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Preparing for the Future: Public Health Leadership & Management Preparedness Series 21st Century Global Health: A New Leadership Paradigm Stephanie Bailey, MD, MSHSA Chief, Public Health Practice Office Centers for Disease Control and Prevention US Department of Health and Human Services Northwest Center for Public Health Practice Objectives By the end of this module you will be able to: • Describe the evolution of public health and public health leadership. • Describe the opportunities and challenges for leaders of 21st century Global Health. • Discuss the ramifications and implications of small world networks for public health leaders. • Define the concept of Meta-Leadership. • Discuss the necessity and opportunities for crosssector collaborations. "We need to learn how to build a connectivity that includes people who are not like us—people in business, people in the faith-based sector, people in the health care delivery system, people in the nonprofit community—and there is one absolutely essential requirement to our capacity to do this kind of collaboration. It is the concept of metaleadership." —Julie Louise Gerberding, MD, MPH Director, Centers for Disease Control and Prevention Unique Features of the Public Health System • Social justice • Inherently political nature • Expanding agenda • Link with government • Grounded in science • Focus on prevention (prime strategy) • Uncommon culture and bond A New Brand of Public Health • Living by design Making choices Vision New science Broadening the landscape Transformation Application Building Connectivity: WHO Collaborating Centers for Influenza WHO Collaborating Centers Countries with at least 1 WHO influenza laboratory Building Connectivity and Expanding Scale: CDC/WHO Global Disease Detection Response Center Collaboration 3 ERO region 3 EMRO region 3 PAHO region 3 AFRO region 3 SEARO region 3 WPRO region GDD Response Centers Health Protection in a Small World Requires: • Fast detection • Fast science • Fast and effective communication • Fast and effective integration • Fast and effective action Globalization, connectivity, and speed! We know what the future promises: Surprise. A speeded up existence. And a fair amount of chaos. The future also promises us new possibilities. Astounding opportunities. A higher standard of living, more job freedom, plus the chance to achieve more potential. And the future will keep its word. —Price Pritchett (1995) (New Work Habits) April 30, 2002 Nothing's Easy for New Orleans Flood Control By JON NORDHEIMER “There's no way to minimize the amount of devastation that could take place under such circumstances," warned Walter S. Maestri, director of emergency management of Jefferson Parish, a suburban region with 455,000 residents on the city's western and southern sides… Many residents give little thought to such matters, counting on the knowledge that New Orleans has escaped hurricane disaster in the past. The New Normal • Protection of health from predictable threats Chronic diseases Environmental threats Injury • Preparedness and response to emergencies Pandemic Food-borne illness Natural disasters Terrorism Emerging infectious diseases Question How closely does this definition of “the new normal” match what you are seeing in your agency? A. Exactly B. Pretty close C. Not very much D. Not at all CDC’s Mission To promote health and quality of life by preventing and controlling disease, injury, and disability Health Protection Goals for the 21st Century Healthy People in Every Stage of Life Healthy People in Healthy Places People Prepared for Emerging Health Threats Healthy People in a Healthy World Centers for Disease Control and Prevention—21st Century Office of the Chief Science Officer Office of the Chief Operating Officer Office of Strategy and Innovation Office of the Director Office of Enterprise Communication Office of Workforce and Career Development Office of the Chief of Staff Coordinating Office for GLOBAL HEALTH Coordinating Office for TERRORISM PREPAREDNESS & EMERGENCY RESPONSE CDC Washington Coordinating Center for ENVIRONMENTAL HEALTH & INJURY PREVENTION NCEH NC = National Center Office of Public Health Practice NCIPC Coordinating Center for HEALTH INFORMATION & SERVICES Coordinating Center for HEALTH PROMOTION Coordinating Center