Greenwashing or great brand marketing?

The Rainforest Alliance‘s Follow the Frog viral video now boats more than 3.8 million views. If you have not seen it, the now-viral video is a made-for-YouTube brand promotion for the organization’s efforts to save the rainforest through preservation and collaboration with corporate partners, who put a cute little frog logo on their products.  (The organization’s actual mission statement is here; and wow, they publish slick annual reports too.)

The video itself mocks what I could only presume to be do-good, liberal-guilt-drenched, white, middle-class YouTube users that direct action, person-to-person contact with other cultures, and global-minded activism are failed and meaningless strategies for dupes like the star of this video. The moral? Why quit your job? Why learn about things first hand and be involved in meaningful efforts overseas? Most importantly, why stop shopping? Instead, sit back, relax, and buy more stuff with a little frog. And, by doing that, you can save the forest ecosystems and those charismatic critters and natives you care so passionately about.

That, in a nutshell, is the storyline. Oh, and if you do participate in failed efforts abroad, your wife might leave you for another man who is, yes, not white. (No, I am not making this up. This race element is integral to the “follow the Kermit” story. Please tell me this was not intentional, please, OK?)

Nazi filmmaker Leni Riefenstahl at work with the Nazis during the making of Triumph of the WIll.

Nazi filmmaker Leni Riefenstahl at work with the Nazis during the making of Triumph of the WIll.

Clearly, the Rainforest Alliance’s brand managers and media team hit pay dirt with this one. Be one of us, sport tattoos, be cool, and be a froggy consumer. (These brand managers need to consult in public health, which lacks a hip frog right now.)

Does that mean they are not just, as some critics claim, “greenwashing” consumerism? This creepily somewhat reminds me of the wildly successful Kony 2012 phenomenon, itself the artistic step-child of Nazi propagandist Leni Riefenstahl’s seductive 1934 film Triumph of the Will. That acclaimed masterpiece of filmmaking, by nearly all metrics, ultimately celebrates the virtues of the National Socialist Party led by dictator Adolf Hitler, a year after he peacefully seized control of the German state.

A scene of the Nazis during a rally filmed by Leni Riefenstahl for Triumph of the Will, one the most successful propaganda films ever.

A scene of the Nazis during a rally filmed by Leni Riefenstahl for Triumph of the Will, one the most successful propaganda films ever.

Do not get me wrong. I buy certified organic coffee. I love cat videos and Jimmy Kimmel’s infamous twerking video as much as the next YouTube user. But, ouh la la, there really is nothing more powerful than a good story, a clever media product, and the right artist to sell just about anything, from armchair activism to strong-arm fascism.

Sadly, I do not think you can teach this stuff. The best and the brightest will inevitably also work with the nastiest, wealthiest, and the worst, sometimes more than with the “virtuous.”

So, what do you think about following the frog? Good for forests? Or, something completely different?

Can innovation thrive in the culture of U.S. public health systems

Amazon, despite its critics, has been an innovator in the private sector.

Amazon, despite its critics, has been an innovator in the private sector.

The business press and the communications teams in the private sector work hard to show that innovation mingles in the air like oxygen  at successful businesses. The theory goes, innovation breeds success, which creates profits, which spurs new products and services and wealth, which of course is good for the economy and thus all of us.

Forbes, for instance, showcases business innovators, like Starbucks and Amazon, by highlighting metrics that the magazine considers to be markers of innovation. According to the Forbes’ Sept. 2, 2013, piece on innovation, Amazon’s CEO Jeff Bezos says he looks for traits in innovators in his company and allows for innovation to occur three ways:

  • Rewarding innovators who are relentless in their on their vision but flexible on the details of how to get there.
  • Fostering a decentralized work culture for new products or services, so that the majority of employees feel like it is expected of them (Amazon’s now famous “two-pizza teams”). 
  • Third, teaching teams how to experiment their way to innovations.

But once we start talking about government, talk of innovation gets tossed out the door. In fact, the prevailing wisdom among many in the private sector, and likely in the public sector too, is that government is the ultimate death machine to innovation.

Not only does innovation die still-borne in public agencies, government regulations themselves kill innovation in the private sector, many writers and politicians claim ad infinitum.

Do any public agencies have capacity to innovate?

Government still funds innovation and research and development, particularly in defense and health care. But as a culture, government is not the incubator, goes prevailing wisdom. One global survey completed this year puts trust in government around the world below 50%, behind trust in business at about 58%, for its ability to demonstrate change and new leadership.

Public health, as a public endeavor in the United States, is by definition a public undertaking. Thus it remains government-funded, government-run, and thus, be default, the inheritor of government’s best and worst traits.

As someone who has now worked at the international, state, and local levels of government, including in public health, I can attest to government bureaucracies’ failure in many instances to embrace change, inability to stimulate ideas, and poor track record in adopting new ideas to improve how government does business.

One recent research paper by British researchers Geoff Mulgan and David Albury on the lack of innovation in the public sector noted: “Most service managers and professionals spend the overwhelming proportion of their time dealing with the day-to-day pressures of delivering services, running their organisations [sic] and reporting to senior managers, political leaders, agencies and inspectorates [sic]. They have very little space to think about doing things differently or delivering services in ways which would alleviate the pressures and burdens.” In short, government culture lacks innovation.

