Thoughts on Working at the Local and State Level


Thoughts on Working at the Local and State Level

By Larry D. Jones, MPH

Health Director
Independence Health Department
Independence, Missouri  

Larry Jones has been working in public health since 1970 when he began his career with the Kirksville College of Osteopathic Medicine in their federally funded Children and Youth Project, a program that is dedicated to providing both primary care services, dental services and hospital services to children of low income families from birth to 18 years of age. While Larry was at the Kirksville College of Osteopathic Medicine, he applied for and received one of the first 19 Women, Infants and Children (WIC) Supplemental Food Program grants in the nation. In 1974, Larry joined the staff at the Missouri Department of Health and Senior Services as the Deputy Division Director for Maternal and Child Health. During that time he started a High Risk Maternity and Infant Care program funded by state funds that later became a Medicaid expansion program. He helped start the First Steps Program, a federally funded program for newborn through 3 year olds with developmental delays. He also administered the MCH Block Grant. Larry then spent the next seven years helping to strengthen local public health agencies while working for the Center for Local Public Health Services. He has been the Health Director for the City of Independence since December 2001. In this role, he provides leadership for the health department, the Kansas City metropolitan region and the state. 

We asked Larry to answer some questions about his experience working at the state and then at the local level. He shares his thoughts below.  

Q: Is there a major difference between being an employee at the state vs. the local level?

Over the past nearly 40 years in public health, I have had the privilege to work in both. After both, I would say yes. Working at the state level allows you to see the overall picture of your state; however, it often means the design of one-size fits all program. Just like in clothing putting a one-size-fits-all garment on a 3X or petite person doesn’t work, it doesn’t work in MCH either. Working at the local level lets you see what the real needs are in your area and develop and evaluate programs that impact those needs. You know who really works well with you to impact these needs in your community. Since it works so well for you, you wonder why the state doesn’t just have everyone do it your way. You also wonder why in the world the state is giving money to the only community-based organization in your area that does not cooperate with the rest of the community and always wants to do it their way or not at all. 

Q: What are the key components to building partnerships? 

What really works is a partnership between state, local and community partners. There will never be enough money to fund everyone or everything to the level each feels is necessary. When you are working at the state or local level, it is helpful to have an advisory committee. At the state level, a committee of local public health departments that represent all sizes of health departments; and at the local level, partners that are both willing and unwilling to work with you. You do not need everyone to agree with you -- you will develop some of your best work by seeing the problem from all levels and the pros and cons of your recommended solutions. 

Q: What is the value of sharing best practices?  

We are all working to provide our citizens with the best practice possible. However, we sometimes need to remember that we cannot let recognized best practices stand in the way of development of best practices. All best practices of today were once someone’s dreams. They had the fortitude to try something that hadn’t been done, to evaluate their idea, and to share it with others. If we do not do this as well, we will be in a rut where we only do what we have always done, and we will continue to wonder why we are not making more progress. We also need to share what we are doing that works well with each other. Model Practices at the local and state level need to be shared. State MCH programs could develop web sites that allow the sharing of what is working in your local health departments. Maybe a local agency has adopted an ordinance that restates the state statute on immunizations requirements for attendance at daycare centers so that they can enforce this monthly instead of the once or twice a year that the state might conduct inspections.