Learning Leadership – A Key Component of Public Health Education

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I reluctantly started my PhD in Public Health (DrPH) program with a leadership course in the summer of 2017. As I attended the opening conference, I was eager to get to the quantitative courses. , such as biostatistics, epidemiology and demography. I believed, at the time, that developing my technical and research skills was all I needed to advance my career in public health. Leadership training was not part of my plans.

Just a year and a half after graduating, I now know I was dead wrong. My leadership training was instrumental in my current role as a Tribal Public Health Officer for a small Native American reservation in California. I would say it was even more valuable than the quantitative courses I ended up taking in my DrPH program. As public health practice seeks to recover from COVID-19, I hope to see a greater role for leadership training in public health education.

My first doubts about leadership training started with pedagogy. From previous years of study, I knew how technical subjects would be taught. There would be lectures, problem sets, papers and exams. But how would leadership be brought into a classroom? Would there be sets of “leadership” problems? What would a “leadership” conference look like? I felt the topic was subjective, ambiguous and amorphous – making teaching almost impossible.

This concern was quickly disillusioned by my teachers, who made leadership immediately teachable. They used a variety of approaches, such as case studies, interviews, self-reflection exercises, and the rich academic literature on leadership. Homework included personal reflections, as well as analyzes of situations, decisions and responses. While the scoring could have been more subjective, the lessons were more about what I got than my grades.

Over the next few months, I took several leadership courses. A key first lesson was the idea of ​​adaptive and technical challenges, from Ronald Heifetz, Harvard professor of leadership. According to Heifetz, a technical challenge is a clearly defined problem that can be solved with existing know-how and expertise, such as running a regression model to estimate a correlation. An adaptive challenge, on the other hand, is not clearly defined and usually involves a change in the behavior of many people. Solutions will often require group learning to collectively develop new options, rendering individual technical expertise insufficient. In other words, adaptive challenges require leadership.

I often refer to this lesson in my current role as a tribal public health worker. When I face a new challenge, I try to classify it as technical or adaptive. For example, we needed a standard way to report our number of COVID-19 cases and contacts to the community at the start of the pandemic. I saw this challenge as a technique and used my quantitative training to craft an easy-to-understand situation report.

Other times, there have been adaptation challenges underlying technical issues, such as when we considered updating our isolation protocols during the outbreak of cases last winter. We belatedly moved from a symptomatic approach to a testing approach to eliminate individuals from COVID-19 isolation. Shortly after this update, the CDC shortened its recommendations for the isolation delay, lengthening our orders by a few days. Viewed as a technical challenge, we should have updated our orders immediately to follow CDC best practices.

However, I felt there were deeper issues involved. I thought back to my leadership training where we diagnosed issues in case studies. We learned that people’s emotions and beliefs usually trump data. In the current situation, I knew that community members were very concerned about the recent increase in cases and were already confused by the current prescriptions. Therefore, I felt that a change in our orders would lead to fear, confusion and disrespect. I recommended that we wait until after the increase in the number of cases to update our protocols to ensure the safety of the community. The tribe eventually kept the orders in place for a few more weeks, until the cases dwindled.

Despite over 30 years of calls for leadership in public health, I see confusion between adaptive and technical challenges in other areas of the COVID-19 response. A prime example is the CDC’s hiding update last May. While the latest scientific research has supported not requiring vaccinated people to wear masks, which is technically correct, the CDC’s decision to lift the wearing of masks for vaccinated people did not predict the impact. adaptive, which included many areas the lifting of all mask mandates. There was a deeper and more emotional interpretation, the “song under the words”, of a politics of detente in the mask that they ignored. Although the CDC ultimately canceled mask guidance, an adaptive perspective from the start may have explained this visceral response.

To improve leadership in public health, we must ensure that the next generation of leaders receive leadership training. An encouraging sign is the growth of DrPH programs. According to the Council on Education in Public Health, the accreditation body for public health education in the United States, leadership is an essential component of the DrPH program. Between 2010 and 2019, there were almost 20,000 applications for DrPH programs in the United States and the number of graduates almost doubled. I expect more interest in DrPH due to the pandemic. There have already been several new DrPH programs in the past year alone, such as New York University, Rutgers University, and University of Toronto.

Leadership training, especially in DrPH programs, can improve leadership in public health. The challenges ahead – recovering from COVID-19, adequately tackling climate change, and eliminating unjust and immoral health inequalities – will not be solved by technical solutions alone. Future leaders in public health will need technical skills and leadership. Leadership training will be essential to ensure our leaders have the adaptive skills necessary to solve them.

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Eric Coles

Eric Coles is the Chairman of the DrPH Coalition and the Tribal Public Health Officer for the Tule River Indian Reservation.

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