Profiles in leadership, Part I: JEH goes on a quest.

Introduction

"In one month, we had three retirements," Mark McMillan told the Journal of Environmental Health (JEH). "Between the three of them, they took almost a hundred years of experience with them."

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Like many members of the profession, McMillan, who manages the Mercury and Environmental Problem Solving Program at the Colorado Department of Public Health and Environment, is concerned about loss of institutional memory. For the past couple of years, he has been sitting down with people he considers to be leaders in his department and conducting formal interviews.

By "leaders," he does not necessarily mean people in management positions. "I actually interviewed a gentleman last month who'd been with the agency for 37 years," he said, "and you could tell that in his nearly four decades, the agency had never really asked him his opinion on activities and vision and the future--things like that."

McMillan's agency has also established a mentoring program that pairs senior practitioners with younger staff members who are interested in learning leadership skills. That program has drawn "a huge amount of interest." Some of the younger staff members who have signed up, McMillan acknowledged, may simply be looking for ways of getting promoted. But he also thinks many of them are genuinely aware that there are leadership skills they don't have--and that those skills can be learned. In other words, alongside personal concerns about money and career paths, members of his department at all levels are concerned about the future of the profession.

"People hear about succession planning," he said, "so I find myself in a lot of offline conversations about our mentoring program or other activities that really get at the leadership in the agency. Or not even in the agency, but in the environmental health field as a whole."

For this series of articles, JEH set out to do something similar: to interview environmental health leaders around the country so that the profession as a whole--which is facing not only a wave of retirements, but also difficulties in recruitment--can understand its past and think actively about its future.

But who are the leaders?

The field is broad. Its practitioners are spread across many jurisdictions. One person's leader might be unknown to colleagues a few miles away. Is it even possible to identify leaders for the profession as a whole? Or would it be more accurate to discuss environmental health leadership in terms of classes of people? Perhaps one could define leaders as people who have accumulated years of experience?--or as people who have stories to share. Or as people who have achieved status and recognition. Or who act as mentors. Or who have creative ideas. Or who are open to other people's ideas--perhaps leaders are people who implement other people's ideas and make things happen?

To begin with, then, JEH was on a mission to find out what leadership means to environmental health practitioners. Part I of the series--this article--describes that quest and its results. Part 11 will profile some leaders: the people and organizations whose names emerged most frequently from the interviews conducted for Part I.

Methods

The definitions of leadership suggested above (and many more) emerged from an informal survey of 28 practitioners from across the country. The survey was not a scientific one, and the goal was not to achieve statistically valid results. Instead, the format made room for elaboration on the part of respondents and context-specific follow-up questions on the part of the interviewer. A more rigorous survey format with a larger, randomly selected sample of environmental health practitioners might yield different and equally valuable results.

People were chosen for the initial interviews in three ways:

1. Queries were e-mailed to a number of practitioners who have been active in NEHA over the years or whose work in state or local environmental health departments has caught the notice of JEH staff. Everyone who expressed a willingness to participate in the survey was interviewed. It's worth noting that members of this group might themselves be considered environmental health leaders.

2. The NEHA membership database was sorted by year of birth, and queries were sent to NEHA members under 40 years of age who currently work in state or local health departments. The purpose of this step was to ensure that younger voices would be heard. Again, everyone who expressed a willingness to participate was interviewed.

3. Since JEH wanted to be sure to incorporate the voices of field staff as well as management, some of the initial interviewees were asked for referrals to colleagues and staff members. In one case, a program manager forwarded the initial interview questions to his entire staff.

The sample, therefore, was not random; on the contrary, it was biased toward those who, by virtue of membership in NEHA or because they stood out to a boss or a colleague, were likely to be actively engaged in the profession and concerned about its future. Table 1 gives some basic demographic information on the people interviewed for Part 1 of the series.

Initially, JEH asked respondents the following questions:

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* Is there someone (or are there several someones) whose opinions you are always interested in hearing?

* Is there someone you see as an agenda setter?

* Or someone whose ideas strike you as particularly important?

* Or who cogently defines challenges for the future?

* Also: Why? Why are that person's (or those people's) ideas important?

Results

"The Answer Is No"

"These are tough questions!" said Chris Tofteberg, manager of the Food Safety & Sanitation Program in Anchorage, Alaska. "When are you going to be pitching me some softball stuff?"

"The answer to all your questions ... is 'no,'" wrote Anna Clementi-Cremer, program coordinator for the Tri-County Public Health Consortium in [Kenosha], Wisconsin. "Unfortunately I can honestly tell you that I do not have anyone I could name as an environmental health leader."

"I have two small children," said another respondent. "My world is very small right now."

In fact, out of a total of 28 people interviewed for this article, 14 expressed an inability to name environmental health leaders outside their own departments (Table 2). Furthermore, two of the respondents who said they were unable to name leaders were also speaking on behalf of their staff; in other words, 14 out of 28 may well be an optimistic ratio.

It's worth noting that some of the 14 respondents who expressed an inability to name leaders did go on to actually name people they saw as leaders (either local or national leaders). Some of the "no" responses may be more reflective of respondents' perceptions about the state of the profession than of any actual dearth of leaders.

Life Without Figureheads

Another way of saying this is that for at least some practitioners, the profession does not have a personal face. A member of the field staff at a federal agency, who asked to remain anonymous, said, "There are really no people who stand out. To me, it is more like a group or an agenda." Another field staff member, from a rural jurisdiction, said: "I think agencies [i.e., health departments] stand out more than individuals." Other respondents named associations or federal agencies as leaders.

