Learning to Lead

“First you have to understand the problem and the goals, then you have to decide what the solutions are based on the science, then you have to effectively share that vision, prove the solutions, build partnerships, and carry through to the desired outcome,” says Dean Linda P. Fried, MD, MPH.

Classes that examine environmental or sociological determinants of health, for example, help students to better realize the first part of the equation: figuring out the problem. Then, since science must guide everything a public health leader does, there are classes that teach how to understand public health goals and measure outcomes, sift through large datasets, and analyze the most effective solutions. And finally, because public health leaders must convince politicians, business leaders, political activists, and others of the value of health interventions, there are classes that focus on leadership and skills such as team management, negotiation, effective communication, and conflict resolution. “Public health leaders need to lead based on vision and evidence. They need to be able to have difficult conversations, and to be flexible,” Fried says. Meet seven alumni who are bringing these lessons to life and sharing their own.

LEADERSHIP LESSON:     

WORK BACKWARD RESULTS

Amina Evangelista Swanepoel, MIA/MPH ’08, studied program planning with Linda Cushman, PhD, professor of Population and Family Health, and says that knowledge has been invaluable in helping her start an organization that provides reproductive health classes and contraception in the Philippines. “It’s basically starting at the end, thinking about what impact you want to have, and working your way back,” she says
of Cushman’s prescription for effective planning.

Swanepoel hadn’t envisioned immediately returning to the country where she grew up (her father is Filipino, and her mother is American). But after she graduated, her mother, a professor at Palawan State University, called. Her mother said that her students were having unplanned pregnancies—would Swanepoel and her husband, a teacher, consider moving to Palawan to help her start a program to educate them about sexual and reproductive health? In 2009, the three founded Roots of Health and began teaching classes at the university. Eight months later, they expanded to local high schools and hired nurses to distribute contraceptives. Then in 2017, Swanepoel, as Roots of Health’s executive director, expanded its scope. “Even at the height of what we were doing on our own, we were reaching only several thousand women,” she says. “To bring population-level change, we had to get the government on board.” Roots of Health now lobbies officials to get them to spend more on the prevention of HIV and unplanned pregnancy.

To make sure she’s on track with Roots of Health’s objectives, Swanepoel regularly conducts pre- and post-intervention surveys with stakeholders. Cushman taught her the importance of carefully worded survey questions; the professor would throw out an exam question if more than 20 percent of students got it wrong, reasoning that it wasn’t worded correctly. Funders are amazed that her organization puts so much effort into monitoring and evaluating impact because for many nonprofits that can be an after-thought. “When they ask me how we knew that monitoring and evaluation was so important, I always say, ‘Because I went to public health school.’”

LEADERSHIP LESSON:     

EXAMINE THE OPPOSITION

A Columbia Mailman School class on outbreak investigations taught by a former disease detective with the U.S. Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) motivated Tom Frieden, MD/MPH ’86, to successfully apply for a job with the EIS after he graduated. This set him off on a decadeslong path in public health, including stints as New York City health commissioner and director of the CDC. Along the way, he led responses to a multi-drug-resistant tuberculosis epidemic in New York City and the 2014–2016 U.S. Ebola outbreak.

Looking back on those high-profile jobs, Frieden says he’s learned that public health leaders need communication and negotiation skills as well as an awareness of influences that can determine the public’s acceptance of the science. “Public health officials can be naive about politics,” says Frieden, who is now president and CEO of the nonprofit Resolve to Save Lives, an initiative of Vital Strategies, which focuses on curbing cardiovascular disease and preventing epidemics worldwide. “We seem to think that if we just say what needs to be done, it’ll happen. But you have to analyze why things are not happening and think about what political and economic forces are at play, and where there is leverage where you can make a difference to save lives.” The importance of understanding politics and communication was apparent during the COVID-19 pandemic. When the Trump administration silenced CDC leaders, Frieden helped fill the void, testifying before the U.S. House of Representatives to urge increased funding for coronavirus testing and contact tracing. He gave hundreds of media interviews and wrote dozens of opinion pieces. He is hopeful that, if nothing else, the pandemic will show the importance of public health: “If this isn’t a teachable moment, there never will be one,” he says.

