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DR B C DASGUPTA MEMORIAL ORATION
Year : 2018  |  Volume : 62  |  Issue : 3  |  Page : 171-174  

Public health leadership in India: Reflections from my journey


Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication12-Sep-2018

Correspondence Address:
Anand Krishnan
Room No 13. Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_93_18

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   Abstract 


Public Health discipline has evolved and currently focuses on addressing social determinants of health and working multi-sectorally to promote health. Public Health Leadershipis the practice of mobilizing people, organizations, and communities to effectively tackle tough public health challenges. Leadership is a core competency of public health.Leaders are people with Vision, Influence, Values and Passion to achieve personal and organizational mission.Leadership is not a personal trait but is learnable skill. Leadership is a journey where one goes from being a member of a single team to lead health sector in working with other sectors. A leader moves from carrying out assigned tasks at the beginning of journey to providing a vision to motivate others to achieve their life goals. A true leader grooms leaders to establish a legacy of leadership. Ten lessons from my life would be: Believe in yourself; Seize the opportunities; present a vision of future; get out of comfort zone; expand capacity rather than define limits; strengthen communication and people to people skills; build a team; consider everyone as a potential collaborator; focus on deliverables and on relationships. We should start Public Health leadership course and develop core modules for teaching of leadership to post graduates in all medical schools.

Keywords: Collaboration, communication, competency, leadership, Public health, vision


How to cite this article:
Krishnan A. Public health leadership in India: Reflections from my journey. Indian J Public Health 2018;62:171-4

How to cite this URL:
Krishnan A. Public health leadership in India: Reflections from my journey. Indian J Public Health [serial online] 2018 [cited 2018 Sep 22];62:171-4. Available from: http://www.ijph.in/text.asp?2018/62/3/171/241105



Public health problems pose special challenges as they are generally big in scale, stem from numerous and highly complex causes, play out in the public eye, impact a vast array of stakeholders and require long-term solutions.[1] Today, the field of public health is broadly defined, and the potential for public health solutions to improve and save lives and save money for the health sector is huge. At the same time, Public health is undervalued and underutilized in relation to its capacity to improve the health and well-being of individuals and populations.[2]

DeSalvo et al. called the public health approach in the 21st century as Public Health 3.0. While Public Health 1.0 (till about 1988) focused on water supply, sanitation, and infection control with the development of public health laboratories and strengthening of epidemiologic capacity, Public Health 2.0 focused on HIV/AIDS and chronic noncommunicable diseases with emphasis on health system strengthening. However, today in Public Health 3.0, the need is for addressing inequities and social determinants of health. This calls for cross-sector collaborations and policy development.[3] Even if we talk of antimicrobial resistance, the discussion is not only restricted to humans but also includes the use of antibiotics in animal husbandry and agriculture sector (http://www.who.int/antimicrobial-resistance/global-action-plan/optimise-use/en/). We need to address the full range of factors that influence a person's overall health and well-being-education, safe environments, housing, transportation, economic development, access to healthy foods – the major social determinants of health, or conditions in which people are born, live, work, and age. The type of human resources required to address health issues of today go beyond health sector to include – school teachers, engineers, farmers, waste management, environmentalists, and architects.[4] Current and future challenges in public health are related to climate change, working with industries, international movement of persons and goods, urbanization. Is the public health community in India prepared for these challenges?

From personal experience, I would say that the fraternity of public health in India has not met with remarkable success in past, not to speak of future. This is despite there being tall leaders in this field. I can only speculate on the reasons – we never reached critical momentum of growth either due to lack of leadership or due to lack of unity in our vision and operations. It is also my contention that our fraternity has been focusing too much on the clinical provision of services and has neglected other aspects of public health. There has never been a more challenging time to work in India for public health professionals.

Public Health 3.0 has created both an opportunity and the necessity for public health leaders to make a course correction. The realization of this potential depends on persuading stakeholders – governments, opinion leaders of the value of public health solutions. We need to transform the practice of public health, transform research and teaching of public health and have transformational leadership in public health in India today. Stronger leadership from public health professionals is needed to accelerate improvement in the health and well-being of populations. To transform both the influence and impact of public health, public health leaders need to be increasingly competent in challenging and moving people and organizations, with more urgency and success than they have had in the past.[2] This will not happen unless public health practitioners commit to leadership activities and have the competencies to perform them.