"I'm always the kind of person who wants to help somebody [who is conducting a survey], because you get very low response rates," said a member of the field staff at a federal agency. "But I have to say I don't have one person as a leader."

Nobody at all? Nobody whose work she admires or whose research she keeps an eye out for? There's nobody like that at all?

"Not for me," she said.

"Maybe It's Just Me"

A commonly expressed sentiment, especially among local practitioners, was that an inability to name leaders said less about leadership in the profession than about the individual respondent's extreme state of business. As a member of the field staff at a major urban health department put it,

  I'll be honest in that I haven't been--I've been spreading myself in
  so many different fields that I haven't been at enough conferences to
  see who the real transcending thinkers are. I know they're there;
  every time I go to NEHA events or anything APHA-oriented, I see people
  I think are just excellent.... I think there are all these people who
  are just really impressive and have the right thing in mind; they're
  very selfless, and they're doing it for the right reasons.

"Things Used to Be Better"

Is a lack of identifiable leaders even a problem? Not everyone thinks so. But many do see it as a marker of decline. Several expressed an ongoing sense of loss. One member of the field staff in an Midwestern urban jurisdiction put it this way:

  When I started, there were these huge leaders in all different city
  departments, and you could count on them. And they've retired, and I
  haven't seen it be picked up again.... No, I couldn't name anyone at
  the national level.... I mean, I can't name any names.

"We're Bogged Down or Something"

Twelve respondents expressed some dissatisfaction with the state of environmental health leadership (Table 3). This group included some who had said they were unable to name leaders, as well as some who were able to do so. A program coordinator who initially expressed an inability to name any leaders refined her answer as follows:

  My general overall response ... is I wish there were more. I wish
  there were people I could say were the agenda setters. I wish there
  was someone who could "cogently define" a vision for the future. And I
  really don't think we have many. It's unfortunate.

For her, this absence has manifested in a lack of timely high-profile environmental health voices in the wake of disasters like Hurricane Katrina. The response-time problem in relation to contemporary news events is "huge," she said. "Huge! We're bogged down or something." She was especially frustrated with the leadership of federal agencies and national organizations like NEHA because they are "not as aggressive, not as visionary" as she would like to see.

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  ... it drives me crazy. I saw one editorial [co-authored by someone at
  the Centers for Disease Control and Prevention], and it was like a
  one-pager. It was just empty words. Basically saying, "Oh, Katrina was
  important, and environmental health is important." But no specificity,
  no energy, no call to action at all.

Several other respondents pointed to a tendency for members of the profession to talk among themselves rather than to address themselves to the public at large.

Others expressed frustration that the regulations or models offered by federal agencies "still don't match up totally" with the science of what's causing illness. Several people also saw a disjunction between the projects undertaken by the leadership at federal agencies and the daily pressures and requirements faced by environmental health practitioners on the local level. There was a desire to see more coordination among the various federal agencies, as well as among national organizations like NEHA and the National Association of City and County Health Officials (NACCHO).

According to several respondents, the profession also suffers from lack of leadership on the local level. George Kupfer, former environmental health director for the city of Milwaukee, told JEH that "a lot of the people who are in the leadership roles now are political people as opposed to people who have actual experience in the broad range of environmental health.... These people learn as they go, but their learning is limited to what they're supposed to do. So it's really hurting us in the long run."

The thought was echoed by Clementi-Cremer of the Tri-County Public Health Consortium in Wisconsin:

  I do think it is a problem in the profession. I see a great
  opportunity for older, wiser "leaders" in the profession to take
  younger professionals under their wing. But instead [of that
  happening] I see many of those younger professionals or people new to
  the profession leaving.... I have had a few encounters with good
  leaders in the profession. But again, few and far between (and it may
  have been dumb luck!?). One of the individuals I am thinking of has
  left the profession.

But Why?--Some Theories

Is It a Matter of Personality?

In a comment that was widely echoed, Brian Collins, environmental health director in Piano, Texas, observed that

  Many people who go into science, candidly, are not exactly well versed
  in people skills. They chose science because it's finite. There's an
  adventure and discovery and outcome. And they haven't necessarily had
  to depend on others in those relationships to make things happen.

He sees new challenges to be faced whenever someone with a technical background gets promoted to a management position. "Many people don't take that next step to actually become the leader that they could be .... they think sometimes that what got them there will keep them there."

McMillan of the Colorado Department of Public Health and Environment agreed. "Perhaps we just have not thought about these soft skills as being very important in terms of the success of one's position--or there's been such a strong emphasis in our [academic] programs on the technical side."

David McSwane, professor of public and environmental affairs at Indiana University, observed that "what we have is a profession that probably has more doers than thinkers. And that's not a bad thing. I'm not being critical. I think that probably, in general, we have spent a lot of our energies just trying to make a difference. And maybe that has not given us the time to reflect upon things and really look at the bigger picture."

A Generation Gap?

Respondents in the under-40 age group and respondents 40 years of age or older both voiced dissatisfaction with the state of environmental health leadership. But there was disagreement about the sources of the shortcomings.

"Sometimes, when I hear things from the 'good old boys' in this profession," said a field staff member, "I just want to scream retire already!!! I am looking forward to the massive retirements to come soon so that this workforce can be re-energized with people who want to come to work every day and work hard."

