Follow-up of my DC trip

Greetings,

After the debacle of “Snowquester” had passed, Washingtonians were feeling quite sheepish about shutting down the federal government for a non-event. Because of that, they were very accommodating to out-of-town visitors whose schedules had been needlessly disrupted so I had little difficulty rescheduling all my “Hill visits” for the following day.

Well stocked with talking points, charts and graphs, and “leave behinds,” I headed for Capitol Hill and a day of visiting members of the Minnesota Congressional delegation. As I met with members of Congress and their staffs in the Hart Senate Office Building or the Longworth or Rayburn House Office Buildings, the conversations generally focused on the need, despite budget deficits, to support basic public health infrastructure for the long-term benefit of our state and country. Specific discussions also occurred around the Public Health and Health Services Block Grant (something MDH has received since 1981 to support state and local public health services throughout Minnesota), the Prevention and Public Health Fund (part of the Affordable Care Act that funds Community Transformation Grants, quality improvement efforts, and environmental public health tracking, among others), Section 317 Immunization grants, and several more. However, as important as these issues are, most of the conversation revolved around Sequestration which had just gone into effect six days earlier.

There seemed to be consensus that Sequestration was not a good tool for making budget cuts, yet there was also consensus that it wouldn’t get resolved quickly. A great deal of blame and hostility was evident on both sides of the political aisle. Recognizing the animosity and divide between the two political parties, I left the Hill discouraged because it is obvious that the effort needed to sustain an effective public health system is going to be long and difficult.

On my way back to the hotel I saw a week-old sign in a bookstore touting the birthday of Theodor Seuss Geisel. [His birthday (3/2/1904) was the day after the Sequester began.] The day’s experiences made me immediately think of one of my favorite Dr. Seuss books, The Butter Battle Book, which begins:

On the last day of summer, ten hours before Fall…
my grandfather took me out to the wall.

For a while he stood silent. Then finally he said,
with a very sad shake of his very old head,
“As you know, on this side of the Wall we are Yooks.
On the far other side of this Wall live the Zooks.”

Then my grandfather said, “It’s high time that you knew
of the terribly horrible thing that Zooks do.
In every Zook house and in every Zook town
every Zook eats his bread with the butter side down!”

“But we Yooks, as you know, when we breakfast or sup,
spread our bread,” Grandpa said, “with the butter side up.
That’s the right, honest way!” Grandpa gritted his teeth.
“So you can’t trust a Zook who spreads bread underneath!

While the nuclear arms race was the basis of that story, Dr. Seuss could just as easily have used Sequestration or health care reform as his inspiration because, in Washington and throughout the country, people are using their Boom Blitzers, Blue Gooers, and Big-Boy Boomeroos to throw invectives at those who think differently than they do about deficit reduction and health care reform.

And what has this gotten us – a stalemate on most issues that affect the health and quality of life of everyone in our country and mutually assured destruction of anyone who tries to collaborate or compromise. Ironically, as Dr. Seuss clearly points out, what most people want is exactly the same – their bread and butter issues are similar. Most public health issues (safe food and water, safe and healthy environments, control of infectious diseases, healthy people at all ages, etc.), are bread and butter issues. Whether the butter is up or down, they shouldn’t be partisan issues.

As I continued on my cab ride, I wondered what it would take to get away from our current polarization on seemingly every issue of importance to our overall health. How could the voice of reason be heard among policy makers so they could come together and collaboratively develop rational health policies? It was then that it dawned on me that I wasn’t the only person from Minnesota visiting our congressional delegation on that day. At every office I saw Minnesotans raising their voices as they advocated for expanded bicycle use, affordable housing, women’s health, improved nutrition, expanded wetlands, and better health professional training in human and animal health. And these were just the ones I talked with in the waiting rooms. I’m sure there were many more throughout the day.

It was then that I realized the answer to my question also resided in another of my favorite Dr. Seuss stories, Horton Hears a Who.