The pair argue that innovation should be a core activity of the public sector. They claim this helps public services improve performance and public value, respond better to the public’s needs, boost efficiency, and cut costs.

Geoff Mulgan and David Albury 's diagram how public bodies do no innovate.

Geoff Mulgan and David Albury ‘s diagram how public bodies do not innovate.

What are people saying about innovation in public health and health care

In Europe, in 2010, the Association of Schools for Public Health in the European Region’s Task Force on Innovation/Good Practice in Public Health Teaching developed a plan that called for seven action items, two of which focused on innovation:

  • Developing more coherence between policies in the fields of education, research and innovation.
  • Measures to develop an innovation culture in universities.

Back on this side of the pond, the Harvard Business School held a conference on innovation in the massive health care sector in October 2012, and then published a study in February 2013 on how innovation was seen as critical to health care and health education, which includes public health.

The report found that 59 of the CEOs of the world’s largest and most innovative health-sector organizations most frequently used the word “innovation.” According to the discussion of the attendees, innovation in its broadest sense was even seen as the “only way that change will happen and that creative solutions will be found for our current problems in health care.”

The most important characteristic for a company according to leading health care CEOs is innovation.

The most important characteristic for a company according to leading health care CEOs is innovation.

Recent evidence shows that innovation can lead to better outcomes. A 2013 study  published in the Journal of Multidisciplinary Healthcare, on technological innovation and its effect on public health in the United States, found a correlation regionally in parts of the country where it was perceived that technological innovation was occurring. The study reported that “relationships between the technological innovation indicators and public health indicators were quantified,” and it was found “that technological innovation and public health share a fairly strong relationship.”

Will innovation remain a dirty word in public health departments at all levels of government?

But does anyone working in a local health jurisdiction, hard-strapped for cash in the post-Great Recession era of downsizing, see innovation taking place in their work environments? As hierarchical bodies, modeled originally after the military since their original inception in the United States, public health bodies are seldom discussed in organizational behavior literature as “innovative.” They are organized hierarchically and often divided by departments with no interchange, and their managers may be unable to allow for information sharing and promote collaboration seen in many for-profit firms.

Yes public health jurisdictions, to win much-coveted accreditation by the national Public Health Accreditation Board, must prove they are committed to quality improvement and a competent workforce. But this by no means is the same as encouraging a culture of innovation to adapt to tremendous change, particularly financial downturns and the challenges posed by chronic disease and the increasing wealth disparity among the top wage earners and the majority at the bottom, which is leading to great health disparities.

One local health jurisdiction that is trying to innovate, the Spokane Regional Health District, developed a strategic plan that calls out as its top two strategic priorities: increasing awareness about the role of public health and securing more stable funding. I think these are spot on and demonstrate how this agency has moved its focus upstream and is adapting itself to succeed in that bruising political arena.

innovation not

More of Tom Fishburne’s artwork can be found on the web site: http://tomfishburne.com/.

But my own sense of public health jurisdictions, small and large in the Pacific Northwest at least, is that other jurisdictions may not wish to emulate Spokane because of agency rivalries and personal jealousies among upper management. I would love for one day to learn that some of the traits of private sector organizational behavior practices, such as rewarding innovators, promoting a culture of innovation, and teaching workers how to innovate take root. Right now, I’m not seeing that within the sector, and the talk is not matching the walk.

How the 10 essential public health services handicap a weakened profession

Public health, as a profession and system to improve population health, continues to fall short in the United States.

Since the start of the Great Recession, nearly a quarter of all employees working for local health jurisdictions have been downsized or laid off because of funding cuts to already meager budgets. The National Association of County and City Health Officials pegs the attrition at nearly 44,000 workers–a fact reported on this blog before.

Proportional changes in inflation adjusted spending for public health (CDC) versus health care spending in the United States.

Proportional changes in inflation adjusted spending for public health (CDC) versus health care spending in the United States.

Today, most Americans have little idea what public health does, why it matters, and why its funding is critical to improving health outcomes at the population level. For that matter, half of all Americans cannot even identify what the core elements of health insurance plans are. 

From its start as a profession in the United States in the early 1900s, public health was deemed to have a political-activist function. In fact, noted public health pioneer C.E.A. Winslow, Yale’s first chair of public health, promoted universal medical care in the 1920s as a principle of sound public health policy, backed later by other public health practitioners in the next two decades who unsuccessfully called for a form of universal health care.

Winslow’s often-quoted definition of public health called for the “development of the social machinery which will insure to every individual in the community a standard of living adequate for the maintenance of health.” Such efforts were overt and unashamed calls for political action and advocacy, the likes of which are mostly not heard today from the profession.

10 essential public health services: a recipe for political impotence?

Since 1994, the U.S. Centers of Disease Control has pushed the “10 essential public health services” model as the gold standard for defining public health’s realm of practice. As far back as 1999, the CDC claimed, “The overall goal for public health’s infrastructure is to have every health department fully prepared with capacity to fulfill the Ten Essential Public Health Services and every community better protected by an efficacious public health system.”

The 10 essential public health services is the U.S. model, not a global model, for defining the profession.

The 10 essential public health services is the U.S. model, not a global model, for defining the public health profession’s realm of practice.

This model has rippled outward to every public health agency, every school of public health, and all professionals in the field as the benchmark to measure quality and effectiveness. Logic models have been developed to see how well health departments were doing according to this standard.  Anyone who works in the field is told that these services define who we are and what we do.

