essay on leadership in public health

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Leadership in public health

Indian Journal of Public Health 62(3):165
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DOI: 10.1007/BF03182303
Corpus ID: 39897572

Leadership in public health

Published in Journal of Cancer Education 19 December 2009

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Leadership through the Eyes of a Public Health Professional

A journey of 43 years.

Kumar, Sanjiv 1,2,

1 Chairperson, Indian Academy of Public Health, IPHA, Kolkata, West Bengal, India

2 Former Senior Advisor, UNICEF, Kampala, Uganda, Former Director, IIHMR, Delhi, India

Address for correspondence: Dr. Sanjiv Kumar, M15, 2 nd Floor, South Extension Part 2, New Delhi - 110 049, India. E-mail: [email protected]

Received May 12, 2020

Received in revised form June 05, 2020

Accepted June 12, 2020

Leadership skills in a public health professional (PHP) are more important today in view of rapidly changing disease pattern, higher priority to universal health coverage, health in all policies, health being demanded as a human right, and emergence of pandemics from zoonotic diseases. Most of us become accidental leaders as we never receive training in leadership skills. This not only undermines the effectiveness of PHP but also undermines the credibility of public health as a specialty. Jim Collin's five levels of leadership are useful to understand the various levels of leadership for a PHP. Technical excellence which denotes first level of leadership is necessary but not sufficient to become a leader. One needs team work, emotional competencies, prioritization (first things first), listening skills, advocacy, negotiation, networking skills, along with conviction, commitment, and courage to do what one thinks is right. Leadership is a life-long journey, not a destination. Being engaged in leadership for more than a decade, I developed a three domain leadership capacity development model very useful in designing and conducting leadership development trainings to develop leadership skills among PHPs, academicians, and health researchers.

INTRODUCTION

All public health professionals (PHP) take up leadership role right from their first assignment. They have to interact with community, community leaders, and bureaucrats to implement various national health programs to achieve assigned targets. The faculties in the departments of community medicine or public health are the role models for their students and leave a lifelong impression about public health. They play an important role in attracting bright students to take up public health as career. Leadership skills among PHPs are even more important today as disease epidemiology is rapidly changing, focus on achieving universal health coverage with launch of Pradhan Mantri Jan Arogya Yojana and Health and Wellness Centres, need to work with other sectors in view of the need for health in all policies, emergence of health as a human right and frequent pandemics. India has become a global economic power and the fifth largest economy in the world but its health indicators are worse than economically less developed countries such as Bangladesh, Nepal, and Srilanka.[ 1 ]

Leadership is a process whereby an individual influences team members and people in the organization to achieve common goals.[ 2 ] Leadership is leading a group of people or an organization to achieve the results. In its essence, leadership in an organization involves establishing a clear vision, sharing that vision with others which they follow willingly, providing them information, knowledge, and methods to realize that vision, and coordinating and balancing the conflicting interests of all members and stakeholders.[ 3 ] This article is based on my reflections of 43 years of experiences starting from primary health center to state level and then to national and international level. I share real life stories to highlight need for various leadership skills at the every level of work of a PHP. It also includes a few concepts for developing leadership skills based on the leadership courses I have designed and conducted over a decade.

The faculties of community medicine have an important role in attracting students to the specialty and are effective role models. In my case, three teachers influenced me immensely. The dedication and persistence of Prof. George Joseph during MBBS. He was so loving and caring that I did not miss any class or field visit after the first PSM field visit that I bunked with all my classmates. Prof Joseph walked into our hostel and lovingly escorted us to the field. He also convinced me and others to volunteer in “Youth Against Famine” program in the Udaipur District of Rajasthan. This gave me an opportunity to live in a village hut and work with and closely observe village life for 3 weeks. Professor LM Nath whose excellence in technical knowledge and multi-tasking made him my role model and Professor CS Pandav, known as “Iodine Man” for his contribution to elimination of Iodine Deficiency Disorders in India and beyond. I am indebted to these public health leaders who attracted me to community medicine and guided my career. It was an honor for me to be listed among 13 eminent public health leaders who emerged from the Centre for Community Medicines, All India Institute of Medical Sciences, New Delhi (AIIMS) at 60 th Anniversary Celebration of AIIMS.

ACCIDENTAL AND SKILLED LEADERS

We have two kinds of leaders in public health. One is “Accidental” Leaders who land up in a leadership positions without leadership skills and second is “Skilled” leaders who have acquired leadership skills. Most of us start our public health career as an accidental leader as we do not have any formal training in leadership during MBBS or MD. One may learn leadership skills by hit and trial, self-learning by reading, observing other leaders, or taking up formal courses.[ 4 ] An average health professional moves up in the hierarchy based on seniority reaching leadership positions. There is no formal leadership training in both undergraduate and postgraduate medical education. There is formal leadership training in many sectors such as defense services and bureaucracy. In medical field, there are many in-service training courses available, but these are neither integrated into career progression nor compulsory. I also started my public health journey as an accidental leader till I got formal training at the age of 53. I reflect on my experiences in public health from PHC upward [ Table 1 ], and the leadership skills I should have had to deal with those situations.