"This", cried the Mayor, "is your town's darkest hour!
The time for all Whos who have blood that is red
To come to the aid of their country!", he said.
"We've GOT to make noises in greater amounts!
So, open your mouth, lad! For every voice counts!"

I hope my voice will help make a difference. That’s why I took the time to go to Washington. But I do know that my voice combined with your voice and those of our neighbors, family, and colleagues will certainly make a difference. For the collective good of our society, every voice is needed and every voice counts. For democracy to be effective it needs to be noisy. So, use your voice for public health and make some noise.

Ed

Greetings from D.C.

In the midst of Tuesday’s snow, I flew out of Minneapolis to attend the ASTHO (Association of State and Territorial Health Officials) board meeting and Day on the Hill in Washington D.C. My flight was delayed so I missed the morning meetings with the Assistant Secretary for Preparedness and Response, OMB Director for Health, and the Assistant to the President for Homeland Security. I was disappointed not only because I couldn’t meet with these folks but because I had never been in the Eisenhower Executive Office Building. My security clearance was for naught. Perhaps next year.

However, I was able to meet with the majority staff for the Senate Labor-HHS Appropriations Committee, and the majority staff for the House Labor-HHS Appropriations Committee. The two meetings were markedly different. Although both meetings focused on sequestration and the impact it would have on public health, the discussion in the Senate meeting was much more about the long-term strategy to protect and enhance public health. The House meeting discussion was much more about increasing efficiency, reducing duplication, and lowering spending. It was obvious that the 2 chambers have different agendas. Regardless of their differences, the bottom line in both meetings was that the next couple of years are going to be difficult ones for public health.

Of note with the Senate staffer was the discussion about Iowa Senator Harkin, who is on the Appropriations Committee and chairs the Health, Education, Labor, and Pensions Committee.  Senator Harkin has been a champion of public health and particularly the Community Transformation Grants and services to people with disabilities. He will not be running for reelection so the question was asked what he would be working on for the next two years. Besides specific public health issues, it was mentioned that he would be mentoring other Senators to take on leadership roles around public health. Of interest to those of us in Minnesota, Senator Al Franken’s name came up as someone who is being groomed to deal with chronic diseases.

This morning I woke up to the news that the federal government was closed because of the forecast of the biggest snowstorm of the season. Because of that, all my Hill visits were cancelled. Fortunately, we were able to hold the ASTHO board meeting today and I was able to reschedule all my Hill visits for Thursday. The irony in all of the weather drama was that there was no snow accumulation in D.C. all day. The temperature remained in the high 30s and the precipitation went back and forth between snow and rain. It was strange to have the federal government shut down because of snow when there was no snow. I hope tomorrow brings less drama.

Part of the ASTHO board agenda was honoring Mary Selecky one of its long-term members who will be retiring in the next couple of months. Mary has been the Secretary of Health for the State of Washington since 1999 and has served three governors. Her tenure is quite unusual. From what I’ve been told, the average tenure of a SHO is between 18 and 24 months. Since this was Mary’s last Board meeting, a surprise celebration party was held for her on Wednesday night. Many public health big-wigs showed up and said wonderful things about Mary. She has played a huge role in public health in the state of Washington and nationally. Most impressive, at least to me, was how she nurtured talent. She has been a mentor, supporter, and role model for hundreds of public health leaders throughout the country, including me. I think that will be one of her greatest legacies.

In talking about her entrance into public health and what has guided her throughout her career, she mentioned that as a child whenever she and her siblings complained about the chores they were required to do, her dad would recite the Henry Wadsworth Longfellow poem “A Psalm of Life.” The message she got from the poem and from her father was “don’t complain – do something to make the world better.” She then recited the following stanzas of the poem:

Life is real! Life is earnest!
And the grave is not its goal;
Dust thou art, to dust returnest,
Was not spoken of the soul.
Not enjoyment, and not sorrow,
Is our destined end or way;
But to act, that each to-morrow
Find us farther than to-day.
Lives of great men all remind us
We can make our lives sublime,
And, departing, leave behind us
Footprints on the sands of time;
Footprints, that perhaps another,
Sailing o'er life's solemn main,
A forlorn and shipwrecked brother,
Seeing, shall take heart again.
Let us, then, be up and doing,
With a heart for any fate;
Still achieving, still pursuing,
Learn to labor and to wait.

