Montana’s State Medical Officer Discusses Public Health Priorities, Skills, and Challenges

May 17, 2018|2:08 p.m.| ASTHO Staff

Gregory HolzmanGregory Holzman is state medical officer for the Montana Department of Public Health and Human Services (DPHHS). Prior to this role, he worked in state and federal government as chief medical executive of the Michigan Department of Community Health and deputy director for CDC’s Office of State, Tribal, Local and Territorial Support (OSTLTS).

Holzman’s connection to Montana dates back to 1998, when he worked as a physician in the Indian Health Service in Browning, MT, as well as a consultant for DPHHS’ tobacco use prevention and maternal and child health programs. Holzman brings a wealth of public health knowledge and experience to Montana. His primary priorities include: providing leadership for statewide public health programs, researching and monitoring emerging public health issues, and representing DPHHS as a medical spokesperson and point of contact with CDC.

ASTHO spoke with Holzman about his collaboration within the director’s office at DPHHS, how his federal public health experience influences his work at the state level, and the progress Montana has made with its strategic plan to address substance use disorder.

What are your primary priorities as Montana’s state medical officer? How do they complement or advance the priorities of the director’s office?

DPHHS is a “super agency,” in that we handle Medicaid, mental health, and other responsibilities, as well as human services, i.e., child protective services, Temporary Assistance for Needy Families, etc. This is in addition to addressing core public health issues: environmental health, healthcare access, tobacco control, substance use prevention, immunizations, family planning—the list goes on. As Montana’s state medical officer, I help coordinate and address medical and public health issues for activities across the agency and issues in communities.

How has your experience working in public health on the federal level as deputy director of OSTLTS influenced your approach to public health on the state level?

Before my work at CDC, I was chief medical executive of the Michigan Department of Community Health. I came to the federal level with a strong state perspective. However, my time as deputy director of OSTLTS gave me a much better understanding of what’s available through our federal partners. Returning to the state level, I now use these resources more efficiently, as I have a better understanding of the knowledge, structure, and bureaucracy on the national level. If I had one wish, it would be that more federal employees had the opportunity to get field experience working at the local, tribal, state, and territorial levels. I think having some time out in communities, being closer to the inner workings of local legislatures, really seeing and feeling the pulse of a particular community—one gets a different understanding of the priorities, issues, and challenges faced by local, tribal, state, and territorial public health.

In 2017, DPHHS released its interim report on the state’s strategic plan to address substance use disorder. What has been accomplished thus far? What other programs and activities does Montana have underway to combat the opioid epidemic?

It’s been challenging, but exciting and meaningful work. The strategic plan has allowed us to coordinate across many different organizations and areas of expertise. It’s been a truly collaborative effort. Departments of correction, the attorney general’s office, child and family services, and many more state and local governmental agencies partnering with nonprofits and private entities have all contributed to comprehensive solutions to address substance use disorder. We have both traditional and non-traditional stakeholders. For example, we are in discussion with the Montana Department of Corrections on a pilot project which I hope to see come to fruition to address medication-assisted treatment for inmates before release from incarceration. In fact, just this past week, I got a call from the Montana Department of Labor and Industry regarding a grant opportunity to help those recovering from addiction gain skills so that they can rejoin the workforce. We're working on those sorts of things, helping to facilitate warm handoffs and developing a hub-and-spokes model to increase access to treatment to help individuals with substance use disorder move into recovery. We are also working on integrative substance use prevention programs. And, of course, we continue to work to increase access to life-saving naloxone.

What qualities or skills do you think health officials need to effectively shape public health policy at the state and federal levels?

If we want to improve the health of the public, our focus should be on bringing partners together from a diversity of fields and expertise to coordinate a systematic response. However, the concept of a multi-disciplinary team approach does come with challenges. One is that the funding in our country is separated from the problem, so we get money from Congress allocated in specific areas through CDC or HRSA that comes down in silos—and that makes things a bit challenging because it doesn’t always address or fit the problem occurring in the community. It’s a matter of adapting the structures of the grant to make sure it’s addressing what the community needs.

Another challenge is the high degree of specialty we now see. Of course, on one level, this is a good thing. However, experts in very specialized fields don’t always have a good perspective on other fields that could be of use to their work. We must ask ourselves: how do we integrate in a better way? How do we figure out where we can collaborate and handoff? How do we use specialists so that we’re not working separately but in a coordinated fashion? And, probably most challenging, is communication. I often reference the George Bernard Shaw quote: “The single biggest problem in communication is the illusion that it has taken place.”

We also encounter information overload. We have access to so much information these days, and yet, as public health professionals, we need to learn how to communicate better. It's not uncommon for somebody to send me an email saying, "Hey, Greg. There’s this great document on substance use disorder. Let me send it your way." And it’s a 250-page document. That puts the responsibility on me, the generalist, to read the full 250 pages and try to understand what the sender wants me to extract. This scenario can happen many times a week with all sort of important topics. There's no way anyone is going to be able to read and comprehend all this information. I’m often saying to my colleagues in different disciplines, “You are the experts. Summarize what you want the reader to understand, send the full document, so one can read further, but filter the information.” To quote Clay Shirky: “It’s not information overload. It’s a filter failure.”

Again, we must ask ourselves: how do we better communicate with our partners so that we can send the right information and they can understand it and pull out the highlights without needing to be experts in everything. That’s the challenge and the opportunity.