LEADERSHIP LESSON:     

LISTEN TO YOUR TARGET AUDIENCE

When she enrolled part time at Columbia Mailman School, Donna Lynne, MPA, DrPH ’O3, was director of the New York City Mayor’s Office of Operations and senior vice president of the New York City Health + Hospitals Corporation. For most of her professional life, she had worked on the business side of healthcare. At Columbia Mailman School, she immersed herself in the human side, taking classes in Sociomedical Sciences, Epidemiology, and Environmental Health Sciences. “It really was eye-opening,” she says. Under the mentorship of Jeanne Stellman, PhD, professor emerita of Health Policy and Management, Lynne wrote her dissertation on how upfront interventions with people who had Type 2 diabetes resulted in fewer ER visits and better disease management. What was even more interesting to Lynne, though, was that patients surveyed said they were happier with their healthcare and felt healthier. “They said, ‘I’m feeling better. I think I can go back to work,’” she says.

With the knowledge that patient satisfaction is key, Lynne earned her degree and went on to serve as
president of the Kaiser Foundation Health Plan of Colorado, then as the state’s lieutenant governor. Lynne embarked on a listening tour in all 64 counties and created a program for residents to give customer-service feedback to the governor’s office. She heard that Internet access and healthcare costs were top concerns, so during her tenure the state increased spending on broadband coverage and passed a bill that averted more than $500 million in cuts to the state’s hospitals.

In January 2019, Lynne became senior vice president and chief operating officer of Columbia University Irving Medical Center, and chief executive officer of Columbia Doctors in New York City. During the early days of the pandemic, she had to temporarily redeploy hundreds of medical center workers to new positions where their skills were badly needed, such as having dental hygienists perform X-rays of infected patients. A few months later, as the hospitals returned to a more normal routine, she sent the staff a survey on transportation and child care, then used the data to expand child care and transportation options. “Thinking back to my dissertation, it wasn’t just about reducing claim costs but about finding out if people actually felt healthier,” she says. “I think subjective information can be powerful when paired with objective data.”

LEADERSHIP LESSON:     

DEVELOP SOFT SKILLS

Transitioning from an organization with a top-down hierarchy to one with more decentralized authority has been an adjustment for Edward Bobb, MPH ’18, who spent 23 years with the New York City Fire Department before becoming assistant commissioner in the Division of Emergency Preparedness and Response at the New York City Department of Health and Mental Hygiene in 2019. “You’re trained as you move up in the ranks in the fire department that when you say, ‘Do X, Y, and Z,’ then X, Y, and Z is done,” he says. That is not necessarily so in his new post. “When you say, ‘Do X, Y, and Z,’ people say, ‘Well, maybe we should do A, B, and C.’”

Fortunately, Bobb got some practice in the soft skills needed to work in an atmosphere where sharing diverse viewpoints is common when he got his Executive MPH at Columbia Mailman School. As with all students, he spent the majority of his time interacting with a specific cohort of fellow students and practicing listening and negotiating, remaining flexible, and keeping an open mind.

Toward the end of the program, Bobb’s cohort performed a simulation that recreated the experience of running a hospital with staffing struggles and financial issues. They considered population demographics, what other hospitals in the region were doing, and which departments they might have to close and which they might augment with more resources. As many group projects do, the simulation caused some disagreements. “At times we had to work at managing egos and a variety of personalities,” Bobb says.

This type of nuanced communication is something he now relies on while helping to run the health department’s emergency response system. Bobb had just seven weeks between when he was hired and when the system was activated due to COVID-19 to figure out the health department’s culture, politics, and personalities so he could lead effectively. He says the experiences he had with his MPH cohort helped immensely. “The program at Columbia helped me to adjust my mindset, my perspective, a lot quicker than if I hadn’t experienced those things with the cohort,” he says. “Making a transition from the fire department to the health department would have been so much more challenging for me without that.”