Public health leadership is the practice of mobilizing people, organizations, and communities to effectively tackle tough public health challenges.[2] Leadership can be defined at a variety of levels (e.g., individual, team, organization, or community); in a variety of ways (e.g., as a personal trait, a process, or a system function). Leadership is not a personal trait but is learnable skill. Everyone has the potential to lead if he or she wishes to lead. Public Health requires different kinds of leaders as shown in [Box 1]. Each of them are key to overall success in public health.



Leaders are people with vision (see a future different than the status quo), influence (able to communicate their vision and win others over to embrace and implement it, values (which provide a foundation for vision and; passion to achieve personal and organizational mission.[2] Leaders are those who lead self as well as engage with others through effective communication. They build a common vision, are goal oriented and build partnerships to achieve them. Finally, they have a “systems” way of thinking while appreciating the role of individuals in the team. Leadership is about rallying a group of people and bringing out the best in them.[5]

The UK Public Health Skills Framework has identified Leadership and collaborative working as one of the core competencies in public health (along with surveillance and assessment, evaluating evidence, policy, and strategy development).[6] Competencies of public health leadership have been defined-systems thinking; political leadership; collaborative leadership: building and leading interdisciplinary teams; leadership and communication; leading change; emotional intelligence and leadership in team-based organizations; leadership, organizational learning, and development; ethics and professionalism.[7],[8]

The leadership development can be seen as a journey at three dimensions or planes – plane of influence, plane of consciousness, and plane of leadership. On each plane, different levels can be conceived as represented in [Figure 1]. Levels of Influence is adapted from the UK Public health skills framework where they have nine levels of career.[9] Levels of consciousness have been derived from the Abraham Maslow's theory of hierarchy of needs. The levels of leadership is modified from one proposed by John Maxwell (https://www.success.com/article/john-maxwell-leadership-ladder).
Figure 1: A conceptual framework for public health leadership.

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A public health leader journeys from being a member of a single team to lead health sector in working with other related sectors. A leader moves from carrying out assigned tasks at the beginning of the journey to providing a vision to motivate others to achieve. The personal growth in the journey is from a self-centered thinking to one that looks for public welfare. Similarly, the lowest level of leadership is positional wherein people follow because they must (being administratively superior). However, a true leader grooms more leaders so that a legacy of leadership is established, and the gains are sustained. The above framework can also be used by individuals to assess their current position in the three dimensions and use that to prepare a plan to move up the ladder in their life and career.

Aspiring public health leaders should not be left on their own to find guidance. Those who have successfully navigated these waters should share their insights as experienced change agents and coach those otherwise working in isolation.[1] Alfred Sommers in his autobiography describes his journey and lists ten lessons in public health.[9] I think that all life journeys have lessons for others and I would like to share some lessons from mine as well. My journey to current position is testimony to the fact that no one ever starts his/her journey wanting to be a leader but ends up being one due to a combination of opportunities, circumstances, and hard work. My journey in public health started from my joining the All India Institute of Medical Sciences, New Delhi in 1988 which provided me with an excellent foundation, platform, and support which has lasted till now. It was my teachers who created the opportunities for my entry into the area of noncommunicable diseases prevention and control which has led to my current recognition as global expert and in heading the WHO Collaborating Centre on Research and Capacity Building on Community based strategies for NCD prevention and Control. The ten lessons from my life for others would be:

  1. Believe in yourself. Leadership demands high levels of commitment and passion. Stand by your opinion even against opposition, if you are convinced of your stance.
  2. Seize the opportunities that life inevitably gives everyone.
  3. Present a vision of future which is different and “better” from the present one.
  4. Get out of your comfort zone. You must wish to change both yourself as well as the community. Maintaining a status quo does not require leaders.
  5. Expand your capacity rather than define limits so that you do not have to say no; if you do not want to.
  6. Strengthen communication and people to people skills. Be open and transparent in your decisions so that a trust is developed. For people to share your vision of future, this is important.
  7. Build a team. There is a limit to what can be achieved at the individual level. Learn to delegate work and have confidence in your team. Groom a successor among your team members.
  8. Consider everyone as a potential collaborator and not as competitor. Networking and partnership development ability is what will define a public health leader of tomorrow.
  9. Focus on outputs and deliverables. You must be useful to major stakeholders such as communities, governments, and international agencies.
  10. Focus on relationships – both personal as well as institutional. They are essential for any long-term achievement.