On the other hand, "we do have a lot of new members in our [state] environmental health association," said Susan Hibberd, coordinator of the Food Manager Certification Program for the Minnesota Department of Health, "and I don't know if it's a matter of us not being welcoming enough, not extending invitations, or them not wanting to be involved. But it seems like they're harder to engage.... I don't know if we're intimidating or being cliquish to them." In general, she's found it harder to get younger members to engage in off-duty professional activities, to join committees and organizations. "Maybe they're just not joiners. Maybe that's typical of a generation." She commented: "Someone has to make these things happen."

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A program coordinator from the under-40 group told JEH that intimidation is a real factor: Members of the younger generation "may have great ideas and may feel confident about their ideas, but they don't want to present them to the older people because they don't want to be cut down or embarrassed or made to feel inadequate." She added, "And I know firsthand that that's a problem."

She's seen it happen?

"Absolutely."

Or was she saying that it had happened to her?

"I can feel it," she said. "Sometimes I'm less apt to speak out about something because of that. Because I know the other people have a lot more experience than I do. Or have been in the field a lot longer, and I know that they could really jump down my throat about some things.... And some of the [younger] people that I work with also are very capable people, with a lot of knowledge, a lot of book smarts. And they're [too] intimidated to speak out."

Peter Thornton, environmental administrator of the Volusia County Health Department in Florida, thinks that the younger generation is not as public-spirited as preceding generations. He thinks younger practitioners are more likely to see environmental health work as a job than as a profession:

  It's just: I'm going to do this, and I'll leave at five. I'll do
  whatever you tell me. I'll do it as well as I can, and then I'll
  leave. And that's the end of the story. You know, if I want somebody
  who's just going to do what I tell them to do, and I'm going to tell
  them to do things constantly, then that's fine. But if I need somebody
  who's actually going to think outside the box and is going to improve
  the situation, improve themselves, improve the profession--I'm not
  seeing so much of that.

"And I'm sure," he told JEH, "that the old folks when I came along said the same thing. Generation after generation."

Still, he thinks there's a qualitative difference this time around. In the past--and he was echoed in this observation by respondents of all generations--more people held middle-level positions, ready to step in as the older generation retired. "And that's not to say that there aren't some very exciting new people coming up, because there are," he said. But on the whole, "the excitement isn't there."

It's not necessarily a matter of lesser talents and energies, either. "It could be that they have other priorities," Thornton pointed out. "It could be that their family becomes more important than the position. Which is fine. There's nothing wrong with that. But it does lead me to have concern that they're not taking as much notice of the profession."

Environmental health is not alone in this trend (Conte, 2006). Nationwide, there has been a retreat from the public sphere; the definition of someone who is admirable and good and altruistic has shifted from someone who does something for the greater good to someone who puts family first. That is not to declare one definition superior to the other, but simply to observe that present trends in the profession reflect a substantial, culturewide shift in values.

Localism?

A culturewide trend towards atomization may have a particularly powerful effect in environmental health because the profession is still struggling to define an overarching national identity. Environmental health duties vary widely from jurisdiction to jurisdiction. Joe Beck, professor of environmental health at Eastern Kentucky University, put it this way: "The effectiveness of the individual field environmental health person is based on how well they can communicate with the people who live in their particular area. And that almost is the definition of parochial."

The duties of field staff, in particular, can be isolating.

"We work on the road," as one respondent put it to JEH. "It's really hard for me to e-mail, because that takes me off my schedule."

So it's in the nature of the work? She doesn't even get onto the Internet?

"One day a week," she said.

Several respondents did mention state NEHA affiliates or statewide networks of departments that occasionally come together to compare notes. Kris Keller, a member of the field staff in Washington County, Minnesota, told JEH that he and his colleagues sometimes get ideas from attending "little conferences," where "these guys [people from other departments who inspire him] are often there and kind of generate the talk. We look at their inspection forms and stuff."

Brian Hanft, environmental health service manager for Cerro Gordo County, Iowa, described the challenges involved in keeping members of the profession connected even on the state level:

  We have 102 boards of health in this state, city and county boards. Of
  the health departments,... some have very large groups of
  environmental health [staff], and some have maybe one or none. And so
  it's difficult to try to bring everyone to the table and keep everyone
  involved. But the environmental health section of the Iowa Department
  of Public Health does a fairly good job of trying to keep everybody in
  the loop.

In response to JEH's questions about people who inspire or set agendas, nine respondents named someone on the local level. Of course, all of these were different names, unknown, for the most part, to people elsewhere in the country. No single individual got named nine times as an environmental health leader. Only one national agency--CDC--was mentioned that many times.

The program coordinator whom JEH quoted earlier complaining about the quality of national leadership acknowledged that because environmental health is so local in its practice, it may be "a contradiction in terms" to expect what she wants from agencies like CDC.

  I have come across many people working at the local level who are
  very, very good. And they're very good in their communities, and
  they're very good when you bring them [to national conferences]
  speaking from the local perspective. But they're not in national
  positions.

She wishes some of these highly qualified local people "would elevate their scope of influence to the national level."

Lack of Time?

Every person JEH spoke with for this article mentioned personnel issues arising either from lack of qualified people to fill vacant positions or lack of money to pay them. "What we're seeing here in the city and elsewhere is that as people leave they don't get replaced," said Ernest Julian, chief of the Office of Food Protection for the Rhode Island Department of Health.

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A number of people said that they are so busy trying to fulfill the most basic requirements of environmental health that they don't have time to stop and look around to see what's going on in the rest of the profession.

"You need to get out to these restaurants; there's more and more restaurants," said one field staff member.