for INFECTIOUS DISEASES NCHS NCHPDP NCPDCID NCHM NCBDDD NCIRD NCPHI OPHG NCHHSTP NIOSH Urgent Threats Extremism Extreme Poverty Extreme Climate Urgent Realities Extreme Aging Extreme Environment Extreme Size Extremism Extreme Poverty: Numbers of Extreme Poor Millions (estimated 1.1 billion people in 2001) 450 400 350 300 250 200 150 100 50 0 2001 East Asia South Asia East Europe Mid East South Asia Sub-Saharan Africa Central Asia North Africa Adapted from Sachs, J: The End of Poverty Extreme Climate Storms, Tornadoes, Hurricanes, Floods, Drought Extreme Aging Percentage of U.S. Population over Age 65 Percentage of Population 25 20 15 10 5 0 1930 1950 1970 1990 2010 2030 2050 Year Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population Copyright 1996, Watson Wyatt Worldwide. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005 (*BMI 30, or about 30 lbs overweight for 5’4” person) 1995 1990 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Pandemics Do Happen! H9* 1998 1999 H5* 1997 2003-2006 H7* 1980 H2 H1 1915 1918 Spanish Influenza H1N1 H3 2003 1996 2002 2003 2004 H1 1977 1925 1935 1945 1955 1957 Asian Influenza H2N2 1965 1968 Hong Kong Influenza H3N2 1975 1985 1995 2005 *Avian Flu Meta-Leadership An overarching leadership that intentionally connects the purposes and work of different organizations or organizational units Source: “Meta-Leadership and National Emergency Preparedness: A Model to Build Government Connectivity”; Leonard J. Marcus, Harvard University, Barry C. Dorn, Harvard University, Joseph Henderson, CDC Question Are you currently involved with “metaleadership” within your community? A. Yes B. In some areas C. Not very much D. Not at all Leading in the Silo Vertical Connectivity Horizontal Connectivity Complex Adaptive Systems More than the sum of the individual parts. The whole is greater than the sum of its parts. Meta-Leadership Big picture: Multi-dimensional perspective Comfortable with the unfamiliar Recognize cultural value Can integrate diverse goals The event The person Connectivity as leader = Optimal results Lead the silo Lead Lead up Five Dimensions of Meta-Leadership Source: “Meta-Leadership and National Emergency Preparedness: A Model to Build Government Connectivity”; Leonard J. Marcus, Harvard University, Barry C. Dorn, Harvard University, Joseph Henderson, CDC The Five Dimensions of Meta-Leadership • Know how to get out of the basement. • Manage your behavior and emotions and be aware of those around you. • Know how and when to be a good passive/active leader. • Acknowledge and manage chaos. • Use your imagination to see where the event may take you. • Create and maintain an operational picture of the event. Source: “Meta-Leadership and National Emergency Preparedness: A Model to Build Government Connectivity”; Leonard J. Marcus, Harvard University, Barry C. Dorn, Harvard University, Joseph Henderson, CDC Meta-Leadership: Hierarchy and Heterarchy in a Small World Network • • • • • Leadership out and across organizational networks Collaborative Participatory Negotiated Centralize strategy; delegate operations and tactics to frontline experts Minimize central “authority” Distribute responsibility—network-centric Coordinate via communication networks and performance measurement Let people lead! Learn as you go! Adapted from Denning: Network Laws. Communications of the ACM 47:15-20, 2004 A Spectrum of Partner and Public Engagement 1 2 Inform Consult 3 Involve 4 Collaborate Empower Increasing level of participation in decision-making CDC: Roger Bernier, PhD, MPH 5 Remember: Many hands make light work and can solve complex problems in the process. Question Can you think of ways in which you can contribute to the building of organizational networks within your community to facilitate meta-leadership activities? A. Yes B. In some areas C. Maybe D. I don’t know how to implement this “The significance of the problems we face cannot be solved at the same level of thinking we had when we created them.” —Albert Einstein Preparing for the Future: Public Health Leadership & Management Preparedness Series 21st Century Global Health: A New Leadership Paradigm Stephanie Bailey, MD, MSHSA Chief, Public Health Practice Office Centers for Disease Control and Prevention US Department of Health and Human Services Northwest Center for Public Health Practice