Share Public Health Podcast Transcript: Staying relevant for public health 3.0. An Interview with Bobbie Berkowitz.

Season 1 Episode 14

Laurie Walkner Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast connecting you to public health topics, issues, and colleagues throughout our region and the country, highlighting that we all share in public health. Thank you for tuning into this series of interviews with public health leaders where we learn about different perspectives on current and emerging public health issues.

Suzanne Hawley Hi, welcome to our leadership series. My name is Suzanne Hawley and I’m from the Midwestern Public Health Training Center. Today we get to talk to a public health leader and learn about public health skills from a personal perspective, so Bobbie I’m really happy you’re here with us today and I would love it if you would just introduce yourself and share us- share with us a little bit about you and what got you into public health.

Bobbie Berkowitz Sure, well my name is Bobbie Berkowitz and I’ve been in public health and education and policy work for a very long time. I became a public health nurse, I hate to even tell you, but 1972- it was my first job out of nursing school- almost my first job out of nursing school and I just totally fell in love with the role. I’ve never been very far from either public health nursing or public health. My most recent- I worked at the State Health Department in, in Washington State and then was in a very- various local health departments. But recently I’ve been at Columbia University School of Nursing as the Dean there and just recently stepped out of that role and I’m looking for new- new adventures.

Hawley Great, great. So with all that you’ve done, I’m wondering: what excites you the most about public health now?

Berkowitz Well, public health, which is not new, public health is always in a state of constant flux and change and re-evaluation of what we do and what our role is, and that’s particularly so in public health nursing. And I think now there’s a- there’s a variety of new ways of thinking about our practice called Public Health 3.0, sort of a new variation of- of challenges that we’ve had for a very long time, which is you know in- in serving the public in terms of improving health status and, you know, reducing health disparities and improving health equity. The challenge has been at what point do we intervene in that work? Is it with individuals or is it whole communities and the globe? And what are the strategies we now use to do that- that’s both challenging and kind of scary, but I think it’s a very exciting time for both public health nursing but also for public health.

Hawley So, I love that you kind of threw in that idea of Public Health 3.0. I’m wondering if someone’s never heard that before and wondered just in a sentence- walking by down the street… what could you tell them about that?

Berkowitz Well, it- it really is sort of coalescing around a few basic premises of public health which we have always- we’ve always thought about and talked about. One is that our- our practice is really population-based. The idea is that if we spend all of our time downstream, in other words, working on problems that have already occurred, we can’t really improve the health of populations at large, so whole communities or cities or whatever, so big concept around population health big concepts around improving health equity and improving how people live and work. And, and, you know, gain access to- to what they need. So, the whole idea about determinants of health, but it also is- is wrapped around assessing the health status of communities at large, so not just you know one household at a time, but how healthy is a community and what parts of communities are not healthy and- and why, and intervening in that early. It also has a big policy component. Most of public health is a government-based process, and so, you know, what- what are the accountabilities and what are the processes? What’s the financing of public health? So, it’s a lot of fairly conceptual ideas, and I think our challenge with all the professions that are in public health, including public health nursing, is to see ourselves on that. So, what is it that- what is it exactly that I do with a community? Is it data, you know? Is it working with elected officials? Is it working with the primary care organizations? Is it working with a health system to bring the idea about health, and all to a point where we can actually imagine some interventions?

Hawley So, you know, you talked about some of 3.0 being- and not going downstream by going upstream, but I’m even thinking about the call to leadership of going upstream and- and really kind of moving past your organization, moving past your usual suspects, and in thinking about how to bring people together. So, I like how you said, you know, we’re just always in a state of flux right because, you know, we always think well this time- the, you know- when we think about the 21st century of public health issues coming, what do we need to do or what do public health professionals need to think about to handle change and to gain- engage in change management- as a kind of a strategic skill?

