From the CEOs

Michael R. Fraser, PhD, Chief Executive Officer, AMCHP





Patrick Simpson, MPH, Executive Director, CityMatCH







For almost 20 years, CityMatCH has supported urban maternal and child health programs nationwide. CityMatCH members are MCH directors and other public leaders in health departments serving jurisdictions with populations of 100,000 or more residents. I caught up with Patrick Simpson, MPH, CityMatCH’s Executive Director in Omaha, Nebraska, where CityMatCH is headquartered.

Mike: So, Patrick, this month’s issue of Pulse is all about state and local collaboration. What do you think are some of the big issues we need to address as we think about this really important topic?

Patrick: I have always liked the quote from Sir Isaac Newton, “if I have seen further than others, it is by standing upon the shoulders of giants.” It highlights that our greatest accomplishments are rarely individual achievements but collaborations with many players or at least giant ones. But what gets in our way of successful collaboration? As resources get tighter and tighter, it is human nature to protect those closest around us: our colleagues, our subordinates, ourselves. Collaboration outside our own agency requires a level of trust that isn’t easy. We have to set aside our self-preservation instincts competing for limited resources and keep the bigger goal in mind which is healthy women and children in our communities.

Mike: I totally agree, and there are certainly many giants in our field that have really helped pave the way for effective state and local collaboration. But Pat, I see us spending a lot of time and energy in conversations about how much money local health departments get from their states and a general sentiment from locals that states do not pass enough money to local agencies within their states. I think we can both agree many local agencies think that state programs “hold on” to resources that many would like to see invested locally. There are legitimate reasons for states to build capacity in their health department, especially as we look at statewide needs assessment activities, epidemiology capacity, and the state role in filling gaps and meeting needs across a state, including areas where there is no local health agency. Do you think we’ll ever be able to agree on what kinds of things states should do, and what kinds of things locals should do that would help us move beyond the conversation about how much money goes to whom?

Patrick: I wish I had an easy “yes” or “no” answer but unfortunately each state and locality is a politicized environment in which what is good for the population and backed by science doesn’t always align with the politics. I think there will continue to be efforts to set standards of practice and core competencies, and that dedicated public health people will continue to strive to do the best for those they serve. It will take strong leadership in state and local government to agree on how best to get the necessary work done. I am hopeful, and patient.

Mike: Yeah, it really does come back to leadership doesn’t it? If the leadership and vision are there, a program can do great things regardless of what level of government they are serving. But money helps!

Patrick: Exactly. Mike, you’ve worked with both local and state health departments. What do you see as some of the biggest challenges to effective collaboration?

Mike: Well, in both settings there is never enough money, nor enough people to do the work. I think chronic funding challenges and workforce recruitment and development issues will continue to create an environment where competition comes before collaboration. It makes sense to me to spend some time as AMCHP and CityMatCH, and probably engage NACCHO and other similar groups, in state specific conversations about what the MCH infrastructure looks like and what a state function versus a local function might be. I have travelled to many states, and honestly there are some areas of duplication and fragmentation at the local and state levels. We cannot afford that – we cannot continue to try to all do the same work without some real strategic conversations about who needs to do what, where, and when, and with whose money! Do you agree?

Patrick: It is a challenge to coordinate programs, especially in large population states where there is so much need. But yes, as we get less and less resources to do more and more work we certainly cannot afford to fragment or duplicate services. It makes sense to have a strategic conversation at the national level about where we all want to go, together, and what we need to do to move forward.

Mike: I notice that we talk a lot about collaboration. What do you think true collaboration, not just “lip service” collaboration, is all about? To me it involves trust, a willingness to identify solutions that are bigger than any one agency or level of government, and a serious commitment to invest resources where the needs is and the work has to get done. Do you agree?

Patrick: I definitely agree with you on that. True collaboration is about trust and putting your resources – money, people, social capital - on the table for the greater good. How to get to the end point is the fun part! The creativity in the planning and the relationships built during implementation of a program are the end results of all the collaborators agreeing on the vision and pooling their resources, and trusting that the right people are there to get the important work done.

Mike: Well, it certainly has been fun starting this dialogue, but I get the sense this isn’t the last conversation we’ll have on the topic, is it? 

Patrick: Certainly not! But let’s work together to move our shared agenda forward – I am glad that we have worked hard over the past two years to better align AMCHP and CityMatCH and state and local MCH practice. Let’s keep going!