"We're being forced to do more with less, and we're getting to the point that we're doing more and more with less and less until we can do everything with nothing," Julian observed. "So I can understand," he added, "when people are saying 'I don't have time to look nationally, I'm putting out fires.'"

Tommye Schneider, director of the Environmental Health & Labs Division in the Madison Department of Public Health, would like to increase her involvement in national organizations like NEHA and is thinking about retirement as an opportunity to do so. In fact, many of the people who got named as leaders in JEH's survey were retired or partially retired or close to retired. That pattern may in part be a result of people having had years to accumulate the experience and achievements that lead to recognition, but having some free time may also be a factor.

"I keep using the term 'capacity,'" said Hanft of Cerro Gordo County, Iowa, "because I think it's important for people to understand: Capacity doesn't necessarily mean increasing knowledge level with the existing staff. It means increasing the number of staff with that knowledge base. And that takes money. Not just tens of thousands, but hundreds of thousands of dollars."

Lack of a Qualified Workforce?

Several respondents pointed to a decreasing pool of qualified environmental health professionals from which leaders would come. Not only are many of the field's most accomplished practitioners retired or approaching retirement, but the numbers of people graduating from accredited undergraduate environmental health programs come nowhere close to matching the need. Even if some of the new recruits are highly educated, with degrees in science, McMillan of the Colorado Department of Public Health & Environment believes it signals trouble for the future of environmental health leadership when the majority of new practitioners are not coming out of environmental health programs:

  For example, people who have a background in chemistry--they've got
  that science background that maybe appealed to someone who would hire
  them to an environmental health position. But they don't necessarily
  have that comprehensive connection to public health and the
  environment.

Recruitment was on the minds of many respondents because of salary issues, as well.

"I do think that this profession isn't all about money," said David Ludwig, division manager of Maricopa Environmental Health in Arizona. "It is about a feeling of self-worth.... You're saving lives, preventing drownings, preventing foodborne illness." But there is a limit, he said. "You know, when you have inspectors who could qualify for food stamps--"

Really? Salaries are that low?

"It's not quite that bad here," he said. "But I've heard stories like that in the state."

In smaller jurisdictions?

"Yeah. All of a sudden, your median house is going for $300,000, and you want to have a starting salary at $28,000 a year. You don't find too many people like that."

The result is high turnover, especially among people who might be future leaders of the profession. "Good environmental health professionals are like a sponge; they soak it up," Ludwig added. Meanwhile, "if you keep on reducing the size of staff [because of budget cuts] and everything keeps growing, we keep throwing more and more onto people's plates. And you can only function at 100 percent for so long. You just get burnout. People just say, 'Hey, it's not worth it."'

Themes and Events as Leaders

At this point, JEH began to notice a pattern: Respondents became more emphatic and more energetic as the discussion moved--and it always did seem to move--from the question of who individual leaders were to more general issues driving the field. Although many respondents had difficulty naming people, they were eager to discuss the larger, more impersonal forces affecting their professional lives. They returned repeatedly to the following themes:

1. It might be possible after all to concretely demonstrate the value of preventive work. While successful prevention can make one's work invisible (that paradox has long troubled the profession), perhaps it does not necessarily do so. A number of respondents suggested the possibility of measuring--and publicizing--the value of illnesses prevented and epidemics averted.

2. It is crucial for environmental health departments to collaborate with other local entities (e.g., the building department, the city manager, the planning department, the fire department, the police department).

3. Environmental health departments should also collaborate with departments in neighboring jurisdictions.

4. The checklist/inspection model of environmental health is inadequate. As Robert Harrington, director of the Casper-Natrona County Health Department in Wyoming, put it, "You become a consultant instead of an enforcer. Well, you're still the bad guys. You still have to enforce. But if you approach it on the basis of consulting and helping and teaching, you end up with a better overall community product." This concept, which has been discussed in venues like JEH for some time now, seems to have permeated the ranks of the profession. Even respondents who described themselves as "inspectors" made a point of saying that their job was to educate operators and to think systematically about what the causes of recurrent health violations might be.

5. Environmental health should have a more prominent profile in schools. Many respondents advocated not only increasing the number of accredited programs at the undergraduate and graduate levels, but also sending practitioners into primary and secondary schools to talk about environmental health as a career option.

The passion with which respondents discussed these themes suggests something interesting about environmental health--that ideas often circulate in this profession without names attached. JEH was struck by the extent to which respondents seemed unaware of the provenance of ideas they were advocating. For instance, one field staff member talked about the importance of "active managerial control," attributing the idea to staff in the neighboring jurisdiction; in fact, the term was introduced into environmental health lingo by John Marcello, a retail food specialist for the FDA Pacific Region, who has used it extensively in training workshops with industry.

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That Quality of Stuckness

Environmental health practitioners have an admirable tendency to put the substance of ideas first. That tendency indicates a true seriousness of purpose. But it can also be a weakness, contributing to the apparent "dryness" of the profession in the eyes of outsiders.

Politics uses figureheads. The media strive to personalize--or "put a face to"--every issue they cover. And they do so for a reason. Most people, to put it bluntly, do not think the way environmental health professionals think. Instead, they use names and faces as a kind of shorthand for ideas and for their feelings about those ideas.

When ideas are circulated without names attached, they circulate more slowly. The lack of a shorthand means that the ideas have to be restated, almost recreated, each time they are discussed. (There are also advantages to circulating ideas in this way, but they tend not to be worldly advantages.) An idea has to earn authority each time it is passed on, and recipients may or may not be aware of the history in which it originally arose.