Formal training in leadership

I started as an accidental leader till I realized the need for formal learning of leadership. After considering various options, I decided to join an online MBA in Strategic Management which included a course on applied leadership at a college in Zurich, Switzerland, affiliated to University of Wales, UK. It included a course on “Applied Leadership” which put me on the road to strengthen my leadership skills. I found the course very interesting and read six books and more than 100 articles including the course material. Each one of these described leadership differently mostly at theory level. This confused me and I yearned for a practical tool which prompted me to synthesize my understanding of leadership based on the literature and my life experiences. The result was the three domain model of leadership capacity building. 5

THREE DOMAIN MODEL OF CAPACITY BUILDING FOR LEADERSHIP

There are numerous models available in the literature of leadership; however, I did not come across any to guide one to develop one's own or others' leadership skills. The three domain model helps in planning and facilitating leadership skills and how skills in three domains interact with each other.[ 5 ] A good leader needs to develop skills in all the three domains. As one moves up the leadership hierarchy the team domain and later external environment domain become more important. The skills mentioned below in the three domains for the capacity development are only indicative and can be added or deleted for the various capacity development initiatives in an organization depending on the needs assessment. The three domains and their inter relationship are depicted in Figure 1 . 5 There are skills in each domain that a public health leader should have which are:

Self-domain

No one can become a leader unless one leads self well. A leader has a vision for self, organization and each one of his team members. He has charisma. He is self-aware of his strengths and weakness and knows strengths and weakness of his team and asks for outside help in areas needed. He has strong communication and listening skills. He possesses change, social, intellectual, and emotional intelligence. He is the model of behavior and values he wants to inculcate in others. He is keen to learn new skills and acquire knowledge in emerging areas. A public health leader has to keep himself updated on the technical areas. If a PHP does not have technical competencies, he cannot remain a leader.

Team domain

A leader enables the team by actively developing individuals, inculcating team spirit. He keeps changing his approach based on what he learns through his network to maximize the efforts to achieve organizational objectives. This domain includes the skills for developing individuals in the team and the organization to effectively work together for the achievement of team and organizational goals. The leader enables the team and organization by developing the individuals in his/her team and the organization. A leader builds, strengthens, and facilitates team spirit and work. Through his/her traits, skills, and attributes, the leader helps his/her team to execute his/her vision. A leader does this by developing the skills in each individual in the organization through putting the right person in the right job, motivating, facilitating learning, and skill development in the staff through training, coaching, and mentoring. Leader is strategic in his/her approach and aligns human and other resources to achieve the organizational goals to fulfill the vision. A leader is in constant touch with his/her employees through his/her formal and informal networks and keeps changing his/her approach based on what he/she learns through his/her network to maximize efforts to achieve the organizational objectives. He/she transforms the individuals in the organization and motivates them to get the best out of them and channels every one's efforts so that they work in synergy to get the best results.

Environment domain

The leader keeps an eye on what is going on outside the organization, how things in the sector and outside the sector are changing, and what are the implications for the organization. A good leader should know how the diseases pattern, trends, and projections and factors within and outside health sector are contributing to this change and how these affect his/her organization. He/she keeps an eye on how the availability of technology and its application in health sector is changing or going to change the way health institutions function and are managed. The newer health interventions are changing management of health problems. He/she plans ahead and prepares his/her organization to benefit from these developments. He/she also keeps in mind how his/her organization contributes to benefit the society. No organization exists in vacuum, and its existence and growth is linked to the society, its norms and values. The leader develops and uses a strong network of formal and informal contacts beyond the organization/team he/she leads to get a regular feedback on how the organization he/she leads is perceived.

Interactions between three domains

The three domains of leadership capacity building are not watertight compartments, and there is a close relationship and overlap in the three domains as reflected by the double arrows in the model. The skills of the leader help him/her in learning from the changing environment in health and related sectors and develop and manage individuals and teams within the organization to adapt to that change. The leader also needs to review his/her personal skills and way of working, identify gaps, and acquire new skills and/or adopt new ways of working.