All the while, public health budgets have been slashed nationally, and at the state and local level, workers have fled or were pushed out of the profession. Still the field of public health continues to push its competent but still toothless model for what is considered a best practice—the 10 essential services.

While evidence-based and certainly valid, this 10-step model is also a self-defeating set of quasi-religious commandments that fails to address the harsh political realities related to developing legislation and orchestrating fights over budget appropriations. It also fails to call for advocacy and political activity, which can and have pushed public health efforts far greater than these prescribed activities.

Politics, money, and real power

For-profit entities working in the health sector thrive because advocacy and political engagement are fundamental to their business models and bottom lines, unlike the model of inefficacy promoted for the public health profession.

For instance, pharmaceutical powerhouse Pfizer unabashedly states, “We believe that public policy engagement is an important and appropriate role for companies in open societies, when conducted in a legal and transparent manner. … The Pfizer Political Action Committee makes contributions to candidates for federal office, and fully discloses its contributions on a regular basis to the Federal Election Commission.”

Pfizer, multinational pharmaceutical firm, published its political spending activities in the United States for the first half of 2013.

Pfizer, the multinational pharmaceutical firm, published its political spending activities in the United States for the first half of 2013.

While for-profit health interests march forward, with ever more dollars and clout, public health continues to retreat. The President’s budget request in 2014 for the CDC, the agency charged with protecting America’s health, is a measly $6.6 billion (for its program level expenditures)—a drop of $270 million over 2012.

This dip likely reflects pushback by GOP lawmakers in the current Congress, who view CDC’s public health activities as synonymous with overt advocacy. Language in funding measures, in the current session of Congress, has attempted to limit federal dollars for grassroots efforts by public health practitioners to lobby on behalf of specific legislation, particularly on efforts to address chronic disease and obesity.

Generally, public health advocacy is not lobbying, which is prohibited when it involves federal or earmarked funds. Exceptions include study or research and discussions of broad social problems.

So it is not surprising that government-funded public health bodies have been generally shy, and in the case of firearms legislation, nearly totally muzzled, from discussing firearms deaths since congressional language banned funding of firearms research starting in 1996. (In my opinion there has been a failure of leadership in public health when such leadership was needed on the issue of firearms violence, which is a legitimate public health concern.)

But should bans on using public funds for lobbying mute the profession from pushing for advocacy approaches and political engagement?

Daniel Callahan and Bruce Jennings’ 2002 article in the American Journal of Public Health examined the ethics of public health advocacy. They noted, “Politics is a necessary component of public health, moreover, precisely in order to achieve public health policies and practices consistent with American traditions and values. Politics is the messy arena in which ultimate questions of the public good are worked out.”

Public health’s failures in the political mosh pit

A perfect example of what happens when public health was not fighting tooth and nail was President Obama’s Affordable Care Act of 2009, which ultimately squashed efforts for a single payer system—the long-held dream of public health advocates from the 20th century—and advanced a health insurance industry, market-based model for “health care” reform.

All told, advocacy groups in 2009 spent $3.47 billion for D.C.-based lobbyists to parse out issues, according to left-leaning Center for Responsive Politics. Not surprisingly, the lion’s share of that spending went to fight the health reform battle. Businesses and organizations that lobbied on “health reform” spent more than $1.2 billion on their overall advocacy efforts.

APHA lobbying 2013

Source: The Center for Responsive Politics

For its part, the American Public Health Association (APHA) spent less than $500,000 annually on lobbying at last count in 2013. (See spending chart for lobbying expenditures by APHA from 1998 to 2013.)

The good news is that this marked a jump of more than 300 percent from what APHA spent in 2012. It would appear that some in the field are waking up to the realities of fighting for public health where the most meaningful impacts can be achieved – through policy and legislation.

By comparison, just one big pharma company, Pfizer, spent more than $800,000 in the first six months of 2013, from local to congressional candidates and political parties nationwide (see chart above).

What is most discouraging is that future leaders entering the profession continue to be shortchanged by graduate programs that do not know how to prepare practitioners to win in the bruising political environment known as “upstream.” This is my general assessment of not just my graduate MPH program, but of the field that I still see through its obsessive and yet parochial obsession with the 10 essential public health services.

The CDC's 10 essential public health services.

The CDC’s 10 essential public health services.

A very smart resource guide developed by the California Endowment sharply noted: “… many public health faculty do not possess the skills or experience to teach advocacy effectively. Faculty surveys show, for example, that despite advocacy for health being recognized as an ethical responsibility and required competency of health educators, many health education faculty do not see themselves as competent for teaching advocacy and lack instructional materials to do so. Degree-granting programs in public health need to provide systematic training in social advocacy. In the absence of formal training in social change, public health graduates must learn this information and develop these skills on a catch-as-catch-can basis. Working in this way means that some will be less effective than they otherwise could be in advancing the health of the public.”

The enduring influence of Bernd and Hilla Becher

Photography is a highly personal artistic and communication medium. I have found that those who are successful in this arena achieve that status because their work is clearly recognizable. Success is never by accident, and the photographers I greatly admire remain consistently clear and compelling over time, and usually with great impact on others in the field.

Sebastião Salgado comes to mind for me in the field of visual storytelling with a clear vision. His impact can be seen widely in imitators and co-travellers. The same can be said with the husband-wife duo Bernd and Hilla Becher.

