Welcome to Inside the Health Department

Welcome to Inside the Health Department, a blog for current and former employees of local and state governmental public health agencies. The purpose of this blog is to provide an on-line forum for staff and middle managers in health departments to freely express their thoughts about their work situations and the future of public health practice.

The missing voice

I created this blog because I have watched governmental public health decline steadily over the years despite warnings from exceptional authors like Laurie Garrett (1) and calls to action from public health leaders through reports from the Institute of Medicine (2), RESOLVE and the Robert Wood Johnson Foundation (3), and Trust for America’s Health (4).  Many of you also likely know of efforts by some states to revitalize their governmental public health systems. Ohio (5) and Oregon (6) are examples. I am concerned, however, that missing from these important efforts is the voice of health department employees; those individuals who carry out public health’s mission in the face of deteriorating conditions.

Should we even try to save governmental public health?

The skeptic in me wonders if governmental public health has the capacity to turn itself around after so many years of neglect and continued assaults. What I have witnessed inside health departments are ongoing cuts to programs and staffing which contribute to untenable workloads, an inability to recruit and retain talent, political gamesmanship, and poor morale. Yet, the public, the media, legislators, healthcare partners, and funders retain high expectations about governmental public health’s performance even when they show little understanding and respect for that work.  As an example, governmental public health has to fight for a seat at the table in current discussions about the changing healthcare environment – an environment that, ironically, emphasizes prevention, Public Health’s raison d’etre.

How much is governmental public health responsible for its decline?

A number of factors have led to the deterioration of public health practice. For instance, public health has never been good at marketing itself as a recipient worthy of healthcare dollars, unlike its sexier sister discipline, medicine, which is naturally endowed with the drama and flash that brings in money. Also, agencies endure and create environments in which employees thrive when they embrace sound leadership, management, and business practices. Governmental public health agencies have either lacked the resources and talent to cultivate great workplaces or doing so has not been a priority. What I have witnessed on this point over the years include:

  • The appointment of individuals to leadership positions who have limited knowledge of public health practice, and whose decisions create rather than solve problems
  • Leaders unable to tackle long-standing problems because of their unwillingness or inability to see them or their fear of political repercussions
  • Passive-aggressive approaches to conflict, in which people who raise concerns are shut-down, pushed out, or as I once observed, had their offices moved into the basement
  • Agencies built on financial houses-of-cards, in which fiscal personnel are not able to tell managers, with any consistency, how much money is in their budgets
  • Human Resources Departments that exist solely for the purpose of preventing lawsuits against the agency rather than addressing personnel issues
  • Decisions made about personnel reductions based on expediency rather than a thoughtful consideration of the agency’s strategic direction

A little hope

Perhaps the demise of governmental public health is not inevitable. Perhaps it just needs to evolve. It is my wager that governmental public health employees can provide valuable insights into that evolution if given the opportunity to share their ideas without having to worry about the communication filters and political agendas of their agencies.

My disclosures

At this point, you may be wondering who I am. In the spirit of full disclosure, financial and otherwise, I will briefly tell you about my background, as it relates to this blog.

  • I have held positions in four local and state health departments since 1999. Before that, I was in public health research.
  • I left my last governmental public health job because I was fast approaching burnout.
  • I have returned to working as a public health consultant, an endeavor I’ve enjoyed previously in my career
  • No one is paying me to write this blog, and I am not doing so to generate consulting business. In fact, I was warned that the blog’s focus may drive away potential clients, but some things are more important than fear.
  • I will likely use this blog to announce the release of a novel I have written, which centers on a local health department, but it will be your choice as to whether you want to read that story.
  • I consider public health practice as my calling. (Believe me, there have been times when I wished it wasn’t.) I want to see if I can play a small role in revitalizing the discipline by providing a forum in which others can speak out.

Making a difference

This blog can also be about affecting change. I truly enjoy project work and am willing to turn the content of our discussions into an actual product. That is, I could summarize your observations, suggested priorities, and solutions, and put these into a list of recommendations, a presentation, or a report that could be given to legislators and other policymakers.

Ground rules

Enough hate is spewed through the internet that I have developed some ground rules for participating in this blog. The blog’s full policies can be found under Recent Posts on this page. In general, comments that contain the following will not be posted:

  • Profanity
  • Spam
  • Messages with questionable or irrelevant links
  • Language or concepts that could be interpreted as offensive
  • Attacks on specific individuals or organizations. Please use generic terms such as staff, management, leadership, agency, etc. instead of a person or organization’s name.

If your comment contains a criticism, also try to include a possible solution.  It is okay to post anonymously. Just don’t use your anonymity to attack others.

It’s your turn

I’d love to hear your thoughts on any of the questions below.

  • What is it like to work in your governmental public health agency?
  • From your vantage point, what is the future of governmental public health?
  • What, if anything, will be lost if governmental public health goes away?

Please share this posting with your colleagues so that we can generate a good discussion, and be sure to subscribe to the blog so that you will be notified of new postings (see the footer of this page).

All the best!  Kathy



(1) Garret L. Betrayal of trust: the collapse of global public health. New York, New York: Hyperion; 2000.

(2) Institute of Medicine. For the public’s health: investing in a healthier future. Washington, D.C.: The National Academies Press; 2012.

(3)  RESOLVE. Transforming public health: emerging concepts for decision making in a changing public health world. 2012. http://www.rwjf.org/en/library/research/2012/06/transforming-public-health.html.  Accessed October 23, 2015.

(4) Trust for America’s Health. Investing in America’s health: a state-by-state look at public health funding and key facts. http://www.rwjf.org/content/dam/farm/reports/reports/2014/rwjf413110.  Accessed October 23, 2015.

(5) Association of Ohio Health Commissioners, Inc. Public health futures: considerations for a new framework for local public health in Ohio. 2012. www.aohc.net/aws/AOHC/asset_manager/get_file/70105?ver=435.  Accessed October 23, 2015.

(6) Task Force on the Future of Public Health Services. Modernizing Oregon’s public health system. 2014.  https://public.health.oregon.gov/About/TaskForce/Documents/hb2348-task-force-report.pdf.  Accessed October 23, 2015.

Leave a comment

Your email address will not be published.