To give one example: The concept of emergency preparedness, which management-level respondents consistently mentioned as an important challenge facing environmental health--and which has been discussed extensively at conferences and in journals over the past couple of years--seems not to have impressed field staff. The only field staff practitioner who mentioned the concept at all was one who worked at a federal agency.

While new themes are trickling slowly through a decentralized profession, world events are moving faster. The quality of stuckness--"we're bogged down or something"--referred to above might be worth reconsidering in this light. Many respondents expressed an urgent sense that the profession needs to engage the most current and pressing threats to public health--and needs to do so soon.

Maybe the Horizons Are Too Narrow?

"Here's an interesting example," said Collins of Plano, Texas:

  When we have people who come into our department, everybody loves food
  safety. The reason is they have a defined set of rules.... HACCP
  brings some flexibility into the program, but it's all very well
  defined. And when you start talking about air quality or you start
  talking about illumination or you start talking about noise
  violations--and you start talking about radon and all these other
  things--the world changes. And people's comfort zone has to expand,
  and if they don't expand, then they get locked into certain programs
  and make a career of it.

Bob Custard, chief of the Environmental Health Division in Alexandria, Virginia, pointed out that microbial agents are responsible for only 3.1 percent of deaths in the United States.

"That's all microbial agents," he said, "whereas alcohol consumption causes 3 and a half percent, poor diet and physical inactivity 16.6 percent, and tobacco 18.1 percent.... And foodborne illness is like 0.2 percent out of all of that." Custard's numbers come from an article published in the Journal of the American Medical Association (Mokdad, Marks, Stroup, & Gerberding, 2004).

"You know," he added, "I'm spending a million dollars a year on food safety, and I'm spending three thousand a year on indoor air quality and the built environment together. That's way out of balance."

None of the respondents suggested that environmental health should stop working on food safety issues. Some do think that, as Custard put it, the patterns of expenditure should more closely reflect the patterns of risk. Even within the realm of food safety, he pointed out, "I'm spending [my money] on 20 percent of the risk, because I have hardly any outreach at all to the person who fixes his food at home, which is where more than 75 percent of food is fixed."

"If I were writing an article in regard to [leadership]," Kupfer told JEH,

  I would hope it would be soliciting some action.... I would like to
  see us get back to making decisions based on a real, true, broad
  knowledge of the field and its overall effect on the health not only
  of our country but of the world. We really have to begin to look at
  the total impact of environmental health, not only as it affects us
  very specifically, but also how it affects the globe. And in turn us.

Of course, environmental threats and public health issues vary from locality to locality. The argument for broadening of perspective needs to be qualified with the observation that the way environmental health practice is organized in this country has the very real advantage of allowing programs to be tailored to individual communities. But Collins thinks it's also important to know that "what might be good for one state or one region is not necessarily good for the entire country."

An issue that most respondents at the managerial level mentioned was global warming. There is a sense that the profession of environmental health could once again come to seem irrelevant, much as it did in the late 1960s and early 1970s when public concern was growing about pollution, and health departments were seen as irrelevant to the most pressing environmental threats to public health. The profession is still recovering from that episode. And yet it seems poised to make the same mistake all over again.

Another Way into the Question

The next installment of this series will introduce readers to some people who could be considered leaders for the profession as a whole; all of these people were named by at least three respondents from different parts of the country. In other words, the field does have leaders--people who are thinking broadly and creatively, who are raising issues and getting things done.

But this article will take another direction. In light of how hard many respondents said they found it to identify such people--how much hesitation, uncertainty, and dissatisfaction they expressed--JEH posed a follow-up question, a hypothetical question:

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  If you were to imagine--and I'm thinking now potentially on the
  national level, although you can answer this question if you prefer
  with respect to the local level--if you were to envision an ideal kind
  of leader for the profession, what would that leader look like to you?
  Could you give me a profile?

"Yeah, well," Carleo of Danvers, Massachusetts said. He took a breath. The thoughts began to flow: "First off, they would of course have to be dedicated to the profession. They'd have to be open to ideas of all sorts. They would have to have an education."

The hypothetical question opened the floodgates. Respondent after respondent settled into long, eloquent answers. A sort of composite profile emerged: an ideal environmental health leader, an extraordinarily accomplished, larger-than-life somebody.

Clearly, no one human being can be all things to all environmental health professionals. The composite sketched below does, however, give a good sense of what the profession wants from its leadership. And it is not strictly fantasy. Real people have been folded into the picture--people who were named as outstanding examples of one trait or another that a respondent wished to illustrate, people who by definition were not likely to be mentioned by respondents scattered across the country because their achievements have been local, and people who perhaps should have been mentioned more often than they were--who might have been mentioned more often if the profession were better networked.

The Profile

Science Background

To begin with, most respondents agreed with Carleo about the importance of education--the right kind of education. Despite recognition that members of the profession need to do more to cultivate "soft skills," environmental health practitioners do not want to leave the science behind. "The backbone has to be the science background," said a field staff respondent who asked to remain anonymous. Collins of Plano, Texas, referred to "foundation skills." Kupfer, former environmental health director for Milwaukee, cited as an example the technical knowledge of Bailus Walker, professor of environmental and occupational medicine and toxicology at the Howard University College of Medicine.

IT Literacy

Several respondents emphasized the value of information technology. Data tracking tools are seen as particularly promising because they can be used to make the case for the importance of environmental health activities. When a department makes innovative use of databases and software to generate statistics about the effectiveness of its programs, it is serving not just its own population, but also departments in other jurisdictions, which can use the statistics to advocate for similar programs.