   What Can Be Done? Top


While I propose some approaches to strengthen public health leadership in the country, I am conscious of the fact that leadership is only a part of the larger set of solutions for improving public health scenario in the country. My suggestions for strengthening public health leadership (PHL) are at discipline level, fraternity/association levels, and individual level.

At discipline level, there has to be an increasing recognition of social determinants of health and the need for intersectoral work and a move away from the narrow medical model of disease prevention and control. This is easier said than done as decades of narrow thinking has permeated our discipline. Strengthening teaching of a broader vision of public health is needed with emphasis on communication, leadership and social engagement. It can also be seen that women are less represented in the leadership positions of public health.[10] A cursory look at Indian Public Health Association (IPHA) fellowship list shows that only 13% of them are women, clearly not representative of their share in the membership. We need to promote women leaders in public health.

I would request IPHA to start a 1-year Public health leadership course with an intake of 10–15 persons every year with a gender balance and based in multiple institutions across the country. The candidates should be selected by a transparent procedure based on predefined criteria. IPHA may wish to constitute a core group to define its curriculum, syllabus, and selection criteria. Creation of the National Public Health Leadership Development Network, a consortium of institutes providing a system for leadership development, and the creation of the Leadership Competency Framework for core curriculum design and development of performance standards for public health practice in the United States is a good example of moving in that direction.[11] Simultaneously, taking cognizance of the fact that leadership is a core public health competency, IPHA should develop a core module for the teaching of PH leadership to postgraduates in all medical schools.

At the individual level, I would urge all of you to consider leading a public health activity in some small way and to work towards that goal by strengthening your skills using the framework referred to above. It will not happen automatically. To realize the vision of Public Health 3.0, strategies and tactics of the past are not sufficient to meet the challenges of the future. To do this, we must transition from individually focused to a collectively focused leadership.[12] Public health in India today demands many leaders and of diverse types. Let us all work toward this purpose. Let there be a sea of public health leaders in India.

Acknowledgment

I sincerely thank IPHA for giving me the privilege of delivering this oration. The national public health fraternity has been very supportive. I cannot overemphasize the role of colleagues and teachers at Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi who have contributed immensely to my journey and growth. My accomplishments are entirely due to my team and collaborators who provided valuable lessons for my growth. Finally, I am greatly indebted to my family members for being pillars of support and ensuring that I never get stressed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Koh HK, Jacobson M. Fostering public health leadership. J Public Health (Oxf) 2009;31:199-201.  Back to cited text no. 1
    
2.
Begun JW, Malcolm JK. Leading Public Health: A Competency Framework. New York: Springer Publishing; 2014.  Back to cited text no. 2
    
3.
DeSalvo KB, Wang YC, Harris A, Auerbach J, Koo D, O'Carroll P, et al. Public health 3.0: A call to action for public health to meet the challenges of the 21st century. Prev Chronic Dis 2017;14:E78.  Back to cited text no. 3
    
4.
Barton H, Grant M. A health map for the local human habitat. J R Soc Promot Health 2006;126:252-3.  Back to cited text no. 4
    
5.
Yphantides N, Escoboza S, Macchione N. Leadership in public health: New competencies for the future. Front Public Health 2015;3:24.  Back to cited text no. 5
    
6.
Public Health Resource Unit. Public Health Skills and Career Framework. England; April, 2008. Available from: https://www.healthcareers.nhs.uk/sites/default/files/documents/PHSCF%20March%202009.pdf. [Last accessed on 2018 Jun 13].  Back to cited text no. 6
    
7.
Health Workforce Australia. Health LEADS Australia: The Australian Health Leadership Framework. Adelaide: Health Workforce Australia; 2013.  Back to cited text no. 7
    
8.
Czabanowska K, Smith T, Könings KD, Sumskas L, Otok R, Bjegovic-Mikanovic V, et al. In search for a public health leadership competency framework to support leadership curriculum – A consensus study. Eur J Public Health 2014;24:850-6.  Back to cited text no. 8
    
9.
Sommer A. 10 Lessons in Public Health: Inspiration for Tomorrow's Leaders. Baltimore: The John Hopkins University Press; 2013.  Back to cited text no. 9
    
10.
11.
Wright K, Rowitz L, Merkle A, Reid WM, Robinson G, Herzog B, et al. Competency development in public health leadership. Am J Public Health 2000;90:1202-7.  Back to cited text no. 11
    
12.
Fraser M, Castrucci B, Harper E. Public health leadership and management in the era of public health. J Public Health Manag Pract 2017;23:90-2.  Back to cited text no. 12
    


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