In Conversation with Professor Callahan

In a conversation with Professor Callahan, he shared how testifying to the State Legislative Committee was a great experience: "The national leaders in epidemiology and those who have been at the forefront of explaining the science and evidence behind COVID-19 responses convened with the purpose of improving ways to protect the lives of Californians and address fundamental concerns about our health and advance health equity. All the levels and ranges of government institutions and the different sectors were involved, which points to a real appreciation for the complexity of all that's needed to respond. I represented the academic community and the cross-section of experts in the national working group," said Professor Callahan. 

What was your role in developing the National Academy of Public Administration on the Intergovernmental Dimensions of the Coronavirus Disease 2019 (COVID19) Pandemic Working Group (WG)?
In my experience, you can't engage in the understanding and the practice of public administration and public health unless you engage in the most pressing challenges of our time, i.e., COVID-19. 

I started talking to different people who work in population health and making calls to current and former state health directors to create The National Academy of Public Administration Working Group (WG), which was co-chaired by Academy Fellows Dr. Kenneth W. Kizer and myself, and formed with 12 additional Academy Fellows and three other experts. Four of the WG members have experience as state health directors (including the District of Columbia) and three have experience with local city or county health departments; several members have experience with multiple different federal agencies, including the U.S. Centers for Medicare and Medicaid Services (CMS) and Food and Drug Administration (FDA), as well as oversight of the National Disaster Medical System; and others have strong research and academic expertise, including five current or former deans of university graduate programs in public health and public administration.

Because it was uncharted territory, having an intergovernmental working group to focus on the dimensions of the COVID-19 response was a unique contribution that can make a valuable difference in moving forward.

What emerged as the key issues took several months of deliberation. We went back and forth on the key problems and how to frame them, and that's how we ended up with four key issues:

1. Testing for COVID-19
2. Non-Pharmaceutical Interventions for Infection Risk Reduction
3. Vaccine Distribution
4. Cross-Cutting and Overarching Issues: supply chain, data collection, and finance

Public Health is a highly decentralized system, and finding a way to make a highly decentralized system work well presents many challenges. Improving effectiveness in advancing health equity was another significant recognition of the working group.

What were the Distinctive Findings?
“Success and metrics vary state by state. Finding the appropriate metrics for the results and impact with this disease is an ongoing challenge. The key metric has always been the tragic number of people who have died,” explained Dr. Callahan. 

• Intergovernmental dimensions are under appreciated aspects for effective and equity driven pandemic responses
• What worked with federal emergency response
• Data collection is central to effective decision making
  testing, i.e., how to avoid bottlenecks and use full capacity
• Vaccines distribution-consequences of underinvestment and history

What are your insights for California moving forward?
“During the hearing, Senator Newman spoke of his military experience and shared the importance of the after-action reports. Those who do emergency management know the critical importance of after-action reports. I hope one of my testimony's contributions is pointing out some of the ways California can structure learning from the Pandemic and move forward more effectively,” shared Professor Callahan.

• Accept the reality of a high decentralized system - make it work better -
• Share with decision makers lessons learned: CA as learning organization
• Fund action research and convening on, e.g. NAPA, NASEM, or others

What are some key learnings you extrapolate from this work?
What jumps out at me again and again is, and this isn't always in the public narrative, how much people care professionally and personally about all those who they're responsible for, whether at the federal or state level. In my experience, there is no doubt in my mind, how much public health officials personally care about the people they serve. The attacks on public health officials don't account for these professionals in times of high ambiguity and high uncertainty or what the military would call VUCA, i.e., volatile, uncertain, complex and ambiguous conditions. These public health officials are doing the very best they can, and care deeply about each and every person.

Their starting point is how much they care and want to protect the lives of Californians and all those in the United States. This came out again and again during the WG discussions; whether it was someone removed from direct services doing data collection, to those that have decision making and more lives can be saved. To me that's the overarching lesson. It's not a misplaced belief in the value of science and evidence that public health people have, it's actually that evidence and data metters; and how do we gather the evidence, how do we do better for people. That's a consistent theme that jumped out to me.

Another key lesson is the need to pay attention to the space in which intergovernmental actions take place. California can't do it alone. It needs to interact and figure out ways to build relationships and have those in place. California really needs to account for those working at the federal government level and work with the various out-of-state agencies, which is the intergovernmental dimension.

The range of the 37 WG recommendations are very solid. It's not a consensus report, it's intended to contribute to the dialogue for moving forward as a society. The challenge in the intergovernmental space is how do you have an appreciation for different pieces and how do you make sure nobody's left behind.

What is the MPH Public Health Leadership concentration focus?
The MPH Policy Leadership program has allowed me to focus on how we provide care to people and advanced population health by leading or working in more effective organizations. It's not an abstract discussion of policy. In the Public Health Systems class, that I teach, I really emphasize what does it take to have effective public health organizations. In California, we deliver public health at the county level, so many of our case studies are what our counties are doing well across the wide range of public health programs.

Students in this program will make a profound difference. We'll give them the tools, the best practices, the knowledge, and professional networks that, if that's their commitment, they can make a difference for the good. We teach the tools that can help them change the world whether in a maternal health program in Sacramento for low income African American women, which is where one of our graduates works, or whether they are in the insuring the uninsured program, where another of our graduates works. 

The first tool that I want to really share with students is a belief that you can change and make a difference.

There are people in California, who have changed systems. An example is Father Greg Boyle, SJ in East LA. He is addressing gang violence and the homicides and the tragedies in the community. Inequities are being reduced, tragedies are being reduced. There are programs that are successful and people that make a difference. And systems are made up of people. Another key theme in public health leadership is the inquiry to get closest to the people closest to the problem to solve.

You have highlighted the diversity of our MPH PHL students. Why is this so important for our learners?
Diversity of perspectives and experiences facilitates the chance to get closest to the communities that you're trying to serve. For example, if you're working in the Hmong community it's great if you can speak the language, understand the culture, and have an appreciation of what said and what's not said.

What motivates you every day?
We can do better and people deserve better.

Three things you are proud of today?
I am really proud to have worked with great people who volunteer their time to the NAPA Working Group. To learn from them and really feel good about the opportunity to work with people who are committed to addressing societal problems.