Leading versus Leadership

There’s a health think tank in the UK that I hate. 

I’m sure the folks working there are nice enough but, in my experience, every single one of their reports seems to conclude that what we need is ‘leadership’. It doesn’t matter what the report is about, the solution is always leadership. 

It’s not the banality of their mono-conclusion that annoys me but the sheer lack of clarity on what ‘leadership’ means. It seems to me that the health system has had leaders – and presumably leadership – for years and yet it’s in a mess. Why would more of the same help?

In a new article, Renée Canady, the CEO of the Michigan Public Health Institute and author of a new book, Room At The Table, and Tony Iton, the CEO of The Health Trust and a former SVP of The California Endowment, a health foundation, have unpacked what they think it means to lead in public health. 

There are two important things about the article. The first is that it makes the distinction between leading and ‘leadership’, the latter being something that’s become performative, inflexible and not fit for the challenges faced by the profession. 

The second important thing about the article is that it is informed by the experiences of six leaders in public health who have shown significant bravery and creativity in recent times: 

• Danielle King created a process by which new bills could be assessed for their impact on different communities
• Jamin Johnson is in the process of reconfiguring an entire health department to ensure it serves everyone
• Joneigh Khaldun led the way in showing that the response to the COVID-19 pandemic did not have to further widen disparities in health
• Lisa Peacock showed what it took to deal with public harassment after issuing a face mask order during the pandemic
• Sara Cody led a coalition of health officers that issued the first shelter-in-place order in the US during the pandemic and then weathered opposition from Silicon Valley
• And Umair Shah has shown how a health department can serve a geopolitically diverse and complex region

Renée and Tony propose what it means to lead. They break it down into what it means to think, talk and do as a leader. Of the 12 ways to think, perhaps the most fundamental is the idea that “health is political”. This is not remotely a new thing to say (indeed, they’ve both been saying it for three decades) but they go beyond the near-platitude: 

• “…health is influenced by the availability of resources and opportunities and how the distribution of these resources and opportunities in society comes down to power differentials across groups.”

And they are clear about what this means for doing public health: 

• “…core to the work is being in relationship with those who have limited power, [including supporting] less powerful communities to build their power”

In a forthcoming article, Tony and I describe how some health departments have worked with communities to build their power, a process known as an inside-outside strategy. 

Of the seven ways to talk described in the article, perhaps the most important right now is to be open to conflicts between the entities that public health needs to work with. We live in times of animosity and polarisation. And while a lot of it is high in hashtags and low on results, the result is an impasse that’s inhibiting action and preventing population-level health improvement. 

The ways of thinking and doing lead to 17 ways of doing. All in, they “offer a more tangible, real-world insight than the increasingly performative descriptions of leadership that are taking hold”. But they are not a series of activities to be copied. To paraphrase Renée and Tony, they are a glimpse into the kinds of things public health leaders need to contemplate as they grapple toward a version of the profession that can respond to unfairness, establish a society that is healthier for all, and reverse the pattern of poor health outcomes that continue unabated.

The article is one of the final outputs of my near-six-year engagement with the California Endowment, which is part of my wider work on the link between community, power and health. My next post – which will probably be about the aforementioned article on inside-outside strategies – will likely be my last as I bring this 13-year programme of work to a close and direct my energies on applying my own learning into doing. 

Until next time. 

Pritpal S Tamber 

The image under the title is by Alice Mollon / Ikon Images