There were lots of misty eyes in the room when she finished. I also sensed that there was a renewed resolve among all present to follow Mary’s example and not let the problems of sequester and inadequate investment derail our public health efforts. Instead, I felt a new resolve in the group to “be up and doing” for the sake of the people we serve. Still, most of us acknowledged that, given our short tenure as SHOs, it is difficult to “Learn…to wait.”

Ed

Heritage Trail of Public Health

Greetings,

At the eastern edge of downtown Minneapolis, the Mississippi River Heritage Trail leads past some of the most important historical structures in Minnesota. At strategic points along the path, informational kiosks are provided to point out these structures and to highlight some of the significant events that occurred in the area. As I walked part of the Heritage Trail this weekend, I was struck by the numerous evolutionary (and sometimes revolutionary) changes that have occurred along this short stretch of river. Hiking the Heritage Trail was like taking a short course in the socioeconomic history of Minnesota.

The crown jewel of the Trail is the beautiful Stone Arch Bridge which was built by James J. Hill to allow expansion of his railroad empire into new territories. However, with the declining importance of the railroad in the country’s transportation system, the bridge became superfluous and stood idle and unused for many years. Twenty years ago it was refurbished to provide bicyclists and pedestrians access to both sides of the river and the historical treasures located there.

The rise and decline of the lumber industry is chronicled along the east side of the river. Spurred on by a bountiful supply of timber from the north woods and the easily accessible energy created by St. Anthony Falls, the Minneapolis lumber industry flourished and great fortunes were made until the supply of trees was depleted. In a relatively short period of time, Minneapolis went from being the leading producer of wood products to being a mere historical note in the evolution of the forest products industry.

The kiosks on the west bank of the river record the evolution of the flour industry in the area. They point out the flour mills of Pillsbury, General Mills, and the Washburn Crosby Company that made Minneapolis the center of flour trade in this county. They particularly note the building that, at one point in time, was the world’s largest producer of wooden flour barrels. Also noted is the fact that the barrel company went out of business four years after reaching that pinnacle; cloth flour sacks were invented and the market for flour barrels disappeared almost overnight. 

The final link in the Heritage Trail is the Hennepin Avenue Bridge. While providing thousands of cars daily access to the state’s largest city, the bridge also provides pedestrian access to the city’s earliest history. Because of the bridge, someone can travel from the oldest to the newest buildings in the city in just a few hundred paces. As I took those paces, I paused to watch the water of the Mississippi River flow under the bridge. The constantly flowing and ever-changing river reinforced the message that I had slowly assimilated during my brief walk along the Heritage Trail - the message that change is an integral and unavoidable part of our existence.  It is part of our history, it is part of our present, and it will be a part of our future.

Nowhere is that change more evident than in the field of public health where, on a daily basis, we see the emergence of new problems like fungal meningitis, ehrlichiosis, type 2 diabetes in children, and Alzheimer’s disease among others. At the same time, we are faced with budget deficits, the implementation of the Affordable Care Act, and discussions about the role of government in health; all of which greatly impact and change what we do.  

As we work our way through the 2013 legislative session, I wonder how we, as a state, will respond to these challenges. Will we be like the Stone Arch Bridge - a symbol of a vision limited to being a “railroad” and not a “transportation” industry? Will we be like the lumber industry that uses up all existing resources, leaving ourselves no support for the future? Will we be like the flour barrel company that couldn’t meet the challenge of a better and more efficient way of delivering a product? Or will we be like the Hennepin Avenue Bridge with a longer term vision that links the past with the present and is periodically refurbished so that it can continue doing important tasks well into the future? And can we be like the Mississippi River which fluidly responds to all the forces on all sides while continuing to set its own steady course to the sea? 

