Monroe, who's deputy director of the Centers for Disease Control and Prevention, told the story of Jellyfish Lake, which is located in the Rock Islands of Palau. Millions of years ago, Jellyfish Lake formed as a landlocked saltwater lake, and the jellyfish got trapped, never to go to the ocean again. So they began to adapt. Their new environment didn't have the same old predators, so the jellyfish lost their stingers. They freely swim to the top of the lake to get sunlight and to the bottom to get rich nitrogen. The jellyfish have the lake to themselves — as Monroe said, they have a pretty good life.
Of course, this isn't a story entirely about jellyfish. Monroe was using it as a metaphor for the kind of adaptation and transformation that public health must undergo as well. During the Wednesday afternoon session on "Visions of the Future: A Leadership Challenge," Monroe, who moderated the session, said public health has to contemplate three things: What should we continue doing, what should we start doing and what should we stop doing.
Massachusetts Health Commissioner John Auerbach told attendees how his state has been transforming and adapting. Six years after the state adopted its own health reform law, 98 percent of Massachusetts residents, including 100 percent of children, are insured. But there's still work to be done, Auerbach said. He said there are five new challenges and skills that public health needs to work on.
First, zero in on the social and economic conditions that affect people's health and employ effective policy to shape those conditions. Second, hone new skills, enhance analytical skills and learn about health information technology. Third, clarify who the payers are and what the responsibilities of public health are. Fourth, be better at demonstrating the value of public health work, particularly prevention (ideally, he said public health should be able to show insurers the return on investment within 18 months). And fifth, link population health and clinical care, and provide input on what quality care entails.
Lillian Shirley, president of the National Association of County and City Health Officials, noted that each jurisdiction will have to struggle according to its own circumstances to make progress. Then Shirley made a well-received shout-out to her fellow nurses, calling on attendees not to overlook the contributions of the nursing workforce. (For example, she said folks in her state of Oregon are "hysterical" over a Medicaid expansion because they say there's not enough doctors; to which Shirley says: what about the role of nurses? Cue more applause.)
"How are we going to knit together all these really great things that are going on...and make it a system transformation," she said. "We have to put our shoulder to the wheel on that one."
Nancy Terwood, East Great Lakes regional director of the National Association of Local Boards of Health, called on attendees to "look at your board of health member as an untapped resource." She noted that board of health members "really are the voice of local public health...we can be your legs, your voices, your arms." Unfortunately, she said that a recent association survey found that boards of health members desperately need training in a variety of areas, including how to do self-assessments and how to advocate for public health. Boards of health members, she said, "want to learn about helping you."
When it comes to the health of American Indian communities, Paul Allis, director of public health programs at the National Indian Health Board, said there's been a lot of progress on partnerships between federal health officials and tribal ones. He noted that the movement toward accreditation is helping to elevate public health within tribal communities. Though he did say that tribal leaders want to interact with state, local or federal leaders, "from nation to nation."
Public health, Shirley said, attracts people to it because of its mission, vision and values. We're attractive to people who want to change the world, she said, so let's "capture that excitement."