Leading State Health: David Sundwall on Public Health and the Presidential Election

November 10, 2016|4:33 p.m.| David Sundwall

With the transition to a new presidential administration, ASTHO continues to advance its nonpartisan agenda to transform state and territorial public health. Past ASTHO President David Sundwall (alumni-UT) discusses the election and the importance of public health as we look to the future.

Q: What can states do to advance their public health agenda with the incoming administration?

A: In transitions, the important thing is getting to know the people in charge. Anyone in a position of influence in public health needs to know their personal elected official. And I don’t mean just their name. I mean, they should actually know them, and if possible, have a personal relationship with them and be a trusted advisor.

But it isn’t just about getting to know the elected official, it’s about getting to know and work with their staff. Some people make the mistake of insisting on only meeting with the elected official, because the elected official is so important and has stature. Bad idea. The elected official always passes things along to their staff. So as you get to know our new elected officials, invest as much effort as you can in getting to know their key advisors and staff, because they’ll be doing a lot of the work.

Q: How can states and public health prepare for the transition to the incoming administration?

A: This, too, is really important. I was talking with Jewel Mullen [HHS Deputy Assistant Secretary for Health and former Senior Health Official for Connecticut] at the recent ASTHO Annual Meeting in Minneapolis and she said, “No matter who wins the White House, we have important and essential work to do, and we will continue to do it, to the extent that we can, with the budget provided, as directed by our elected officials.”

I thought that was a wise and mature statement. It’s exactly what all public health professionals should do. They may have different politics or philosophies than those elected, but it’s important to remember that we work at the pleasure of our elected officials. So, for the upcoming transition, we need to acknowledge this fact and stick to the notion that we have really important and essential work to do. It may not be funded to the degree we would like, and [the new administration] may want to scale back. But nevertheless, we need to make sure the transition team understands what’s essential to public health, and we need to continue to do it as well as we can with the resources provided.

Q: What are three things public health leaders can do to educate and engage incoming policymakers?

A: This is really important. The most important thing is, ASTHO’s message—and most public health messages—should be completely non-partisan. We need to make it clear that this is not a Democratic or Republican issue; this is non-partisan and will affect all Americans.

The second piece of advice I would give is, because this is a Republican administration that will focus on the economy, we [as public health leaders] need to make clear that a healthy economy is dependent on a healthy population. To the extent that we can implement public health principles and practices, we’ll have a healthy citizenry and a healthy workforce.

Finally, I think we should focus policymakers’ attention on the relationship between effective public health and controlling healthcare costs. You don’t have to be a serious student of health policy to know that one of the main issues we’re dealing with domestically is the rising cost of healthcare. It can’t continue, it’s unsustainable, and the only legitimate hope to control costs is preventing disease.

Q: How has presidential campaign rhetoric surrounding public health changed during your time as a public health leader?

A: This election, we didn’t really hear much from the presidential candidates about public health, but that’s nothing new. Things haven’t changed much in that regard. It’s unfortunate that we [as public health leaders] can’t get the importance of what we do to the forefront of presidential campaigns. It just simply doesn’t rise to that level.

In 2008, when I was ASTHO President, a goal of my President’s Challenge was to get public health included in the political platforms of both parties. I simply wanted a statement like, “We value the importance of public health and the inclusion of public health principles and practices in all policies.” Just a one-sentence statement. And do you think I could do that? I could not. Even though I met with key policy advisors for both Senator McCain and then-Senator Obama, I didn’t come close to getting that kind of language in either party platform.

Q: Which public health issues deserve more attention?

A: Emerging infections and the opioid epidemic. And then, I think we need a national initiative to improve infant mortality. We rank 26th in the world, and that’s hard to understand, given the fact that we’re the most affluent and powerful country.

David Sundwall

David N. Sundwall, MD, is a professor of public health at the University of Utah and a primary care physician. He served as the executive director of the Utah Department of Health from 2005-2009 and ASTHO president from 2008 to 2009.