Public-Private Partnerships in Chronic Disease Prevention-Part 3
This podcast is the third of a seven part series discussing public health partnerships with the private sector. In this segment, CDC's Elizabeth Majestic and University of North Carolina's Gene Matthews talk about how building credibility on preparedness issues can help develop support for initiatives around chronic disease prevention. Created: 4/6/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).
Date Released: 4/6/2009. Series Name: Preventing Chronic Disease.
Public-Private Partnerships in Chronic Disease Prevention-Part 3
[Announcer] This podcast is presented by the Centers for Disease Control and Prevention. CDC - safer, healthier people.
[Elizabeth Majestic] Gene, as our society changes so do our health problems. Twenty years ago obesity wasn't on anybody's radar screen. Today, it's a concern for both the American people, as well as American business. Are there new partnership models that public health should consider that preserve institutional integrity while improving public health impact?
[Gene Matthews] Well yeah, I mean, that's a good question. There’re sort of… there’s at least two approaches that come to mind. One is bringing back an old approach and then there's new work as well. Now the old approach is like that old Jesse Jackson stump speech that he gave maybe 15 years ago about common ground, "Where's the common ground?" that he would thunder from the lectern. We have a historic opportunity to look at the incentives that exist between the private sector, between public health leadership, and certainly the public health law renaissance that I've been working on. So we now know in the preparedness arena, and this can apply in other arenas as well, but just bear with me for a moment, in a preparedness sense, business wants to talk to public health about preparedness. You know. We are concerned about our community. Bill Blunden gave a presentation last month at the ASTHO/NACCHO conference and said that if the community believes that public health is able to handle an emergency, then the community… the focus groups will tend to believe, with credibility, the rest of the things that public health leaders in that community say. If the community does not believe that their public health is ready and will really protect them, or move to protect them in an emergency, it doesn't matter what you say about diabetes or injury or chronic disease prevention or immunization. They're not going to listen; you have no credibility. So business community is one of those; they want to hear public health talk about what you're doing to protect High Point, North Carolina if we have SARS or a flu epidemic or a fire or flood or whatever.
The second opportunity is the public health leadership in this country...Georges Benjamin at APHA, Bobby Pestronk at NACCHO, Paul Jarris at ASTHO, are all very much interested in developing new partnerships and networks with the private sector. They're no fools; they realize there’re not enough resources to go around and we need to do better. And certainly something that I've been part of has been the public health law initiative that’s developed over that last eight years in this country. And part of that has to do with looking at how to use the law in ways to improve the ability for public and private sectors. What is their common ground? Liability protection is just one of them. But you can use that same common ground model for chronic disease. Again, you've got to be sure there's credibility on the preparedness front or I think you're dead in the water. But there's also common ground having to do with obesity in the community. Active Living By Design is one program based here at the North Carolina Institute for Public Health that talks about encouraging active living, having more parks, well that has resonance in High Point, North Carolina, as an example. And so there's common ground there between the business community, the civic leaders, the nonprofits, and public health in doing that. And we can move out. I think the big trigger that's now… the big elephant that's standing in the corner of the room here… is economic downturn. And we're all going to have common ground, whether we're in the private sector, whether we're in the government sector of public health, or the legal sector of dealing with that. So that's one model to use.
Now a second, if I could shift to sort of a more recent model that I ran across. It’s Goldsmith and Eggers’ book Governing by Networks. And they put out a very provocative matrix on how to improve government. And there's a slide that we can use here of first of all moving on a horizontal axis between low and high network management capabilities. So we go from hierarchical government and we moved up to joined-up government so that we've got, say in bioterrorism, we've got agriculture agencies talking to public health talking to law enforcement talking to environmental, etc. That's joined-up government. Then, if we move up a vertical axis, between zero public-private coordination and cooperation, up to high cooperation, we move again from hierarchical government up to outsourced government, which can cut both ways. We outsource our communications. We outsource our HRMO function. You know, it can work badly and it can work well. And what Goldsmith and Eggers are moving towards is that sort of fourth box up in the upper right hand corner of networked government. And he gives a good example in his opening chapter about the Presidio. And when the Presidio in San Francisco was given all of this land, was the good news. The bad news it was a… it was toxic; it had been used as a waste dump and there were no funds available for the National Park Service to admisister it, to clean it up, or whatever. But some midlevel managers in San Francisco took a very creative approach to this and partnered up with the private sector, with the local government, with the nonprofits, with the for-profits and have turned it in to a beautiful area.
If I could extend what Goldsmith and Eggers started, but these are my words, not theirs, you can have negative values to joined-up government and you can have negative values to public-private cooperation. And so instead of having hierarchical government you can have anarchical government. And that's what I think we saw after Hurricane Katrina where you didn't have public-private cooperation and you didn't have the various silos of governments, whether at the federal, state, or local level, talking to each other very well and we saw anarchy. So it isn't always just a zero-sum game. We can go negative in this if we're not thoughtful in how we do these things, but certainly the goal that Goldsmith and Eggers talk about is network government and I commend that to folks.
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