ASTHO’s New CMO Brings Clinical Perspective to Public Health

January 04, 2018|3:00 p.m.| ASTHO Staff

Marcus PlesciaMarcus Plescia is chief medical officer of ASTHO. For the past fifteen years, Plescia has served in public health leadership roles at the state, local, and federal levels, including director of chronic disease for the North Carolina Division of Public Heath, director of national cancer control programs at CDC, and county public health director in Charlotte, NC. Prior to this, Plescia spent ten years in academic family medicine, teaching medical students and family medicine residents and providing patient care. In addition, Plescia has remained active in public health research, publishing in medical and public health literature and serving as principle investigator of REACH 2010, a large, CDC-funded health disparities intervention project.

What have you learned from your experience working in both healthcare and public health?

I started my career in family medicine working in a federally qualified health center in the south Bronx during the height of the AIDS epidemic. Making a difference in people’s lives gave me great satisfaction on a daily basis. Although we rarely see this sort of immediate change in public health, the impact of our work is profound due to the scale and reach of our interventions.

As a public health professional, I have learned to take risks and embrace change. As a result, I have been involved in some seminal changes, including addressing racial and ethnic health disparities, passing a strong smoke-free law in North Carolina, and working on ACA implementation at CDC. This approach has not been without challenges. As public health director in Charlotte, NC, I led an effort to transition the department to a more assertive, population-based agenda, until an unanticipated performance issue in our clinics sparked controversy about whether the department should have remained more focused on its traditional role as a safety net provider.

More than anything, however, my career in public health has taught me humility and tenacity, the importance of focus, and the different ways to exert influence for positive change.

As ASTHO’s chief medical officer, what do you hope to see regarding the relationship between state public health and healthcare? 

I have long been interested in the intersection between medicine and public health. Traditionally, the culture and interests of medicine have dominated the relationship. However, I would like to see more emphasis on health and prevention moving forward. It’s important to remember that empathy drives much of our society’s emphasis on medical care. We should find ways to embrace this instinct by placing more emphasis on the role of public health as an agent of change and force for social justice. As public health leaders, we do this by influencing policies, regulations, and social norms at the state level. It’s been my experience that experimentation at the state level, driven by state public health agencies, ultimately prompts change at the federal level.

How can public health leaders utilize partnerships with healthcare organizations to improve the health and well-being of individuals in their communities?

Public health has strong partnerships with healthcare organizations regarding issues such as infectious disease control and preparedness. Our role in these partnerships is clear and our authority is respected. However, partnerships surrounding non-communicable diseases are less clear. With that said, public health should focus partnerships on three areas:

  • Medical care services: With the emergence of the medical home concept, public health should expect healthcare systems to take the lead and be the source of primary and specialty medical care. As public health leaders, we should partner with healthcare systems to define unmet needs across every state and territory and leverage their significant infrastructure to address these needs.
  • Prevention: I believe healthcare organizations will work with the public health community to implement evidence-based prevention strategies. Partnerships should identify physician and industry leaders to help advocate for these changes. Healthcare organizations will support public health efforts to implement policy, systems, and environmental changes to make the healthy choice the easy choice, but they expect us to take the lead.
  • Self-Management: Exciting opportunities are emerging for creative and progressive partnerships to support the self-management of individuals with chronic conditions. ASTHO has received significant support from CDC and other funders to explore these partnerships, test innovative approaches, and define best practices. I believe some very important roles for public health will emerge from this work.

From a medical standpoint, how can states best address the opioid epidemic?

There is still some opportunity for quick wins regarding the availability of naloxone and policies to make access to medically assisted therapy more widely available. I also think prescription drug monitoring systems are powerful tools that can help the medical community restrict access and eventually drive changes in prescribing behaviors. Ultimately, influencing social norms and public understanding of addiction will likely be the most effective (albeit challenging) intervention. The recent report from Trust for America’s Health calling for a national resilience strategy offers strong solutions. I have been particularly impressed with ASTHO’s national leadership on this issue. State and territorial health departments have aggressively sought solutions and implemented promising practices. I am eager to help take these efforts to scale.

Marcus Plescia is ASTHO’s chief medical officer. Follow him on Twitter @MarcusPlescia.