Long range planning and having a vision for the future we would like to create is vitally important but how we prepare ourselves to respond to the unpredictable and immediate outside forces is just as important. Although many of these forces are beyond our control, our responses are not.  How we respond will be part of our Heritage Trail linking our present with both our past and future. I am confident that at MDH we can embrace and integrate both a short and long-term vision of public health and effectively articulate that vision to state policy makers. Because of that, I look forward to walking with you down that Heritage Trail of Public Health with smiles on our faces while creating smiles on the faces of all Minnesotans as we go.

Ed

Reflections - Inauguration Day

On November 15, 1953 my father took me to my first Packer football game at the Green Bay City Stadium which served as the home field for the Packers and the East High School Red Devils. The Packers were playing the Detroit Lions. The Packers lost 14 to 7 but that was far from the most memorable thing that happened that day.

In those days, kids got to sit by themselves on the field behind the end zone and got to walk around behind the team benches during the game. As a 7 year old, I was more interested in wandering and witnessing the spectacle of the afternoon than in the actual football game so I spent more time behind the bench than on the end zone grass. It was during that wandering time that I saw Bobby Mann, an offensive end wearing number 87. He was the first African-American that I had ever seen.  

On our walk home from the game I peppered my dad with questions about the football player who didn't look like any of the rest of the players. I particularly wondered why there weren't others like him on the team or in our city and why I didn't see him around town like many of the other players. I remember specifically what my dad said. “He’s a Negro and he comes from Detroit. He’s allowed to live in Green Bay only during the football season. Then he has to leave.  While he’s here, he has to live in a cabin behind Krolls (a restaurant near the edge of town).”  

To me that didn't seem fair. My dad agreed but said, “That’s the way things are right now. Let’s hope that they change in the future. Maybe your generation can do that.”  

Ten years later I was a senior in high school playing football in hand-me-down Packer equipment thanks to the connections of our coach Ted Fritch, a member of the Packer Hall of Fame. At that point, nearly half of the Packers were African-American. After football practice on August 29th, the day after Martin Luther King, Jr. gave his “I have a dream” speech, I shared my 1953 experience with Coach Fritch. His response was similar to that of my father ten years earlier. “We’ve made a lot of progress (in integrating our society) since then but a whole lot more needs to be done. I’m hoping that your generation will be able to do that.” 

I thought of those two events 60 and 50 years ago as I listened to Justice Sonia Sotomayor swear in Vice President Biden and President Obama give his second inaugural address. It was evident that we have made tremendous progress. Probably more than my father or Coach Fritch could have imagined. And it deserves celebration. But still, my mind kept telling me that so much more needs to be done. My emotions were conflicted.  

As I work in public health, my first instinct is to follow Geoffrey Vickers’ definition of public health – “the continual redefining of the unacceptable.” At its core, this is a glass half empty view of the world, especially when our data demonstrate that racial and ethnic disparities are present in all aspects of our society. But today’s events and the reflections that they prompted reminded me that the Vickers perspective is only half of the public health equation. The other half comes from the Institute of Medicine definition of public health – “what we, as a society, do collectively to assure the conditions in which people can be healthy. “

Sixty years ago my dad knew things weren’t right but he had hopes and dreams that they could be made better – perhaps by my generation. Fifty years ago, my coach knew much more had to be done to achieve racial equality and hoped that the kids he was coaching could help make that happen. Certainly, Martin Luther King, Jr. knew the extent of the problems of inequity in our society but he articulated a dream 50 years ago that still resonates.  

Today, our President, an African-American, articulated a similar message. While noting and celebrating that we have made tremendous progress, he acknowledged that there are still problems and that there is still much to be done. In fact, he noted that the work will never be done. “We must act knowing that our work will be imperfect. We must act knowing that today’s victories will be only partial, and that it will be up to those who stand here in four years and 40 years and 400 years hence to advance the timeless spirit once conferred to us in a spare Philadelphia hall.” He also challenged us to continually work together to assure the conditions in which people can be healthy. “That is our generation’s task, to make these works, these rights, these values of life and liberty and the pursuit of happiness real for every American.” As I heard those words, I silently hoped that my generation had done its part in setting the stage for those tasks.