Berkowitz Well, all of this work for a very long time in public health- we have been wrestling with this idea of upstream thinking, but it’s been hard to get away from the day-to-day- the day-to-day challenges that occur in public health, so, you know, environmental health and food and water and air quality, and, you know, it’s a whole range of problems that public health, and then how healthy are people and what’s keeping them from being healthy? So, there’s all these all these challenges of public health people work with. So, the idea is to sort of try and get a different perspective on communities and populations- that’s one, but the, you know, the- the leadership around that… so there’s this- there’s this concept of the chief health strategist that’s part of this whole movement…

Hawley The 3.0.

Berkowitz In 3.0, and it’s actually been around for a while, but it’s- it’s becoming- more people are thinking a lot about it. I mean, that’s basically, you know, what we’ve called a health officer, you know, the way I think about that is that, so why couldn’t public health nurses be chief health strategists? I mean why can’t- why can’t we- why can’t we? So that’s a fun challenge- a fun challenge. I think that, I think one of the biggest challenges with all of this is, because we’re still trying to understand and define it, one of the big areas that were- we need to be working on is financing for all of this work. So, you know what is- it cost to really continue to evaluate a community’s health and then a set a set of strategies to intervene in assuring that health is a priority in communities? What do we do about health equity? I mean how do we approach that? What’s the fundamental process of improving the equity of people who live in this- in this country, and then do we have a global responsibility? Because, you know, the world is just not, you know, it’s- it’s- it’s the whole world now, whatever you talk about, it- it spreads, you know, it’s- it’s- it’s bigger than the U.S. anymore. So what do we do about that? So it’s all these complexities; all of that creates a real need for- for better financing of public health. We struggle with this forever- I think that- I think the data is that- if we did all the things that we’re talking about, it would be, you know, four point five billion dollars. Well, that sounds like a lot of money…

Hawley But that’s pretty achievable.

Berkowitz Actually, a lot.

Hawley I mean, we are pennies on the dollar, so a lot of money.

Berkowitz Yeah, so I think these are some of the, you know, around this rather conceptual thinking about health in the future and health now, and what we need to be doing. There’s a lot of challenges to put sort of the- the meat to the bone, and financing is a…

Hawley Finance, you’re right. Oh, I got to think about that- that idea of financing because, you know, you’re right. When you think about, okay, things are constantly changing. Are we really- need to rethink our role, and it’s just not local, but its global, and we need to have really- many ways of slicing and dicing how we conceptualize public health and- and that- that’s even managing all of that information is, in a way, change management, because it’s going to change tomorrow. Thinking about complexity- I’m now thinking about systems thinking and wondering, how do you feel like systems thinking is going to help our leaders kind of make progress on some of these daunting issues?

Berkowitz Well, you know, I think it’s critical, because if the literature that’s out there- not a lot of it- but that’s out there about this sort of challenge that we have about healthier- healthier populations, we need- we- we can’t- we can’t do it alone. I mean that’s clear. I think everybody agrees with that, so public health cannot do this challenge alone. We need all these partners, that’s one of the big premises of this- of this work, and each of these areas of sort of people’s key competencies. Public health has key competencies, health systems have key competencies, primary care has key competencies, government has key competencies. You know, communities, the way they- they organize and run, all have key competencies, but they’re all systems, you know, they’re all organized in systems, and that’s been one of our challenges is to get people to kind of break out and work together. So, systems thinking is, you know, if we line up all the actors in our interest in becoming health- a healthier planet, if you will, we have all these systems to draw from, but we have to be thinking about how you move a system to change, you know, to do things differently? To partner, which is different for some- some of the systems, it’s- it’s a different concept of partner, you know? We never used to think about public health and hospitals except with the- in the concept of the community benefit assessments that hospitals are required to do. There’s two very different systems that really you can’t do a community health assessment without a variety of- of partners, and so each of those systems need to really think differently about their contributions. So I think that’s a thing, that’s a big deal, and I think it’s a- it’s a set, you know, it’s a- it’s another competency to understand how systems work and- and how do you utilize them and how they learn, you know, how systems learn.