Lime kilns, by Hilda and Bernd Becher.

Lime kilns, by Hilla and Bernd Becher.

The German couple photographed industrial architecture in Europe and North America for nearly 40 productive years, until Bernd’s death in 2007. Their easily recognizable subjects include water towers, blast furnaces, gas tanks, timbered homes, and other industrial features.

The pair published books with their images, grouped together in what they called “typologies,” or sets of images of the same objects from different geographic locations, usually in sets of say nine or 21 images. Each image would be photographed identically, with direct frontal composition, no lens distortions, and with a neutral density skyline that did not distract the viewer from the subject.

These ordered collections had almost no captions and simply conveyed the form of the objects, letting the similarities of the objects communicate the meaning without any of the often absurd and blabbering arts-speak that is usually associated with art and photography commentary. (I imagine the Bechers would find such nonsensical writings absurd.)

Their books of photographs, such as Industrial Landscapes and Typologies of Industrial Buildings, compile their work into compelling sets of images. The influence of their aesthetic can be seen in numerous imitators and students, including this series I found recently on abandoned homes in Detroit.

Toward the end of his career, Bernd taught at the Kunstakademie in Dusseldorf, leading to a crop of photographers and a style of picture-taking that is is known as the “Dusseldorf School of Photography.” Bernd’s well-known and accomplished students include Thomas Ruff and Andres Gursky, one of the most celebrated photographers of the world who has sold the world’s most expensive photographic print.

Bernd and Hilda Becher, Blast Furnaces, at the St. Louis Art Museum.

Bernd and Hilla Becher, Blast Furnaces, at the St. Louis Art Museum.

I may have stumbled over the Bechers’ work without knowing it. However, I do recall feeling trapped in a hypnotic trance when I discovered a collection of their blast furnace images, or typology, in the new wing at the St. Louis Art Museum in December 2013.

I felt a deep kinship with their interest in industrical landscape, perhaps because I grew up in St. Louis and was surrounded by similar forms in a city the was dying as an industrial center during my years there. I also felt a connection because I sensed something profoundly post-World War II about their work.

Their work is distinctly German to me, and their images are imbued with the personal experiences of two people who were in their adolescence during the Nazis’ brutal reign in Germany, when the world turned upside down, where the Holocaust and slave labor on a mass scale were engineered, and where killing and death were woven into the DNA of every German as a result of the country’s destruction that followed the country’s efforts to conquer Europe and beyond. (Bernd was born in 1931 and Hilla in 1934.)

Like it or not, they were a product of that experience, and I can feel it having also traveled widely in Germany on several trips and having studied this period of history intensely.

What is strikingly odd to me is I do not believe I was influenced by either of them. Yet the way I chose to explore my photographic project documenting concentration and death camps in five European countries closely mirrored the style of the Bechers. Even the way I chose to layout my photographs of crematoria, where murdered prisoners bodies were burned, bears an eerily familiar resemblance to the Bechers’ amazing work.

I don’t know what more to make of this except to say that I feel satisfied that my presentation style and methods are not singular. I also feel that the effect of combining similar images of strikingly mundane but complex objects can have greater weight in the format of a typology.

With that heavy photographic pontification complete, I present a screen snapshot of my crematoria series on my web site, followed by two screen snapshots of the Bechers’ typologies that I found online and also captured as a screen snapshot.

Rudy Owens' series on crematoria at Nazi concentration and death camps in Europe.

Rudy Owens’ series on crematoria at Nazi concentration and death camps in Europe.

Bernd and Hilla Becher, Gas Tanks.

Bernd and Hilla Becher, Gas Tanks.

Screen snapshot of the Bechers' many typologies and series, taken from Google's "image" tool.

Screen snapshot of the Bechers’ many typologies and series, taken from Google’s “image” tool.

More than 20,000 views and still counting after 20 months

Thanks to everyone who has taken time to visit my blog focussing, mostly, on public health and health. I continue examining issues with the additional perspectives of history, culture, personal experience, and enterprise journalism. This month I crossed the 20,000-views threshold. See the screen snapshot below, taken today.

Wordpress's outstanding analytics tools provide a snapshot how many visitors and views have been recorded, in November, and since I launched this blog in late March 2012.

WordPress’s outstanding analytics tools provide a snapshot how many visitors and views have been recorded, in November 2013, and since I launched this blog in late March 2012.

WordPress’s analytics also report the following categories and tags attracted the most eyeballs:

Tags & Commentaries:
Most popular topics you’ve written about

Topic & Views

  • Public Health 81
  • Health 77
  • Travel 57
  • Obesity, Sweden, Sweden, most beautiful women, Sweden has the world’s most beautiful women, infant mortality, life expectancy, Norway, Nordic Countries, public health systems, national public health investments, beauty stereotypes, national stereotypes, national obesity rankings, fat countries, obesity health threats 51
  • Photography 18
  • Native American 12
  • Africa 11
  • Human Rights 10
  • History 10

The most popular post on my blog looks at why Swedes have a reputation for being attractive, and whether that is related to the country’s strong public health system and universal health care. No doubt a fair number of visitors came looking for pictures of blonde Swedes in bikinis, but hopefully came away with some knowledge of how investing in health upstream can pay dividends that are linked to, yes, physical appearance and overall health.