Our work, the work of public health and the work toward social justice, will also never be done.  There will always be unacceptable problems and there will always be a need to work to assure health for all. But, as my mother said when she heard of our conversation on the way home from the football game in 1953, “Life can be unfair and unjust but it’s not unchangeable. If you want, you can help change what you saw today. Just remember, to whom much is given, much is expected.”  

Ed 

Happy New Year

Holiday Greetings,

Darkness is the predominant theme in the weeks surrounding the Winter Solstice in the Northern Hemisphere. Almost every culture and every religion throughout history has marked this time of the year with various celebrations or symbols commemorating the movement from darkness to light. (For information on some of the Winter Solstice celebrations throughout the world check out http://en.wikipedia.org/wiki/Winter_solstice.) Given my Germanic background, the Christmas tree has been one of the predominant symbols of light in my family at this time of the year. The choosing, cutting, placing, and decorating of the tree have always been surrounded with numerous rituals and traditions. That’s why this year was such a departure from tradition when, for the first time in my life, I put up an “artificial tree.”  

While assembling and decorating the “tree,” I wondered how this change would affect our holiday celebrations. I worried that I might lose some connections to the past. I wished that circumstances hadn't changed so much that an artificial tree was necessary. As I pondered the uncertainty of this holiday season, my musings brought me back to age 8, the first time that I was actively involved in the Christmas tree rituals.  

In many respects, the 1954 Christmas season was like that of any other during my childhood. The four weeks of December had been used by our family as a time for the emotional and spiritual preparation for Christmas, while most of the physical preparations were postponed until Christmas Eve day. During that day the tree had to be trimmed, the house cleaned, the baking done, and our hand-made gifts given last-minute finishing touches.  

One of the things that made this Christmas different was that my dad brought me along on Christmas Eve morning to pick out our Christmas trees - yes TREES! By December 24 most tree lots were nearly empty and trees were almost being given away, so my dad got two for the price of one. I thought this was a pretty good deal until I looked at the trees and saw how scrawny they were. Tears came to my eyes and I whined to my dad that neither one of those trees would be as beautiful as the ones that had graced our living room in previous years.

It was then that my dad confided in me that he always got 2 trees and that they always looked horrible at first. He promised that he would show me how to use some Christmas magic to make one of them look beautiful. When we got home, I received my first lesson in branch transplantation. We took the best looking of the two trees and at every bare spot drilled a hole in the trunk. A branch from the other tree (the donor tree) was then carefully harvested and inserted with surgical precision into one of the holes. After transplanting 4 or 5 branches, our 99 cents tree looked better than the ones in the downtown department store windows. When we brought the tree into the house it received universal acclaim as the best tree ever.  

As we sat around the decorated tree that evening, exchanging our hand-made gifts, my parents were impressed with how we all had transformed plain wood, paper, leather, or clay into beautiful gifts. My mother remarked that “it’s not what you have that matters but rather what you do with what you’ve got.” My dad then looked at me and said, “Yes, even scrawny pine trees can become beautiful Christmas trees, if you use a bit of creativity and imagination. But,” he continued, “it’s not just things that can be transformed. Every moment of every day is an opportunity for transformation. What you do with that opportunity is up to you.”  

That memory of 1954 comforted me as I finished decorating our 2012 Christmas tree. I knew that the holidays would be wonderful even with an “artificial tree” because the season wasn't really about the tree but about the personal moments of the holiday and what we made of them.    

Those distant memories reoccurred again today, New Year’s Eve, as I began to look forward to my 3rd year at MDH. I know that we face lots of public health problems and challenges; and I know that in many respects now, with state and federal deficits and a distrust of government by some, is a dark time for public health and for public employees. However, I also realize that each of these challenges is an opportunity for positive transformation, depending on how we respond to that opportunity. Knowing that I’m part of a great public health team that understands how to collectively take advantage of any opportunity, gives me a sense of optimism as I look forward to another year. You’ve modeled very well in the past how to seize opportunities and I’m confident you’ll continue to do that in the New Year. I’m blessed to be part of a team that knows how to do the best with what we’ve got and how to move forward despite challenging circumstances.  