Hawley So, so you’re saying, you know, what I’m hearing is that, you know, it depends on the system that you’re working at in terms of who you partner with. But in terms of just, I’d say generally speaking to public health professionals, what are some of the partnerships that you think can help us, as a profession, to further a real conversation to move and progress public health?

Berkowitz Well, because I’ve been an educator for a long time, I think academic environments are an absolutely essential partner and system. They educate, that’s the- they’ve been tasked with educating the future workforce in public health, and as- academia has always lined up with practice and vice versa, but there’s a lot out there going on in terms of partnerships between the practice environment, including public health, but- but mostly in health systems partnering with academic institutions to create the kind of workforce that we need. And that’s that doesn’t seem like a hard thing to do, but it hasn’t been something that has come easily either for health systems or- or academia, but it’s not just health systems that need to do that. I mean, if we- if we look at the- the literature on what it takes to do the Public Health 3.0, it’s not just health systems or public health, you know, it’s all these other areas in a competency or workforce that needs to come to the table. So, you know, informatics and data science and all of that- that’s a- that needs to be a public health major public health competency because it’s something that we bring to- this we bring to the table. So I think there’s- I think there’s a, you know, a real opportunity here. I mean, I see that as- as a very positive to move forward to. I talked to primary care people about their responsibilities or role in public health. I hear a lot of enthusiasm, you know, I think they see that they’re a hub of a community. As well, hospitals see themselves as hubs of communities. So, you know, we’ve go-t probably got more in common than we don’t, but it’s been tough to bring people to the table and…

Hawley Yeah, I mean, you- you know, you talk about academia, which seems like you know a partner that would be, you know, kind of easy to think about or consider, but, you know, here I’m sitting- I’m in academia in public health, you’re in academia in the School of Nursing, and yet there still is that challenge for us to stay relevant within the practice community so they can really keep us-

Berkowitz Yeah.

Hawley -up-to-date and, and then how we kind of cross pollinate together I mean it’s- it’s hard to- to do that because each of us are working with the community, but sometimes, you know, we could always do a better job of talking to each other.

Berkowitz Right, right.

Hawley Well obviously not us.

Berkowitz But, you know, I mean the challenge in education is that we have, just as other organizations, we have key competencies that we educate- to- and those are- those are what you might consider such a certain amount of regulatory to get the workforce to the place where they can pass their exams and- and these safe clinicians and practitioners, and, you know, there’s a whole bunch of stuff that academics have to do and, and it, you know, when you educate nurses- let’s take nurses, for example. You’re not just educating nurses to be public health specialists, you’re educating for this whole realm of things to do, and now we’re really educating to be sort of population health ambassadors, so global- in my own university- global is a big deal. Global is a big deal because we see the necessity of working across- across countries and across continents, but we also see the value of culture, of bringing cultures together, so, you know, and for in- in public health nursing, I think there are other countries that are doing some really significant and innovative things and utilizing public health nurses that we know, we’re not- we’re not always doing. So bringing people together in a global context, I think is, you know, it’s not one of the core competencies, but it’s- it’s I think it’s essential and academia, I think has recognized that it doesn’t- does a lot of that global work, but that could be something that the health systems could do as well.

Hawley So, you know, thinking about connecting with global initiatives, learning from other countries, other models certainly beyond our local community, but all of that is going to take effective communication.

Berkowitz Oh, yeah.

Hawley You know, to make those partnerships happen, and I think about cultures and building trust. So what are some of your thoughts on what you feel are important communication skills and bridging those connections?

