Public Health Leadership: The Art of Balancing Advocacy and Inquiry

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Public Health Leadership The Art of Balancing
Advocacy and Inquiry

• Richard A. Aronson, MD, MPH
• February 2002

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Essential Purpose of MCH

• Beyond pathology, morbidity, mortality, risk
  oriented approach
• Foster capacity and strength in families and
  communities community change as key factor in
  improved health
• Foster potential of all children and families to
  dignify their lives and that of their communities.

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Health Mind, Body, Spirit

• How we live together the quality of our
  relationships influences our health
• Human beings, at their best, seek connections,
  support and celebrate each other
• Draw on our creativity, humor, gifts
• We pay least attention to spirit in health care.
  More than 95 health care goes to modern
  medical technology

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Fundamental Assumptions of MCH

• Security of society physical, mental,
  emotional, and spiritual health of children and
  families - Title V 1935 (Eleanor Roosevelts
  role)
• Health of families depends on healthy communities
  and systems to support them.
• Empowerment as internal process.

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MCH

• Making
• Community
• Happen

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The Access Challenge

• Even with the best insurance coverage, optimal
  child care, transportation, reasonable hours,
  one-stop co-location of services, and individual
  motivation
• If the health care environment is not a welcoming
  one that honors people and affirms their power to
  heal themselves
• Then why, already burdened, choose to go?

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Definition of Cultural Competence

• Cultural competence is a set of congruent
  behaviors, attitudes, and policies that come
  together in a system, agency, or among
  professionals and enable that system, agency, or
  those professions to work effectively in cross
  cultural situations.
• National Center for Cultural Competence
• http//www.dml.georgetown.edu/depts/pediatrics/guc
  dc/cultural.html

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Why the Need for Cultural Competence?

• Respond to demographic changes in U.S.
• Eliminate long-standing disparities in health
  status according to race, ethnicity, and culture.
• Meet legislative, regulatory, accreditation
  mandates.
• Improve the quality of services and health
  outcomes, including optimal access
• Gain competitive edge in marketplace
• Decrease likelihood of liability/malpractice
  claims

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Cultural Diversity in Treating the Common Cold

• Isolation
• Hot steam
• Orange juice, Vitamin C, and go to school
• Go to the Doctor and get a Strep culture
• Diaper pinned to pajamas with Vicks
• Brandy
• Goose grease
• Whiskey and water
• Chicken soup
• Mustard plasters
• Honey and lemon
• Garlic

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5 Essential Elements for Cultural Competence

• Valuing and celebrating diversity
• Capacity for cultural self-assessment
• Awareness of the dynamics inherent when cultures
  interact (Ethnocentricity)
• Systemic adaptations to service delivery that
  show an understanding of diversity
• Institutionalized knowledge and respect

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The Cultural Competence Continuum

• Cultural Destructiveness (Racism, classism, etc.)
• Cultural Incapacity (Unintentional systemic bias)
• Cultural Blindness (Expressed philosophy of being
  unbiased)
• Cultural Pre-Competence (Realization of
  weaknesses, strengths and needs assessments)
• Cultural competence (Genuine respect for cultural
  differences, ongoing self-assessment)
• Cultural proficiency (culture as core to who we
  are)

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Interview Questions for Cultural Competence

• How would you incorporate a familys
  culture-specific and spiritual beliefs into a
  home visit for a pregnant woman?
• How would you make a conference family-friendly
  one that includes families as key stakeholders?