As we move into the New Year, my resolution is to work with all of you, as a department, to bring the light of public health to Minnesota in a way that transforms the darkness of poor health, missed opportunities, and disparities into a long-lasting season of health for all Minnesotans. 

Happy New Year,

Ed

Violence is a public health problem

Greetings,

On April 16, 2007, I was in Florida on vacation from my job at Boynton Health Service. I was rocking my 8 day old grandson when my daughter hollered from another room, “Dad, something bad is happening at Virginia Tech.” When I walked into her study and saw the headlines on her computer screen, my mind immediately traveled to Blacksburg, Virginia where I pictured my college health and counseling friends and colleagues at Virginia Tech in the midst of a nightmare that had become a frightening and deadly reality. I knew they would be among the people responding to the carnage that had occurred, but given the stressed and distressed students who seek assistance every day at college health and counseling services, my first thought was for their personal safety. I silently hoped that my friends had been spared physical injuries so that they would be available to help others with recovery and not have to first deal with their own.

Unconsciously, my mind quickly jumped to my own campus, a large urban university with a complex and diverse student body 850 miles from Virginia Tech. While the University of Minnesota has many unique characteristics and is located in a markedly different part of the country, it has more similarities to Virginia Tech and other post-secondary institutions than differences. What was happening in Blacksburg could have been happening on any college campus anywhere in the country.  

Five years later I was in the middle of the State Community Health Services Advisory Committee (SCHSAC) meeting when I heard the news from Newtown, Connecticut that multiple students and staff at the Sandy Hook Elementary School had been shot. With a sense of déjà vu, my mind traveled to the Connecticut school where I pictured the well-rehearsed response of school, law enforcement, and medical personnel doing what they were trained to do in the face of great danger and tragedy. But my mind also jumped to the elementary schools in Blaine, MN and Jacksonville, FL where my grandchildren are matriculating. 

My mind travels and my sense of fear, anger, and disbelief reminded me that all of us are affected by violence wherever it occurs. No one and no area is immune to these kinds of events. We are all vulnerable.  Having had shooting events at Red Lake and Rocori High School reinforces that vulnerability. 

In 2007 I felt an intensely personal connection to the tragedy that had occurred. I’m feeling the same way about last week’s tragedy in Connecticut. This personal connection makes me want to do something as an individual to keep similar events from happening again; but what can an individual do? Looking back on 2007 when I was monitoring a terrible situation with an 8 month old in my arms, I realized that what I had done in raising my children, getting involved in their schools and in our neighborhood, coaching soccer, volunteering with special needs individuals, and being a present and supportive father and grandfather were probably the best things that I could have personally done to help prevent similar events in the future. The importance of staying involved in the lives of one’s children, grandchildren, and community is probably no different today. 

However, as someone working in public health, there is also a profound professional obligation to work to prevent these kinds of events from happening again. Violence is a major public health problem. It affects a large number of individuals directly and it affects everyone in our society indirectly. It affects both our physical and our emotional health and it detracts from our ability to optimally enjoy our environment and our society. It is also a problem that is preventable. The precursors of violence are evident throughout our society – adverse childhood experiences (ACEs), unaddressed (or ineffectively addressed) mental health problems, bullying, easy access to firearms, racial and economic disparities, sexual exploitation, family disruption, substance abuse, lack of economic opportunity, media messages, and many more. While all of these have been seemingly intractable problems, we should not assume that they are impossible to change. I believe they are amenable to changes in appropriate policies, in the environment that fosters violent behaviors, and in the social, education, and mental health systems that fail to effectively deal with troubled individuals.