Berkowitz Well I’ll give you an example, this is something that we’ve been doing at Columbia Nursing. So we received a grant, the- Columbia University has global centers all over the- the world, and the- the purpose of those centers is really to create environments where people could come together from across cultures. It’s not workshops, it’s not, but it’s it’s a venue for- for really getting to know getting- to know other cultures- it’s really wonderful idea so we- we received a grant to bring- to get- and one of it in nursing, and this is an all professions, I think, but in our profession to sort of raise the bar for everybody about the ability to- to express research findings in- in journals. So it’s a skill, you know, writing a manuscript to get published is- it’s a big skill, and in the U.S. we just take it for granted that you do that, but that’s not ubiquitous. So, we were doing some work in- in Jordan and- and the Arabs, Arab countries, and in Africa, and this was an area that the nursing leaders in these areas expressed that they were interested in sort of learning that art and learning the art of getting published about key issues that they were working on. So we got this grant, went over there and met with- we convened in- in Jordan where we have a center and worked on manuscript development. We did these workshops and, you know, they would tell their stories and then we, you know, we’d help them and- and some of them- not all of them- got their papers published, and so that’s a, you know, that’s- and we learned probably more from them about the challenges that- that they were facing to just- to do, you know, to do day-to-day work. I mean we had one representative from- from Mosul whose School of Nursing got destroyed in the- got bombed and they have no school, but they were still- they were still doing what they could to prepare nurses, so that’s why I think global- sort of having a global mindset, it’s so critical to this working in public health.

Hawley Well, what you’re saying goes really beyond what I was even thinking, you know, and thinking about just mine- how narrow my thought was with okay what are just basic communication skills to be persuasive for your own, you know, for the gain of public health? But, you know, giving somebody else a voice through empowering them with communication skills, not that we have to give that story or say that story, but really what are these countries doing, and maybe some actually very innovative work with low resources. And have a story that they want to disseminate which we can do –

Berkowitz Yes.

Hawley Or we can help them, which is exciting today I want to do that!

Berkowitz Yeah, no it was, I mean, I was really more of an observer. It was our research folks that were that- were they were really doing the work and- and it went on for awhile, and there was a lot of consultation, and- but I would say from a lot of things we’ve done globally, this was such a such a wonderful experience in terms of working across cultures and for us, for a similar purpose, to transmit knowledge and information that could be utilized by- by more people. But just having a- needing a little sort of… showing the way a little bit- a little bit.

Hawley So, I appreciate how you’re elevating today, the idea of, you know, a global community and really opening up to other ways of thinking and learning through that. What are some other skills that maybe we haven’t talked about that you think about that could be important for people who really want to make progress on these public health issues?

Berkowitz Well I think, you know, the- again, this is a both a challenge and a skill. So, if we look at the Public Health 3.0, these are- these are concepts, but what we expect people to do is then to put them into action so then- then we’re talking about the practice of Public Health. So, it’s one thing to sort of conceptually think about assessing a community, it’s another thing to- to do it and then it’s even another thing to say who- who is sort of suited? What- how do we put together a team? Who is on that team? And then we have the complexities of the- of the disciplines. So 3.0 doesn’t talk about the disciplines, just talks about the concepts, but once we think about the workforce for public health, we have to think about, so who are these people? Say, do you have any thoughts about that? Or, you know, I well I have a lot of thoughts about it, but I think that- I think one of- the way forward is to- is to really, I mean, I think part of it is in education: to educate, to a role, and to think about. So in nursing, where are our skills would be best utilized in this sort of this idea about 3.0, I think, you know, the public health schools are certainly thinking about what- what do they need to educate – it certainly doesn’t look like it used to, so I think education is a big part of this, but I think, you know, the beauty of this and the challenge of this is that this is engaging- it’s way beyond the workforce. It’s really expecting communities to embrace what we have to offer to solve and prevent problems. So, I think the one that I think is for me personally and I think is- that’s the most challenging, is to really think about- is to really get a grip on the notion of health equity. Knowing that we serve, let’s just say we serve the globe, so when we think about health equity, what is the- what is the intervention there that belongs to public health? I mean it’s a rhetorical question because I’m not sure I know the answer, but I think that’s the kind of challenge we need to really be thinking through at a community level given every community has health equity challenges, but it’s not the only challenge we have. So I think the critical sort of nature of our work which in- in some ways has been defined through the through the 3.0, to understand how we educate to that- how we do research related to that for new innovation and to always keep our mind on the idea that we’re trying to prevent- we’re trying to prevent inequity.

