Final Score on Who Handled COVID-19 Best

Why a  Professor Becomes a Health Officer

David Bishai, MD, MPH, PhD

On January 1, 2021 I left my job as a tenured public health professor to become a full time health officer for Harford County Maryland.  I did this to help save lives and ultimately to help rescue a discipline that is in disrepair and disarray.

There is no way to spin 2020 as a success story for American public health. Professionals must be judged by their results.  Architects whose buildings collapse, coaches who lose, doctors whose patients die, must all re-examine their approach. Americans have been dying. Public health must avoid the temptation to just blame politicians and skimpy budgets.  We must soul search and recommit to all of our discipline.

Public health is the practice of science in a value rich environment. Historically, public health has helped transform foul, dank, sewage strewn communities into clean healthy human habitats. Public health conquered, TB, cholera, malaria, typhoid and has moved on to stem deaths from tobacco, car crashes, and obesity. Public health practice embraces the need to sell the public on investing in their own collective health.  The craft of science has to meet the art of sense-making amidst diverse values. I spent 24 years as a health economist at Johns Hopkins Bloomberg School of Public Health teaching and researching how to help public health departments save the most lives possible with limited resources. My profession is all about locating and measuring the value of public health for citizens.

 That is why I am pivoting from professing by writing  about public health departments to professing by practicing inside  a health department. Researchers are outsiders.   I want to see from the inside what makes public health departments succeed.  We have all seen how exceptional public health departments in Taiwan, Thailand, and Vietnam rose to the occasion and kept COVID-19 at bay. We have asked these countries the obvious question, and they have given us the obvious answer. "We swung big," they said. 

Babe Ruth gave the same answer when asked how to hit home runs. He said, "I swing big, with everything I've got".  The "swing big" reports coming out of the world's successful COVID-19 fighters list obvious solutions: lots of tests, tracking, compliance with social distancing, masks, hand-washing, and good trusted communication. The recipe for fighting COVID-19 used by successful countries is not special.  What we really wish we had asked is not, "How did you do it?", but "how did you be it?" How do you acquire the big swing?  A more helpful Babe Ruth would have described devoted years of the discipline of eyeing pitch after pitch from the batter’s box. Doing becomes being.  

Front row seats don’t let you stare a pitcher in the eye and feel the crack of the bat on a fast ball.  The  practical knowledge of public health that must be captured and shared is the knowledge held by those who swing the bat.   I cannot be the teacher I want to be, if my only tools are powerpoints and whiteboards.  Being in the game lets me admit the  next generation of public health leaders into a batter’s box rather than a classroom.

No doubt, America will throw more money at health departments in the next decade like they have after every crisis. More public health money will not be enough without a new generation of professionals who can lead a renaissance of the art and craft of leading communities to improve their health and prosperity.

It's time more public health schools have professors who show up at county council meetings, school assemblies, church basements, and food pantries. I plan to be loud about what I do and share with anyone who wants to  build a 21st century health department.  It will be my privilege and honor to lead the way forward. Stay tuned to this blog for more.