Soft Skills

A good leader is good with people. Does that even need saying? According to some respondents, it does; they feel that the soft skills--communication skills, collaborative-leadership skills--still do not garner respect within the profession as a whole. "Once you have been trained with the science, it's hard to get out of that box," said Collins of the Piano, Texas, Environmental Health Department. McMillan of the Colorado Department of Public Health said, "There's no question that the successful leaders I see around me--they may not have mastered all the soft skills, but they've got an appreciation for them, and they're developing in that area."

"Nobody puts it on their [environmental health] job listings," said Tofteberg of the Anchorage Food Safety & Sanitation Program: "'Must have a vibrant personality and be able to work with difficult people.' But really that's a must, in a regulatory capacity."

Pragmatism 

Harrington of Casper-Natrona County, Wyoming, admires leaders who take a "results-oriented" approach that in essence says: "'We need to do the right thing, and we'll figure out the rules later.'" As several respondents pointed out, this kind of pragmatism requires risk taking; it involves accepting responsibility for results rather than simply cleaving to sanctioned procedures. There was a sense that professional growth of this sort is hard for many practitioners, who still think of their profession primarily in terms of regulations, inspections, and checklists.

"I don't know if it's personality types, but I think there are a lot of people who sort of drop into this inspector/enforcement mentality," said Hibberd. "I don't look to those types for ideas, vision, leadership. Because we're more than that."

Integrity

Pragmatism means getting things done, but the kind of pragmatism environmental health practitioners are looking for in their leaders does not involve compromising core values. Beck of Eastern Kentucky University put it this way: "I'm a great respecter of people who are willing to have alternative ideas that go against what I call the political correctness of the time and are willing to stay with them."

One field staff member described what she was looking for (and not finding) in her jurisdiction: "Just their strong belief.... Their ability to voice these very important things. And to stay strong with them and not back down."

McMillan pointed out that even if the prevailing political and economic forces seem to be against an undertaking--even if one loses some key battles--having a reputation for advocating positions "consistent with your ethics and values," increases credibility in the long run.

This idea is an old one. It gets a lot of lip service.

Actually putting it into practice requires a rare degree of courage and self-knowledge: If you are proposing something that everyone else opposes, how do you know that you aren't wrong? When is sticking to your guns a matter of principle, and when is it good old-fashioned egotism? Leaders need to have an instinct for the difference.

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Clarity of Purpose

For environmental health professionals, knowing the difference is a matter of keeping purpose of the profession in mind.

"Some of the agencies I look to as leaders," Keller said, "are ones that primarily focus on public health. Public health is their main objective--not inspection numbers, politics, or other limiting factors."

This sentiment was echoed over and over. There seems to be a tremendous hunger for renewal of a sense of purpose within the profession.

"A true leader," said Thornton of the Volusia County Health Department,

  will result when he or she stops talking about the correct position
  titles and regulations and the lack of respect we have. The leaders
  will talk about stopping disease. They will convince the profession to
  change from what it is to what it must be. They will be an expert in
  knowing, and in portraying, the difference between success and
  significance. They will not settle for the status quo. I am saddened
  to say that I have not seen that yet.

Big-Picture Thinking

The purpose must be a large one--larger than personal career aspirations or even the best interests of one's agency or department or the good of the public in one's jurisdiction. Many respondents expressed admiration for those who help agencies other than their own, whether through example or through sharing of information, or who take into account the statewide or regionwide impacts of policies they advocate. Several respondents also mentioned the importance of international collaboration and the global impacts of public health decisions made in this country.

Insurgent Ideas

Respondents envisioned a number of different ways in which leaders could introduce new ideas. One of these, of course, was to generate new ideas.

"I still look for anything from [former NCEH director] Dick Jackson even though he's not national anymore," one respondent told JEH:

  I think he brought the field along significantly when he was at CDC.
  He had a lot of great ideas for environmental health in the broad
  sense. And he was really into children's environmental health, really
  into land use planning, really into environmental justice. When he
  started,... those things were not mainstream.

Another way is to have a sharp eye for emerging patterns. Hibberd of the Minnesota Department of Health cited Mike Osterholm as an example. Osterholm, who is director of the Center for Infectious Disease Research and Policy, associate director of the Department of Homeland Security's National Center for Food Protection and Defense (NCFPD), and a professor at the University of Minnesota School of Public Health, sets new directions for the field because, Hibberd said, "He seems to recognize things [diseases] as they're coming down the pike--before the rest of us seem to know about these things."

Tom Gonzales, environmental health manager for the Larimer County Department of Health & Environment in Colorado, told JEH about a college professor who still influences former students all over the state through monthly columns in the newsletter of the Colorado Environmental Health Association.

"Some [of the articles] are controversial," Gonzales said:

  In one ... he wrote about how sometimes local environmental health
  specialists are puppets of their state health departments in that
  we're not using good science; we're using state regulations or doing
  what the state tells us to do; we're out there just being puppets.
  Boy, I'll tell you, the responses coming back were really interesting.
  But he did that just to stir conversation (Blehm, 2005).

So he was playing devil's advocate?

"Yeah," Gonzales said. "He does that a lot."

What he writes isn't necessarily something he believes heart and soul?

"Right."

There's an interesting lesson here not only about intellectual daring, but also about intellectual flexibility--the ability to try ideas on for size.