Hawley So when you when you take those- those concepts and, you know, you build a team and then let’s just say it’s a team that- that sounds pretty good with academia and practice and perhaps even a business in a local community I’m wondering what that team needs to kind of try something, you know, together with their collective knowledge of the community and what they all bring to the table. If, you know, a new public health person is kind of on that team and thinking, “what do I do?” Would you have any advice for that- for?

Berkowitz I think, I mean, the- my sort of my sense of this notion of the chief health strategist, so this is my kind of interpretation of that- this- I see this is the person in communities who will get the get the people to the table and it’s a- it’s a big leadership role it’s- to get the people to the table to begin to work through those… what do we, you know, what in our community do we where can we be healthier? What do we need to change? What does our community look like? What does our population look like, you know? Who do we have that we can bring together, you know? That’s the community’s job, and I see this chief health strategist who is really the public health leader. I think it could be a nurse.

Hawley Yes, I think I’ve said that, but let’s say it one more time-

Berkowitz But I think- I see that is sort of the, you know, the- creating the- the synergy and the, you know, the dance that we’re all going to do together. Somebody has to create the excitement and the vision, and I think that’s what this person, what their responsibility is and, you know, if- if, that’s a- maybe that’s a role we need to begin to educate- to, but I think it’s basic, you know, it’s basic leadership stuff. It’s- it’s getting people together and- and, you know, hammering out a way forward.

Hawley Sure, sure. So are there any final thoughts that you have that you’d want to share about anything we’ve talked about today or?

Berkowitz Well, I’ll share with ya- share with you- yeah, my cat’s- I’m herding cats as my husband says, I’m on the glide path to retirement and one of the things I’ve taken on us his new kittens- literally, literally. You know, I think I’m very excited about public health nursing in the future, but I also have concerns because the ranks of public health nurses are shrinking, so where we used to have lots and lots of them in local health departments and in state health departments, the numbers of them are- are shrinking, and I think that it is big- this is my, you know, my sense of this is when we have slowly moved from a public health nurse having a role with individual families and their individual challenges and working with them on a day to day basis, you know, the all “going out into the community,” working in schools and working with families? We don’t do that much anymore, and that was- been a big role for public health nurses and I think the- the bringing public health nurses into the sort of new space, I don’t think it’s public health nurses. I don’t want to go there, but I just think it’s the- creating this new vision for the role that I’m not sure, I mean, this conference is talking- this is what this conference is about- is talking about, and there’s lots of examples throughout the conference about how public health nurses are doing that, but the fact is our ranks have shrunk and- and we’re still educating to the role, but I think a lot more of that is going on in schools of Public Health rather than schools of Nursing. So I think, you know, that’s a- that’s not a doom story, but I think we need to really think- think through the role which is why I’m so pleased that the conference is about public health nursing 3.0 to get people thinking about, you know, what do- what is our way forward and how do we stay relevant? And what is our, you know, what is our, you know, mission in public health?

Hawley And I love that we can be together today; that I could actually hear some of your ideas. So I know you’re maybe slight preference to a public health nurse being a chief strategist-

Berkowitz Absolutely.

Hawley [inaudible] sarcasm, so I would- thank you so much for your time today. I really enjoyed this time, Bobbie. And thank you so much, I hope you gain some insights with this leadership discussion, and we hope you will join us in a future leadership series.

Laurie Walkner Thank you for joining us today. Special thanks to our guests, Shirley Orr, executive director of the Association for Public Health Nurses, Suzanne Hawley, Roger Hileman, Melissa Richlen, Hannah Shultz, and Laurie Walkner.

Funding for this webinar is provided by the Health Resources and Services Administration. Please see the podcast notes for an evaluation and transcript.

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