The data are great validation for the idea that first launched this enterprise. It began during a spirited discussion at the University of Washington School of Public Health about the value and validity of training future public health leaders to specialize in publishing in peer-reviewed journals as opposed to open-source communications like WordPress-enabled blogs or social media or non-scientific publications. This is a topic that is being debated by many seeking to improve public health’s relevance for the year 2013 and beyond.

Having public relevancy in the face of funding cuts remains a critical issue in the field of public health, which has seen its workforce at the local level shrink by 44,000 jobs, or nearly a quarter of all workers, since the start of the Great Recession. Budgets in local health jurisdictions have been slashed to the bone according to a national survey of those organizations by the National Association of County & City Health Officials (NACCHO).

In fact, I would recommend to anyone contemplating a career in public health, outside of epidemiology or biostatistics, to consider advanced degrees in law, business, or applied health like nursing rather than this field, based on the national employment data. Or future public health leaders can learn through other means how to integrate new tools of communications to engage the public with research, to build support for funding health.

In fact, those who now manage the nation’s graduate public health programs need to use the tools of program evaluation, which they teach in the nation’s finest universities, and engage in a serious discussion if their education model is still working and achieving longer-term goals and ultimately leading to a better public health system and healthier country.

How many MPH graduates in 2013 found jobs within six months? Is that number acceptable? Why train a workforce for many jobs that may not be in high demand or nonexistent, with skills that are not reaching a wide audience, thus preventing the public from knowing what public health is and why it matters?

This will remain a fundamental issue at the heart of the crisis facing the field today and for years to come. Meanwhile, I think there will continue to be a bottoms-up response to how the profession adapts to change in the new era of diminished resources. I hope that this blog will continue to be involved in that larger discussion, and the numbers show that at least some online readers are hungry for information in easier-to-access ways.

Roger Gollub, a model for leadership in public health

Dr. Roger Gollub and his beloved golden retriever, Sophie, at the famous Balto  statue in downtown Anchorage.

Dr. Roger Gollub and his beloved golden retriever, Sophie, at the famous Balto statue in downtown Anchorage.

Five years ago today, on a cold Alaska night, I was awoken by a strange phone call left on my answering machine saying something had happened to my Anchorage friend, Dr. Roger Gollub. Confused, I called the emergency room at the Maniilaq Health Center in Kotzebue, a remote bush city in the Northwest Arctic Borough, 26 miles north of the Arctic Circle on the Chukchi Sea. Roger had flown there a day earlier on assignment—I was with him the night before. I could not believe what I heard. The medical personnel told me, with great difficulty, that one of county’s finest pediatricians and public health caregivers had died from injuries sustained on a trail just outside of town that night.

Dr. Roger Gollub, a career pediatrician with the U.S.  Public Health Service’s Indian Health Service, never returned home from his short visit to care for patients in this mostly Native community. He, along with a coworker, were mushing on a shared-use trail in subzero weather, under Alaska’s majestic starry skies, when they were run over by a snowmachine. The driver had a criminal background and was under the influence of drugs and booze. It was about a senseless a crime as I could have ever imagined, and more brutal because of the injuries Roger and his coworker sustained. (Note, Roger’s colleague survived, but only after heroic procedures and months of recovery, all costing more than any non-wealthy person can afford.)

After a bitter scream of disbelief upon hearing the news, I caught myself and thought, what would Roger do. I then spring into action for the next 24 turbulent hours, and the years beyond. In fact, my response to Roger’s tragic passing continues to this day. I would never have gone back to graduate school and earned my MPH in 2012 had I not been inspired by Roger’s amazing life’s work. He remains the finest man I have ever known.

Roger Gollub's good friend and champion in so many uncountable ways, Gunnar Knapp, stands by spot where Roger was taken. Thanks, Gunnar, for sharing this with all of us who cared about Roger.

Roger Gollub’s good friend and champion in so many uncountable ways, Gunnar Knapp, stands by the spot where Roger was taken on Nov. 19, 2008. Thanks, Gunnar, for sharing this with all of us who cared about Roger.

Roger had just retired from a distinguished career, which included an epidemiological residence with the U.S. Centers for Disease Control and path-breaking work with Native American and Alaskan Native communities (details here). He was still working under contract serving his many patients, and thinking about an active life ahead, including research, time with his wife and two daughters, projects with the Anchorage Amateur Radio Club, and travels he long delayed. Roger’s death forever changed my life, but also in a good way. From that time on I vowed to work even harder at showing the type of leadership that Roger demonstrated throughout his life.

Though he was only 5’6”, Roger towered above his peers as a professional, and particularly as an exemplary caregiver who understood his young Native American and Alaskan Native patients and their families. He was named physician of the year by the national health agency he dedicated his life too. He had legions of fans across the U.S. Public Health Service who held him in the highest of regards.

At Roger Gollub's "Celebration of Life," hundreds of well-wishers offered condolences and happy memories of one of Alaska's finest doctors ever (December 2008).

At Roger Gollub’s “Celebration of Life,” hundreds of well-wishers offered condolences and happy memories of one of Alaska’s finest doctors ever (December 2008).