Leadership in the realm of ideas also involves the ability to hear and see value in the ideas of others. One anonymous field staff member at a federal agency sees a leader as "someone who's receptive to recommendations that staff make--so someone who's not narrow-minded."

"Some people create ideas. Some people spread them around," said Bob Custard, chief of the Environmental Health Division of the Alexandria Health Department in Virginia. He sees the spreaders as "insurgents who infiltrate organizations and bring new ideas and ways of doing things."

An Ability to Make Things Happen

"You have to get from here to there," said Melton Knight, director of Sacramento County Environmental Management. "That's what leadership is about."

Moving from ideas to action can be a delicate business. One member of the field staff suggested that making things happen involves "tactful idealism." It is important, he added, for leaders "not to be fooling anybody, including themselves, about what is possible and not be married to keeping the momentum if it's not in the right direction."

"Leaders create movement," said Collins of Plano, Texas. "And you do that through various relationships and through exerting the influence that you have."

Leaders exert influence in a variety of ways, from cheerleading the efforts of others to speaking for professional organizations to bringing stakeholders together to hammer out solutions.

"I want," said Tommye Schneider, director of the Environmental Health & Labs Division for the Department of Public Health in Madison, Wisconsin, "to give you the name of Tom Sieger [director of the Bureau of Environmental and Occupational Health for the Wisconsin Public Health Division]":

  he is able to bring lots of different people together; he's able to
  represent the viewpoints of his top management and industry and local
  health departments--which is a huge challenge right there. He can
  speak to all of their various needs.... He's been quite involved in
  CDC. He was one of the few people who got a CDC environmental health
  tracking grant. So he's been working on that in Wisconsin. And that's
  one of the biggest issues for environmental health. I think we're
  fortunate to have him at that level in the state to help the locals
  move forward.

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For Hanft of Cerro Gordo County, Iowa, a leader is someone who not only goes after what he believes in but is also willing to stand back and leave room for others to do the same. He cited Ron Osterholm, director of the Cerro Gordo County Public Health Department, as an example. "I manage the food program," Hanft said,

  And I manage the onsite wastewater treatment program for residential
  dwellings. And if there's an issue that needs to be taken to the
  statehouse, I can do that. I can contact our state
  representatives--without going through him--and let them know how I
  feel. A lot of other people who sit in similar capacities around our
  state aren't afforded that opportunity. They have to ask, and I don't
  have to do that.

Political Skills

Respondents repeatedly spoke with admiration for (and occasionally a tinge of amazement at) practitioners who have good political instincts.

"He gets the political piece," Hibberd said of environmental health consultant Harry Grenawitzke. She described his ability to charm people as almost magical.

How do people come by that skill (which seems magical to JEH, too)? Is it a gift from the gods? Or can it be learned?

"I think," said Beck of Eastern Kentucky University, "it is a combination of intellect and an incredible social sensitivity that tells you when you fight and when you fold--and that, when you fold, it doesn't necessarily mean you're folding permanently; it's simply choosing to fight on a better day."

For Hanft, political skill means understanding that "there are many different interests at the table" and knowing how to weigh them. "You need to weigh them in how you approach them to get what you want.... A lot of times they don't all agree. So how do you work with all sides? And"--he emphasized--"still get done what you need to get done?"

That last bit is the rub.

When the only goal is personal or perhaps electoral success, the guiding principle can be a simple one: expedience. When one has an additional purpose or "interest" at heart--say, protection of the public health--the ability to maneuver may be more limited. Ultimately, it can take more finesse to be a politically effective environmental health professional than to be a successful politician.

The Power to Persuade

Respondent after respondent emphasized public-speaking skills. Schneider of the Madison Environmental Health & Labs Division said that "a presentation style that makes people excited and interested" is one of the key traits she looks for in a leader. "Someone really able to make it fun for me to go back and think about something new," she said.

Passion was frequently mentioned as an essential ingredient in effective public speaking. Respondents also emphasized the ability to communicate with people outside the profession.

"I think that a leader on the national level needs to make it so that environmental health is taken much more seriously," said one field staff member. Another respondent, who works at the coordinator level, wants "nationally seen statements about the environmental health role in things [like Hurricane Katrina or avian influenza]."

Tofteberg of the Anchorage Food Safety & Sanitation Program suggested that the field needs a national bully pulpit--something like an environmental health czar. He pointed out that on the federal level environmental health issues are addressed not only at CDC, but also at FDA, USDA, and U.S. EPA.

"And they all work together somewhat," he said, "But it would be nice if there was just one spokesperson for all of that in a federal seat." Environmental health professionals are also, however, discerning listeners (a warning here to aspiring leaders): Empty happy-talk will not suffice. "The people I sit in the meetings with who make the final decisions are ... more interested in the numbers and the handshakes and the pep rallies," another field staff member commented. He added:

  I just really enjoy a legitimate environment. You know, people who
  know what they're talking about and want to make a difference and are
  educated and have taken it upon themselves to learn and answer
  questions and not be deluded by the propaganda.

Historical Perspective

"I'm a great believer," said Beck of Eastern Kentucky University, "that understanding history allows you to walk at least two steps forward and only one step back [as opposed to vice versa]."

McMillan of the Colorado Department of Public Health and Environment agreed, which is why he has been conducting the interviews described at the beginning of this article: "The history piece is huge. We're all thinking about where do we go from here, not where do we come from. And I think someone who's been in the field a long time can give that perspective."

[ILLUSTRATION OMITTED]

Vision

"There's got to be something you're trying to achieve, that you're trying to get to," said Hanft of Cerro Gordo County, Iowa. "An ideal leader has the ability to look for where we want to go."

