New Jersey Health Commissioner Shares Vision for Public Health in the Garden State

April 19, 2018|9:59 a.m.| ASTHO Staff

Shereef Elnahal is commissioner of health for the New Jersey Department of Health. Elnahal previously served as Assistant Deputy Under Secretary for Health for Quality, Safety, and Value at the U.S. Department of Veterans Affairs (VA), where he initially held a White House fellowship in 2015. In this capacity, Elnahal founded the Diffusion of Excellence Initiative to establish consistency in clinical and administrative best practices. Elnahal is a licensed physician with a dual-degree MD and MBA from Harvard University.

This April marks the fifth anniversary of the Boston Marathon bombing—a tragedy Elnahal remembers well from his time as a resident physician at Brigham and Women’s Hospital. Elnahal saw firsthand what unfolds when an unexpected crisis hits a healthcare system. ASTHO spoke to Elnahal about this experience and how partnerships are vital across the public health landscape to respond to both emergencies and ongoing priorities, such as access to care for veterans and the opioid epidemic.

How did your career in public health begin?

I have been interested in the social determinants of health since I entered the medical field. After exploring ways that I could contribute to mitigating social risks, I discovered that health policy and management were fields that allowed you to change the lives of folks at scale. In my last year of residency, I was selected for a White House fellowship and was assigned to the VA. I thought I would be there a year and then go back to clinical medicine, but I was presented with an amazing opportunity to remain at the VA as assistant deputy under the secretary for health for quality, safety, and value. Another incredible honor came along when New Jersey Gov. Phil Murphy, a great champion of public health, asked me to serve as health commissioner. I couldn’t refuse the opportunity to come back to my home state and serve.

Reflecting on your experience at the VA, how has your work to improve access to care for veterans and service members influenced your approach to population health?

As a health systems executive at the VA, it was an honor to serve nearly nine million veterans, a population similar in size to New Jersey. Many of the issues I addressed at the VA are like the challenges we face in New Jersey. A lot of veterans were addicted to opioids or at risk of becoming addicted. There were shortfalls in extending access to women’s health. And there was a high prevalence of chronic disease that was sometimes hard to treat due to issues with access to care. The strategy I undertook at the VA, in partnership with leadership and frontline employees, was to identify where best practices existed in the sprawling 166 hospital system, and determine how to scale these initiatives to treat thousands more veterans. We are taking that same approach in New Jersey. In fact, we already have an innovation webpage that will carry a different theme every month, highlighting not only institutions that are leading in their respective areas, but publishing their protocols—their play book, if you will—with the intention of having other institutions adopt their approach.

As a physician with experience treating mass casualties during the Boston Marathon bombing, what advice do you have for public health officials who may be called on to respond to similar tragedies?

While my role was limited to helping triage some folks who were injured after that tragedy, I got a firsthand look at what a crisis looks like when a healthcare system is not expecting it. From a preparedness perspective, planning, coordinating with multiple partners, building relationships, and exercising plans are the keys to a successful emergency response. When New Jersey hosted the Super Bowl in 2014, the department of health began planning more than a year in advance. Law enforcement, first responders, acute care hospitals, local public health officials, as well as county emergency preparedness officials came together to design a plan and exercise it. By the day of the Super Bowl, there was a thorough plan, clear lines of communication, and strong working relationships. We used the same preparedness model during Super Storm Sandy, as well as major snow storms and responses to emerging public health threats such as Ebola. Each time you exercise your preparedness plans, you are better prepared for the next public health emergency.

What is your vision for the future of public health?

Public health approaches need to evolve to a place that is more explicitly operational. Public health goals are inherently broad and ambitious—when you’re trying to change outcomes for entire populations, you’re facing an uphill battle. That is why I’ve asked my teams to focus on tangible goals, timelines, and metrics for our public health priorities, all buttressed by operational plans that align resources with expected results. As we’ve begun to do this, it has become very obvious that we absolutely need robust partnerships with two main players: statewide advocacy organizations and local governments (counties and municipalities). Doing so not only connects you to citizens operationally; it also vastly expands the resources that a coordinated approach will need to effect real change.

The public health crisis of our time is the opioid epidemic, and we would like to take this approach here. Gov. Murphy recently allocated $100 million for an organized, coordinated, data-drive multiagency approach to eradicate an epidemic that took the lives of 2,200 New Jersey residents in 2016. We’re really trying to make progress on this epidemic by also addressing social factors like unemployment and homelessness, which place individuals at risk for substance use and relapse. That will require the operational strategy and partnerships mentioned above.

Other priorities include: creating single license for behavioral and primary care so services can be better coordinated, reducing disparities in infant and maternal mortality, increasing access to affordable healthcare and health insurance, expanding access to our medicinal marijuana program, and putting a greater emphasis on telehealth and interoperability of electronic patient health information in a seamless manner from one provider to another.

Finally, all of this should (and will be) buttressed by a foundation of data interoperability and innovation. Not only will this allow us to receive more real-time feedback regarding how much we are moving the needle on these priorities; it will also scale the impact of our interventions. Telehealth, bolstered by an interoperable system of health information, is just one example that could directly feed into our goal of expanding mental health access across the state. The opportunities are vastly expanded with this type of approach.