LEADERSHIP LESSON:     

FIGHT FOR POLICIES YOU BELIEVE IN

Hedia Belhadj, MD, MPH ‘00, was deep into a career in international public health when she decided to get her master’s degree at Columbia Mailman School. The native Tunisian was in her early 40s, had a medical degree from Tunis University, and had spent years working to bring reproductive healthcare to places like Yemen and Djibouti. Then she moved to New York City to work for the United Nations Population Fund and began taking evening classes at Columbia Mailman School to bolster her public health knowledge. Eventually, Belhadj decided to get a master’s degree. Through her job at the UN, Belhadj had already met and worked with the late Allan Rosenfield, MD, Columbia Mailman School’s dean from 1986 to 2008. The two shared a passion for women’s reproductive health.

During her public health law and policy classes, Belhadj was surprised to learn how much power state governments have over health laws in the United States, especially to place limits on abortion access. “I didn’t have that part of public health, which is economics, which is policy, which is law. That’s what I found with Columbia,” she says. Today, she is president of Groupe Tawhida Ben Cheikh, a Tunisian nonprofit that fights to protect abortion rights. Women have long had the right to abortion in Tunisia, but after the 2011 Arab Spring, fundamentalists in the national legislature threatened to criminalize the procedure. To combat that, her organization surveys midwives and other frontline reproductive health professionals to see what kind of obstacles they are facing and lobbies ministers in Tunisia’s government. “It’s over our dead body,” she says of any policies hoping to do away with abortion.

LEADERSHIP LESSON:    

ALWAYS CONSIDER THE CONTEXT

When he arrived in Washington Heights in the late 1990s, Brian Castrucci, DrPH, MA ‘06, discovered there were no full-service grocery stores in the area. It wasn’t easy to cook without easy access to fresh, affordable food, but it did give him a taste of what daily life is like for many of the people he helps today as president and CEO of the Bethesda, Maryland-based de Beaumont Foundation, which promotes community health in impoverished areas. “You can only make a choice to eat healthy if there’s a healthy option,” he says.

One of Castrucci’s inspirational professors was Jack Elinson, PhD, who founded Columbia Mailman School’s Department of Sociomedical Sciences (SMS) in 1968 (it was the first such department in the nation). Elinson believed in looking beyond a community’s health to scrutinize its surroundings and other factors. Castrucci took that to heart. Earning a master’s degree in SMS prepares students to look at public health “not just through a health lens,” he says, “but through a health lens and a sociological lens, or through a health lens and a political lens. Because health is rarely understood, if it’s not contextualized.”

Those lessons are reflected in the work Castrucci does, which focuses on leading his organization to start programs like CityHealth, which rates the country’s 40 largest cities in nine policy areas and awards gold, silver, and bronze medals. Castrucci says that CityHealth has contributed to 59 policy improvements
since the program’s initial assessment in 2017. None involve delivering healthcare. Instead, they focus on things like affordable housing, smoke-free indoor air, and healthy food procurement. This particular way of thinking about health, which Elinson envisioned over 50 years ago, is still a bit radical to some. “Policy is a much stronger determinant of your health than pills,” says Castrucci. “That’s a pretty progressive way of thinking even now. Columbia was really ahead of the curve.”

LEADERSHIP LESSON:     

REACH OUT TO THE NEXT GENERATION

While working as a research assistant for then-Columbia Mailman School professor Eva Petkova, PhD, at the New York State Psychiatric Institute, Julie Ma, PhD ’01, learned to design and run clinical trials and to analyze data using the statistical software R. “Working with her on those projects, I felt like I really understood the concepts of statistics,” Ma recalls. Petkova also demonstrated how to explain the data to physicians involved in the clinical trials, then gave Ma the independence to communicate directly with them, a skill that she would use frequently in her career.

After graduation, Ma worked at a series of pharmaceutical companies. She recently joined Assembly Biosciences in South San Francisco as a vice president of biometrics; there she focuses on the development of drugs for hepatitis B. In her previous role, at Gilead Sciences, she used her statistical acumen to help the company earn a U.S. Food and Drug Administration breakthrough therapy designation for Sovaldi, the first drug to cure hepatitis C. In each new role, she guides her team to be more efficient and to avoid errors that she made as a younger biostatistician. She lets them interact independently with physicians on the drug trials they run, and just as Petkova stepped in to walk her through difficult problems, she does the same for her staff. “My professors at Columbia generously gave me this knowledge and advice,” she says. “I would like to follow them as an example and give back to these younger researchers.”