I saw hardened, even stoic and cantankerous men who knew him through his ham radio activities openly weep when trying to make sense of his death. (Roger was an advanced ham, who knew Morse code, and who brought amazing life into the local club.) I saw more than 500 mostly Alaskan Natives give him the highest honors normally bestowed only to revered elders. I heard dozens of stories describing how Roger helped and even saved their very sick children, all while preventing costly medical waste within a sometimes-inefficient bureaucratic health delivery system. That alone is amazing, and Roger never expressed cynicism about that system that often thwarted him and his seasoned colleagues.

This letter, published in the Anchorage Daily News shortly after his death, captured a sentiment that lit up the blog coverage of his passing, with comments pouring in nationwide: “I am sure I’m not the only one who feels a great loss with the recent passing of Dr. Roger Gollub. He was truly a man with a servant’s heart and had a tremendous impact on my family. As a pediatrician at the Alaska Native Medical Center, he has shown pure dedication to the Native community and loved each and every patient. He had a place in my heart and my children’s. Once, my daughter had to see another doctor while he was on vacation, and cried for her doctor to come back. The world will never see another with the same compassion, dedication, intellect, integrity and valor as he. I was privileged to know this man for six years and he will never be forgotten in my children’s heart and mine. Linda Tomaganuk Anchorage.”

On the darkest of days, Roger still managed to smile. He always took phone calls from worried parents–at home, in his car, on his walks, wherever. How many doctors take house calls, or personal calls, ever? That was Roger. That was the kind of leader he was. He breathed it. He lived it.

Roger demonstrated to me examples of the leadership that I admire most:

Emotional Intelligence: Roger demonstrated this trait that most researchers say is the best predictor of leadership. He never appeared flustered. His coworkers described his ability to bring chaotic situations under control, in hospital wards or during infectious disease outbreaks, with a calm, deliberative, thorough, and positive manner. It proved contagious, and he earned trust and credibility among his peers.

Understanding of and Respect from his Peers: Abraham Lincoln, America’s greatest politician, was infamous for his empathy and his ability to understand his friends and opponents, which helped him articulate decisions and policy choices that always seemed perfectly suited for the difficult challenges ahead. He knew where the audience was, and where he needed them to go. Roger was celebrated in the Indian Health Service for his true commitment to community based participatory research, for which he earned the deepest respect from his Native American medical professionals. Mention Roger to anyone who has worked in this community, and you will quickly learn of Roger’s deep and genuine appreciation for the community he served during his lifetime. I met a former career pediatrician in the Indian Health Service last spring and mentioned Roger’s name, and was greeted by the most contagious grin I had seen in months. One University of Washington School of Public Health faculty member, who specializes in the field of community based participatory research and who knew Roger in New Mexico, said unequivocally, “Roger was the real deal.”

Leading by Example: Dorris Kearns Goodwin’s portrayal of Lincoln’s wartime cabinet, his famous “team of rivals,” highlights Lincoln’s eventual winning over of Democrat Edward Stanton. Before the Civil War, the former Ohio attorney had ridiculed and mocked the then lesser-known Illinois lawyer as a “long-armed ape” during a legal case during which Stanton shunned Lincoln’s work. Lincoln did not hold a grudge, and he then sought out Stanton to run the War Department during the Civil War, because he had the right qualities to master a complex organization. Stanton later become Lincoln’s strongest ally. Lincoln’s ability to put aside personal grudges and genuinely collaborate even with his political rivals was not an act. It was genuine.

Roger treated everyone he interacted with, even those who did not return the courtesy, with respect. I never once heard him utter a bitter word or even cynical comments, even when I expected them. I have met few people who have demonstrated this trait. Roger had a work ethic paralleled by few. He put in 12-hour days and longer, never compromised his duties as a father or husband, and excelled at nearly anything he tried to do—medicine, engineering, ham radio communications, running, parenting, research, epidemiology, research. Roger adopted practices seeing patients that saved taxpayers tens of thousands of dollars, which his peers steadfastly noted at his funeral. He never sought glory, though during his life he was gaining a national reputation he could never even imagine.

That tiny little guy you see in the front row, in the middle, is team captain Roger Gollub (University City Senior High School Track Team, 1973).

The small guy in the front row, in the middle, is team captain Roger Gollub (University City Senior High School Track Team, 1973).

Roger  particularly demonstrated this talent at University City High School, where he ran track and cross country. I attended the same high school, though ten years after Roger. Roger was the smallest man on an interracial track team, which was comprised of very large young men who towered over Roger. Racial tensions were real here, but so were the strong bonds. I know this school, and I can assure you this is a serious alpha dog environment and not for the faint of heart, particularly among young, competitive men. Roger’s peers voted him captain of the track team, because he pushed the bar farther and competed harder and ran faster than all of them. In short, he inspired them to do better. He never asked for that title. He earned it. He made his team a genuine competitor at the state level. Roger carried that excellence to Yale where he competed for the Yale track team as well. (Roger’s own running hero was Olympian Edwin Moses.)

Moral Vision and Visionary: Roger’s values were nurtured in his Jewish, middle-class upbringing in a diverse community, University City, Mo., which we both called home. (I lived next door to Roger, but only briefly overlapped when I was younger, as he was 10 years older.) It was an often-hard place to learn about racial differences, but also a great place to dream big about pursing a path that made a difference. Roger knew exactly who he was and what he wanted. He graduated class valedictorian in 1973, and never forgot his roots. His vision was, as his friends said, a mix of Mighty Mouse heroism mixed with the Star Trek prime directive to do no harm–and yes, these describe his actions and values as a doctor working cross-culturally.

