans. We were the second state in the country to have an EMS system. Indiana, I think, was the first.
Hugh: What’s your definition of success as a State Health Officer? What is that?
Lumpkin: I think success of a Public Health Officer at the state level is threefold to the extent that they create the conditions in which local public health can be successful. Health and public health occurs at the local level where people live, learn, work and play. The State Health Agency’s primary job is to make sure that that happens at the local level and that could occur through working through local health agencies or through direct action by the State Health Agency itself. The second measure of success is to the extent in which the broader health context is addressed. That means initially working with other state agencies whose primary purpose may not be health, but who have a direct impact upon the health of the people in that state. That includes the Department of Education, Department of Transportation, as well as others that are more likely suspects like Human Services. Then, the third measure of success is the extent in which the Public Health Director, the Public Health Official improves the functioning of their agency through adoption of quality-improvement methods, through the focus on innovation and a persistence of focus upon the workforce to help improve the qualifications and capacity of that workforce to be able to carry out our continuing public health mission.
Hugh: What is your definition of a successful state health officer?
Monroe: I have to tell you, Hugh, my definition of a successful state health officer is someone, to be honest, first and foremost, that enjoys the job and enjoys engaging with the public, and with the legislators, and with their governor and all the stakeholders, because I think that's one of the keys to success. Going from there, if you get those relationships well established and you're enjoying it, then you can take on the challenges. Honestly, as a state health officer you do want to see some policy advance. So that's one of the successes is if you've advanced really good public health policy in your state, which is not an easy thing to accomplish, by the way. If you get the stakeholders and the coalitions, begin to build coalitions or promote coalitions that have already been established that are actually doing good work, I think that's another characteristic of a successful state health officer.
Hugh: I'd love to hear your definition of success from your own experience and maybe a few of the factors that you think made you successful.
Mary: Approaching that term "success" is very interesting when you're at the state level because, depending on the issue, it might be a very quick issue with a quick turnaround, and what you're hoping is that you're really going to have a longer-term impact on the population in your state. As I think about success it's always wonderful to have hindsight and to look back and say, what was that thing that really made a difference? I was very fortunate that I got to serve multiple governors for a number of years. And a big issue for us was tobacco prevention, for example, but it took 10 years to see what difference that made. We did get a smoke-free state, and you see that pretty quickly. You do get some numbers that tell you kids are starting to smoke less. But you're looking for, what's that health impact? And as we got more adults to quit we actually saw a reduction in respiratory diseases showing up in hospitals. Success can look like an epidemiology curve. Success can be a good headline that thanks the department of health for doing something very well. Success can also be an okay nod from a governor giving you an attagirl or an attaboy for following through on something that was very tough.
High Turnover Among State Health Of cials/Public Health Directors: Implications for the Public’s Health
State health officials (SHOs) serve a critical role as the leaders of state public health systems. Despite their many responsibilities, there is no formal process for preparation to become an SHO, and few requirements influence the selection of an SHO. Furthermore, to date, no studies have examined SHO tenure or their experiences.
State Health Officials—Defining Success and Identifying Critical Success Factors
Governmental health agencies at the state level are traditionally led by appointed state health officials (SHOs). While there have been SHOs leading our nation’s state health agencies since their creation, little is known about the personal and professional characteristics or organizational factors that make those occupying these key positions successful.
What State Health Officials Wish They Had Known and How They Learned Best
Most SHOs function as the chief executive of cers (CEOs) of their health departments. However, unlike most CEOs, many SHOs come to the position not having had extensive managerial experience and, like- wise, lack experience in a governmental setting, in public health, or both.
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