Thursday, September 13, 2012

Greetings from Austin, Texas


One of the slogans that the locals in this city use is “Keep Austin Weird.” You see it in many of the gift shops, clothing stores, bars, and live music venues throughout the downtown area. I can’t say whether or not the slogan has been successful in keeping this place weird but the city (13th largest in the country) certainly has managed to keep the feel of a college town that also happens to be the state capital – think Madison. You decide if that is weird.
One thing I do know for sure is that the things covered in today’s ASTHO meeting were anything but weird. In addition to the numerous topics covered in our Prevention Policy Committee, of which I’m a member, the agenda today covered 3 major topics: the Integration of Public Health and Primary Care, Working with Hospitals to Improve Prevention, and Making the Case for Prevention. Superb presenters from the Institute of Medicine, the Catholic Hospital Association, and the Robert Wood Johnson Foundation (among others) made the day rich with information and new ideas.
I learned a great deal from the sessions but the thing that struck me most was a passing reference to the writings of psychologist Justin Menkes. This was mentioned in the context of the challenges facing public health today. In his book “Better Under Pressure,” Menkes writes that people who maximize their own potential and the potential of their colleagues and their organization embody “three essential capabilities or drivers:
  • Subservience to purpose,
  • Finding order in chaos. and
  • Realistic optimism and sense of agency.
The first two are somewhat self-explanatory. Dedication to a purpose gives people the drive to realize their potential and that of their organization. For the sake of a larger good, people who demonstrate this quality put the mission of their agency or organization ahead of their own personal interests.
Finding order in chaos means being able to see the opportunities that crises provide, which sets the stage for the possibility of tremendous progress. This requires clarity of thought and the drive to solve the puzzling problems that arise every day.
“Realistic optimism and sense of agency” is a bit more complex. In the face of today’s multiple challenges and unpredictable circumstances, successful people display a sense of that the future can be better and thus are willing to prepare for whatever comes their way. “Realistic optimism” helps people minimize constraining fear and maximize their odds of success in a world of overwhelming ambiguity. A person’s “sense of agency” is the single most important factor in being able to cope with all these multiple challenges and unprecedented change. According to Menkes, a sense of agency is “the degree to which people see their circumstances and the outcomes they experience as within their control. For people who look outside themselves for explanations, long-term success becomes much more difficult. For those who look inward, learning and adaptive behavior come more readily.”
This brief reference to Menkes in today’s opening session struck me because it seemed very relevant to the situation of public health in Minnesota and to the Minnesota Department of Health. I have never been in an agency that is so mission-driven as MDH. Staff are experts in their fields but also dedicated to the mission of improving and protecting the health of all Minnesotans. I am confident that, as an agency, we possess the first characteristic. I think we are also looking to find order in chaos. There are great threats that face us but our current situation also contain great opportunities. I think we have the clarity of thought and desire to solve these puzzling problems for us to legitimately claim that we possess the second characteristic.
That brings us to realistic optimism and sense of agency. This is an area on which those of us in public health need to focus. We (myself included) often complain about the paucity of funding, invisibility because we prevent things from happening, the lack of understanding by policy makers of the importance of public health, the short-term focus of budgets, and the dominance of the medical care system. We need to learn that we can’t look to others to take the lead in advancing public health. We can’t be victims and succeed. We have to recognize and believe that the future of public health is really within our control. That realistic optimism and sense of agency will foster creative thinking, increase comfort with risk-taking, and create a confidence to move forward a programmatic and policy agenda that breaks new ground for 21st century public health.
The longer I’m at MDH, the more I’m recognizing that we do possess realistic optimism and a sense of agency. We are an agency poised, in this time of chaos, to take advantage of some unique opportunities to improve the health of all Minnesotans in both the short and long-term. I am confident that we will not only do “Better Under Pressure” but we will actually do great under pressure.
Ed