At Roger Gollub's celebration of life, his family assembled assorted "tools of the trade" he used to care for sick kids, and of course the famous lobster hat.

At Roger Gollub’s celebration of life, his family assembled assorted “tools of the trade” he used to care for sick kids, and of course the famous lobster hat.

I never once saw Roger lose faith in others or in the inherent goodness of people. His service to patients, the core mission of the U.S. Public Health Service, and purposes far bigger than himself can be seen in every personal and professional choice he ever made. He demonstrated and articulated a clear, humane vision for health care, community, family, race relations, and society that he blazed intensely everyday, inspiring dozens if not hundreds by his example.

Don’t be fooled by that doctor you see in this picture with a goofy grin, and a lobster hat and Elmo toys. That was a master professional’s slight of hand to get nervous kids comfortable and the most conniving of change agent’s subversive and effective strategy to reform a health care system that has long forgotten how to put compassion ahead of egos and profits.

I have yet to meet anyone in the field of public health and public service who embodied all of the leadership traits Roger seemed to have in spades. Sometimes we just get dealt the right hand and can say, damn, I was lucky I had a chance to work with or know such a gifted, natural leader. Thanks, Roger!

Public health’s evolving role promoting U.S. military interests

The seal of the U.S. Department of Defense, representing seven branches of the U.S. military.

The seal of the U.S. Department of Defense, representing seven branches of the U.S. military.

The U.S. Department of Defense (DoD) remains one of the most sophisticated media production machines on the planet. Its ubiquitous advertising filters into every aspect of our lives, from public schools to product placement in the lucrative gaming industry to traditional online ads.

In 2007 alone, according to a Rand Corp. study, the total recruiting budget for the Army, Navy, Air Force, and Marine Corps exceeded $3.2 billion. Rand Corp. analysts also deemed those investments as successful as measured by recruitment, even during two ongoing wars in Afghanistan and Iraq.

Events with military personnel always feature sophisticated press and social media coverage. One of the more nuanced and I think effective messages I have seen from the DoD is how the military is not just about defense, but about a more deeply and morally resonant “good.” The U.S. Navy’s very slick videos call the branch a “a global force for good,” and show Navy SEALs in action carrying that message.

This clip from a U.S. Navy recruiting video shows a successful branding effort by the U.S. Department of Defense to promote its global activities as a moral good, including special ops efforts by U.S. special forces

This clip from a U.S. Navy recruiting video shows a successful branding effort by the U.S. Department of Defense to promote its global activities as a moral good, including special ops efforts by U.S. special forces.

Helping to prop up that messaging is the country’s long-standing integration of public health services into the DoD and overall military readiness. The military is successfully integrating public health activities, and it is branding these as part of its global efforts, including on the new battlefield in Africa.

Through contracting opportunities that support these efforts, many U.S. based firms who specialize in development and traditional public health activities are actively supporting these initiatives, in order to monetize their own business models.

Chasing contracts serving two masters: public health and defense

I recently stumbled on a job posted on the American Public Health Association (APHA) LinkedIn page by a company called the QED Group, LLC. The position was similar to ones I see posted on their job site now, for work on a “monitoring and evaluation” project in Africa.

This is one of many government-contracting agencies that chase hundreds of millions of contracts with U.S. government agencies and the major public health funders like the Bill and Melinda Gates Foundation.

In this case, the company was specifically targeting those in the public health community, who are entering the field or currently have positions with backgrounds in public health, economics, science, and health. The 15-year-old company itself actually began as a so-called 8(a) contractor, which means it could win no-bid and lucrative government contracts that are now the center of an ongoing and intense controversy over government waste. (These companies were created by the late Alaska Sen. Ted Stevens, who created the provision to steer billions in government contracting to Alaska Native owned firms that partner with companies like Halliburton and the Blackwater overseas and in the United States.)

QED Project in NorthAfrica

The company QED Group showcases its recent work evaluating anti-terrorism-related efforts in North Africa.

Today, QED Group, LLC claims “it is full-service international consulting firm committed to solving complex global challenges through innovative solutions” by providing clients “with best-value services so they increase their efficiency, learning capacity, and accountability to the public in an ever more complex and interconnected world.” It lists standard international development and public health contract areas of health, economic growth, and democracy and governance.

QED Group is not the only multi-purpose public health and development agency chasing military and global health contracts in Africa.  Another health contracting company called PPD boasts of its “long history of supporting the National Institutes of Health, the nation’s foremost medical research agency,” and that it was “awarded a large contract by the U.S. Army.” It claims its is also a “preferred provider to a consortium of 14 global health Product Development Partners (PDPs), funded in part by the Bill & Melinda Gates Foundation.”

As a public health professional, QED Group looks like a great company to join. However, if one scratches deeper, one learns that this company also uses its public health competencies with the U.S. military, which is spearheaded in Africa by U.S. Africa Command, or AFRICOM.  This raises larger questions of the conflicting ethics of both promoting human health and public health and also serving the U.S. Department of Defense, whose primary mission is to “deter war and to protect the security of our country.”