The precursors to violence can be changed with a systematic and comprehensive approach. We need to review whatever epidemiological information we have on violence and determine what other information is needed. We need to learn more about “best practices” and/or “evidence-based” approaches to violence reduction. And we need to solicit partners in the effort to prevent violence, if it is to be successful. We also need to recognize that implementing these measures will take a long-term commitment to some bold actions and changing some of the ingrained patterns of functioning in our society.

As I watched my daughter care for her infant son in 2007, I realized that all of the work that people do to reduce poverty, improve child development, support families, foster social justice, increase educational achievement, enhance communication, and strengthen parent-child bonds serves to prevent myriad future physical and mental health problems. These, in-turn, help to prevent violence. There is no vaccine that will prevent violence, but I’m hoping that what we do today to address all forms of violence in our communities through policy, systems, and environmental change will help reduce the problem and alleviate the worry and the fears from my grandchildren and all children so that they can reach their full potential and help lead us all into a more peaceful future.

Ed

Greetings from Arizona

Greetings,

I’m sorry that I had to miss this morning’s First Monday meeting.  I was in Scottsdale, Arizona attending an Association for State and Territorial Health Officers (ASTHO) Board meeting.  While you may dream about changing places with me - your being in a cloudy 38 degree environment while I’m in a sunny 75 degree one – consider the fact that it’s quite disheartening to be in a pleasant environment and not be able to enjoy it.  Because of the packed agenda, I was not able to get outside at any point during the entire day.  Being in a meeting and seeing the palm trees, green grass, and  people in short sleeve shirts enjoying the day and not be able to join them is less than pleasant.  I continue to make the case to ASTHO that, since we never get to enjoy the city where the meeting is held, it would be much more efficient to simply hold our meetings at the O’Hare Hilton. 

Despite the environment issues, the board meeting was quite good.  We covered a multitude of topics that are pertinent to our activities at MDH.  Given the late hour, I’ll share just a couple of things that I heard – things that are relevant to our budget and to the functioning of our department. 

As most Minnesotans have heard, the Governor is concerned about three things:  balancing the budget in a fair and equitable way, creating jobs, and providing children with a quality education.  If you don’t happen to be part of the Department of Labor and Industry, the Department of Employment and Economic Development, the Department of Revenue, or the Department of Education, you might wonder how you might fit into the upcoming budget discussions. 

What I heard today should give us some hope.  Several states mentioned that major corporations had been considering establishing new plants/operations in their states but backed-off because of the increasing rate of obesity in those states.  The message was that obesity means both an unhealthy workforce and an environment that does not support health.  Since poor health is a drag on the bottom-line of business, a healthy population is a major determinant of where they want to do their business.  These anecdotes reinforce the view that health is a major determinant of a vibrant economic environment.  For the sake of jobs, we need to invest in health – health that prevents disease and disability.  That needs to be a part of our budget presentation.

The other thing in the Board meeting that particularly caught my attention came out of our discussion about the characteristics of a good board member and a good leader.  Among the characteristics of a good leader listed by ASTHO board members - good listener, integrity, strategic thinking, courageous, honest, value driven, etc. – one stood out for me.  It was the characteristic of humility.  Really good leaders are humble.  That is, they recognize that their view of the world is incomplete and that they need to hear the points of view of others. 

As Commissioner, I’m officially the leader of MDH.  In that role I have to deal with all of the things that MDH is responsible for.  I’ve come to realize that I know a lot about a few things, I know a little bit about a lot of things, and I know nothing about some things.  Yet, I have to speak about and represent MDH on all of the issues within the MDH portfolio.  Because of that, there are many instances when I need to hear the points of view and the expertise and the advice of others.  From my perspective, I don’t know if this is humility or simply honesty.  I’ve come to realize that “it takes a village to support a health commissioner.” 

I’m appreciative of all the help that MDH staff have given me over the last 2 years and I look forward to even more consultation.  It has been invaluable.  It reinforces the wisdom of the Institute of Medicine definition of public health – “what we, as a society, do collectively to assure the conditions in which people can be healthy.”

Thanks for all your help.

Ed