For McSwane of Indiana University, it's not good enough to "keep up with change"; the ideal is to "actually stay ahead of the curve and make things happen or make things change."

In other words, "vision" means not allowing oneself to be immobilized by the winds and counterwinds of the present. That's another reason a grounding in the history of the profession is so important. An environmental health practitioner who knows how the present differs from the past is more likely to be able to imagine a future different from the present. For Knight of Sacramento County, Dick Roberts, former director of the San Bernardino Department of Environmental Health Services, was such a person: "He was very, very good at that--very influential with me as a young person in knowing what the field could be. Not just what it was, but what it could be."

Living Up to the Profile

"The qualities you would want in a leader--that's a big combination of qualities," JEH remarked to one respondent.

"It is," she said.

Perhaps it's not surprising that environmental health has fewer acknowledged leaders than many other professions do. Maybe it's not just that environmental health practitioners in this field are overworked and spread out across the country. Maybe it's also that their standards are high. Could anyone in the world embody all the traits sketched above? Amazingly, there are people who come close.

Acknowledgements: First and foremost, JEH acknowledges the 28 people who responded to the survey questions with so much honesty and thoughtfulness. Special thanks are due to Professor Joe Beck of Eastern Kentucky University, who kindly shared his work on values as a form of mental shorthand. That concept helped JEH formulate the discussion of "stuckness" that appears in this article. Thanks also go to NEHA Executive Director Nelson Fabian, with whom the idea for this series originated, and to Journal Content Editor Joanne Scigliano, with whom several conversations over the months helped JEH make sense of a mass of material and give shape to the series.

References

Blehm, K. (2005, Fall). Guided by the law or assaulted by it? CEHA Point Source, 4, 12.

Conte, C. (2006, February). Expert exodus: As baby boomers retire, governments are trying to keep knowledge and experience from going out the door with them. Governing. Retrieved May 24, 2006, from www.governing.com/articles2know.htm.

Mokdad, Marks, Stroup, & Gerberding. (2004). Actual causes of death in the United States, 2000. Journal of the American Medical Association, 291: 1238-1245.

Rebecca Berg, Ph.D.

TABLE 1 Respondents--Demographic Information

Number  Age                           Gender  Type of Position

 1      <40                           F       Field staff
 2      <40                           F       Field staff
 3      <40                           F       Field staff
 4      <40                           M       Field staff
 5      <40                           M       Field staff
 6      <40                           M       Field staff
 7      <40                           F       Supervisor
 8      <40                           F       Coordinator
 9      <40                           F       Liaison/coordinator
10      <40                           F       Program manager
11      <40                           M       Program manager
12      <40                           M       Program manager
13      <40                           M       Program manager
14      <40                           M       Program manager
15      [greater than or equal to]40  F       Field staff
16      [greater than or equal to]40  F       Coordinator
17      [greater than or equal to]40  F       Director
18      [greater than or equal to]40  M       Director
19      [greater than or equal to]40  M       Director
20      [greater than or equal to]40  M       Director
21      [greater than or equal to]40  M       Director
22      [greater than or equal to]40  M       Director
23      [greater than or equal to]40  M       Director
24      [greater than or equal to]40  M       Director
25      [greater than or equal to]40  M       Director
26      [greater than or equal to]40  M       Director (retired)
27      [greater than or equal to]40  M       Professor
28      [greater than or equal to]40  M       Professor

                    Place of Employment
        Federal
Number  Agency   State Agency  Local Agency  University  Region

 1      X                                                Mid-Atlantic
 2      X                                                Southeast
 3                             X                         Midwest
 4                             X                         West
 5                             X                         Midwest
 6                             X                         Northeast
 7                             X                         West
 8                             X                         Midwest
 9                             X                         Midwest
10                             X                         Midwest
11                             X                         Midwest
12               X                                       West
13                             X                         Northwest
14               X                                       West
15                             X                         Northeast
16               X                                       Midwest
17               X                                       Midwest
18                             X                         Southwest
19                             X                         West
20                             X                         West
21                             X                         Northeast
22                             X                         Mid-Atlantic
23                             X                         Southeast
24                                           X           West
25                             X                         Southwest
26                             X                         Mid west
27                                           X           Southeast
28                                           X           Midwest

TABLE 2 Respondents Who Expressed an Inability to Name Leaders, by
Position

                  Number Who Expressed
                  an Inability to Name          Number of Respondents
Type of Position  Environmental Health Leaders  in Category

Field Staff        7                             7
Supervisor         1                             1
Coordinator/       2                             3
liaison
Program manager    4                             5
Director           0                             9
Academic*          0                             2
Retired            0                             1
Total             14                            28

*Refers to respondents whose primary employment is as faculty for a
university or college (i.e., this category does not include respondents
who teach occasional courses as adjunct faculty but whose primary
employment is elsewhere).

TABLE 3 Respondents Who Expressed Dissatisfaction with Environmental
Health Leadership, by Position

                     Number of Respondents       Number of Respondents
Type of Position     Expressing Dissatisfaction  in Category

Field staff           4                           7
Supervisor            0                           1
Coordinator/liaison   2                           3
Program manager       3                           5
Director              1                           9
Academic*             1                           2
Retired               1                           1
Total                12                          28

*Refers to respondents whose primary employment is as faculty for a
university or college (i.e., this category does not include respondents
who teach occasional courses as adjunct faculty but whose primary
employment is elsewhere).