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MCH Five Guiding Principles
PHILOSOPHY
Cultural Competence
Cultural Competence
Family Centered Care
Community Leadership
THE FAMILY
THE FAMILY
Capacity and Resiliency
Outreach
POLICY
SERVICE
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Principles of Community Wide Leadership

• Vision - Create rather than solve
• Collaboration - Honor all stakeholders as
  partners and experts
• Risk - Let go of turf and become open to new ways
  of doing business
• Leadership as a great learning

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Future Search Process

• Whole system participation
• Global context, local action
• Focus on common ground and desired future
• All voices validated
• Shared leadership and self-management
• Everyone is an expert

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What Is a Future Search

• Unique conference used world-wide by hundreds of
  communities and organizations
• Helps large diverse groups discover values,
  purposes, and projects they hold in common
• Enables people to create a desired future
  together and to start action right away
• Helpful in uncertain, fast-changing situations
• Include people with a stake in the issue,
  creating unlikely new partnerships and enlarging
  potential for leaning and action

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Leadership Paradigm Change

• Leadership is like cow manure. If you spread it
  all around, everything grows. If you put it all
  in one place, it stinks.
• Life is a series of golden opportunities
  carefully disguised as unsolvable problems.
• Experts solving problems (1900) to everyone as an
  expert creating a shared vision and action plan
  to achieve it (2000).

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Balancing Inquiry and Advocacy (Senge)

• Managers trained to be advocates - solve
  problems, figure out what needs to be done,
  enlist support to get it done.
• Inquiry skills involve questioning, listening,
  learning - leads to including all voices.
• Pure advocacy - positions become rigid, limited.
• Pure inquiry - hides our own view
• Balance - learn from each other and find the best
  action

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Resiliency and Assets

• Capacity of children, families, neighborhoods,
  communities to bounce back and do really well
• Power of people to recover, heal, grow, and
  succeed in the midst of change
• Equip people and communities with tools to
  empower themselves
• Focus on strengths and celebrate success

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Resiliency at Individual Level

• Flexible and Adaptive (Werner and Smith)
• Problem Solving, Planning Skills (Rutter)
• Internal Sense of Power, Locus of Control
• Sense of Purpose and Optimism
• As human beings, our greatness is not so much
  in remaking the worldas in remaking ourselves
  -Ghandi

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Community Resiliency

• Rich in social support networks (Garbarino,
  Kawachi)
• Associations (McKnight, Putnam)
• Shared vision and purpose (Weisbord)
• Resources for healthy child development - health
  care, child care, parenting support, job
  training, employment, housing, recreation

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African American Family Resiliency (McManus)

• Importance of extended family for support
• Male spouses/partners
• Education, Employment, Income
• More likely to interact with people not in family

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African American Family Resiliency Project

• Resilient families attended church with greater
  frequency
• Resilient families more mobile.
• Ownership of automobile
• Non-resilient families more likely to feel
  powerless, helpless, and inept.

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Public Health Physician Leadership Examples

• Setting direction and policy to achieve 2010
  public health objectives
• Reduce health disparities
• Consult with Healthy Start Projects
• Maternal mortality review
• Analyze and use data to drive policy
• Newborn Screening Program
• MCH Program Advisory Committee
• Medical and Dental Home Initiative
• Inter-disciplinary collaboration
• Incorporation of cultural and linguistic
  competence into systems
• Home visitation programs

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References

• Aronson RA. Transforming MCH to enhance the
  health and safety of children, families, and
  communities in Wisconsin A work in progress.
  Wisconsin Medical Journal 2000 9918-24.
• Berkman LF and Kawachi (eds). Social
  Epidemiology. Oxford University Press, 2000.
• Putnam RD. Bowling Alone The Collapse and
  Renewal of American Community. Simon and
  Schuster. New York, 2000.
• Senge PM. The Art and Practice of the Learning
  Organization. Currency Doubleday. New York, 1994.
• Weisbord M and Janoff S. Future Search An Action
  Guide to Finding Common Ground in Organizations
  and Communities. Berrett-Koehler Publishers. San
  Francisco, 2000.

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The test of a civilization is the way it cares
for its children Pearl Buck We must lean to
live together as brothers and sisters, or we
shall perish together as fools Rev. Martin
Luther King, Jr.
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For Further Information

• Richard A. Aronson
• (W) [phone]
• (F) [phone]
• aronsra_at_dhfs.state.wi.us