AFRICOM’s emerging role flexing U.S. power in Africa

AFRICOM’s demonstration of “hard power” is well-documented through its use of lethal firepower in Africa. AFRICOM is reportedly building a drone base in Niger and is expanding an already busy airfield at a Horn of Africa base in the tiny coastal nation of Djibouti. On Oct. 29, 2013, a U.S. drone strike took out an explosives expert with the al-Qaida-linked al-Shabaab terrorist group in Somalia, which had led a deadly assault at a Kenyan shopping center earlier that month.

One blog critical of the United States’ foreign policy, Law in Action, reports that the AFRICOM is involved in the A to Z of Africa.  “They’re involved in Algeria and Angola, Benin and Botswana, Burkina Faso and Burundi, Cameroon and the Cape Verde Islands. And that’s just the ABCs of the situation. Skip to the end of the alphabet and the story remains the same: Senegal and the Seychelles, Togo and Tunisia, Uganda and Zambia. From north to south, east to west, the Horn of Africa to the Sahel, the heart of the continent to the islands off its coasts, the U.S. military is at work.”

U.S. efforts in Africa require health, public health, and development experts. As it turns out the company, QED Group,  won a USAID contract examining U.S. efforts promoting “counter-extremism” programs in the Sahel. That study evaluated work using AFRICOM-commissioned surveys, all designed to promote U.S. national security interests in the unstable area.

The area is deeply divided between Christians and Moslems. It is also home to one of the largest al-Qaida based insurgencies known as al-Qaida in the Islamic Maghreb, which has similar violent aspirations as the ultra-violent Boko Haram Islamic militant movement of violence-wracked northern Nigeria. Al-Qaida in the Islamic Maghreb military seized control of Northern Mali in 2012, which ended when U.S.-supported French military forces invaded the country and routed the Islamic extremists in January 2013.

Public health’s historic role with U.S. defense and national security

“Hard power” and “soft power” are tightly intertwined in U.S. overseas efforts, where health and public health personnel support U.S. interests. This is true in Afghanistan and is certainly true in North Africa. This particular QED-led program used the traditional public health method of a program evaluation of an antiterrorism program to see if a USAID program was changing views in Mali, Niger and Chad—all extremely poor countries that are at the heart of a larger struggle between Islamists and the West.

That research methods used in public health–and which I have used to focus on health equity issues in Seattle–can be used equally well by U.S. development agencies to advance a national security agenda is not itself surprising.

However, faculty certainly did not make that case where I studied public health (the University of Washington School of Public Health). I think courses should be offered on public health’s role in national defense and international security activities, because it is nearly inevitable public health work will overlap with some form of security interests for many public health professionals, whether they want to accept this or not.

U.S. Public Health Service Corps members proudly serve their country and wear its uniforms.

U.S. Public Health Service Commissioned Corps members proudly serve their country and wear its uniforms. This photo published on the corps’ web site demonstrates that pride.

Public health in the United States began as a part of the U.S. armed services, as far back as the late 1700s. It was formalized with the military title of U.S. Surgeon General in 1870. To this day those who enter the U.S. Public Health Service Commissioned Corps wear military uniforms and hold military ranks.

A good friend of mine who spent two decades in the Indian Health Service, one of seven branches in the corps, retired a colonel, or “full bird.” He always experienced bemusement when much larger and far tougher service personnel had to salute him when he showed his ID as he entered Alaska’s Joint Base Elmendorf Fort Richardson looking often like a fashion-challenged bum in his minivan (he frequently had to see patients on base, and was doing his job well).

The U.S. Public Health Corps' web site shows the different uniforms worn by their members.

The U.S. Public Health Service Commission Corps’ web site shows the different uniforms worn by its members.

The U.S. Army’s Public Health Command was launched in WWII, and it remains active today. One of its largest centers is Madigan Army Medical Center at Joint Base Lewis McChord, in Pierce County, Washington. Public Health activities are central to the success of the U.S. Armed Services, who promote population-based measures and recommendations outlined by HealthyPeople 2020 to have a healthy fighting force.

AFRICOM charts likely path for the future integration of public health and defense

Africom photo

This screen snapshot of an AFRICOM media file highlights the public health and health related efforts AFRICOM personnel undertake in the region, where military efforts are also underway to suppress and disrupt Islamic extremist groups.

Today, the U.S. military continues to use the “soft power” of international public health to advance its geopolitical interests in North Africa.  In April 2013, for example, AFRICOM hosted an international malaria partnership conference in Accra, Ghana, with malaria experts and senior medical personnel from eight West African nations to share best practices to address the major public health posed by malaria.

At last count, the disease took an estimated 660,000 lives annually,  mostly among African children.

At the event, Navy Capt. (Dr.) David K. Weiss, command surgeon for AFRICOM, said: “We are excited about partnering with the eight African nations who are participating. We’ll share best practices about how to treat malaria, which adversely impacts all of our forces in West Africa. This is a great opportunity for all of us, and I truly believe that we are stronger together as partners.”

I have reported on this blog before how AFRICOM and the United States will increasingly use global health as a bridge to advance the U.S. agenda in Africa. And global health and public health professionals will remain front and center in those activities, outside of the far messier and controversial use of drone strikes.

It is likely this soft and hard power mission will continue for years to come. Subcontractors like QED Group will likely continue chasing contracts with USAID related to terror threats. Global health experts will meet in another African capital to discuss major diseases afflicting African nations at AFRICOM-hosted events. And drones will continue flying lethal missions over lawless areas like Somalia and the Sahel, launching missiles at suspected terrorist targets.