COMPLEMENTARITY OF ADMINISTRATIVE, MANAGERIAL OR LEADERSHIP ACTIONS

Leadership, managerial, and administrative skills are often understood as the exclusive skills. However, in real life, these skills are complementary and synergistic. According to John Kotter, “Most organizations are over managed and under led.”[ 10 ] It is also true for public health in India. A good leader knows and takes administrative, managerial, and leadership action as the situation demands. It is common to the individuals in the leadership positions who continue to be an administrator or a manager and “micromanage” their subordinates. These leaders are still stuck in transactional style and need to move to transformational style, which is necessary for a leader. A leader may take administrative or managerial actions at times but is more focused on creating vision, mission and mandate, develops and transforms the organizations and individuals, creating right environment, anticipating future, and adapting the organization for it. Whereas managerial actions are focused on creating structures to achieve specific targets through effective and cautious use of available resources with stability. Table 2 below gives the examples of administrative, managerial, and leadership actions in day-to-day work.[ 11 ]

Progressive levels of leadership in public health professionals

Leadership among PHP can be divided into five levels which is adapted from Jim Collin.[ 12 ] It is important to realize that the role of a PHP changes as one moves up the ladder in the hierarchy. The five levels of public health leadership as shown in Figure 2 (Adapted from Jim Collins' model of five levels of leadership). Level 1 leader is a highly competent PHP who makes productive contributions through her talent, knowledge, skills, and has very good work habits. It is important for health professionals to understand that technical competencies are essential but not sufficient to become a good leader. They need to develop skills of higher levels to become effective leaders. In the health system, professionals are promoted by seniority as the sole criteria. Thus, it is quiet common to see a technically competent person promoted to Chief Medical and Health Officer or Professor Level due to their seniority alone. Most of them do not have skills to perform higher level functions. Level 2 refers to the ability to a competent team player. At this level, an individual does his work well and also helps others in the department or team to achieve their individual objectives. A level 2 leader works effectively with others in the team and the helps them to achieve the team objectives. A level 3 leader is a competent team manager and leads a department or a team well, has skills to organize people and resources toward achieving the team objectives. As a team leader, leads his team to achieve the team objectives with judicious use of available resources. Level 4 is an effective public health leader who can lead an organization well by catalyzing the commitment in vigorous pursuit of a clear and compelling vision for the organization and stimulates higher performance standards. Level 5 is visionary leaders who possess the skills of levels 1–4 and have a blend of personal humility and strong professional will. They are incredibly ambitious, but their ambition is for the institution to bring it to greatness, not for themselves. Level 5 leaders build cultures, processes and systems in the institutions which continue to do well even long after they have left. One important aspect of developing leadership skills is continuous and lifelong learning, starting with self-awareness of leadership skills or lack of these, address weaknesses, and build on strengths, regular review of application of these skills. This cycle of the identification of areas for improvement, learning, application, and review of progress in leadership skills continues life-long.

Leadership and management program of International Clinical Epidemiology Network for the (LAMP) leadership in health research

INCLEN had developed and conducted Program LAMP in 2002. We found NHS, UK leadership program approach of Fact, Reflect, and Act very suitable to develop leadership skills. This was adapted to develop Fact, Reflect, Act, and Review approach [ Figure 3 ] to conduct LAMP training. Fact refers to learning about the major leadership skills which are covered during the face to face training. Reflect refers to the participants reflecting on their leadership skills based on the learning. This starts before the face-to-face training through the assignments to assess each participants' leadership skills. They reflect on these assignments after the plenary session on each leadership skills. They identify the gaps and strengths each participant has to become a good leader. Act refers to the preparation of individualized leadership development plan based on Fact and Reflect. Each participant's progress is reviewed during the post workshop contacts. The participants are encouraged to keep reviewing their performance as a leader even after the contacts are over. Six courses have been conducted so far. These four steps continue to guide learning throughout the life course of a leader. A summary of approach and skills covered in this course have been published.[ 4 8 12 13 14 15 16 17 ] The programme is under revision based on a recent Wellcome Trust DBT leadership in health research in India study conducted by INCLEN. This four steps approach has also been used in workshops for leadership in academics and for leadership for PHPs and found effective.

Skills for leadership

There are various skills a PHP should have. Technical competencies in public health are foundational and essential for every PHP. It is vital that they keep updating their knowledge through regular readings about public health in India and globally. The other skills for moving up the levels of leadership include

Team working, team leadership including mentoring and coaching
Communication with focus on listening
First things first (time management), setting priorities, and work-life balance
Advocacy and negotiation
Organizational culture, values, vision, and mission
Emotional competencies
Dealing with difficult people.

Many other skills can be added to the above eight. The details of these skills can be read elsewhere.[ 4 8 12 13 14 15 16 17 18 ]

Family support for public health leaders

Family support is very important for a PHP for his professional growth and focus on his work, especially when one is posted away for long periods of time. Very often, these places are non-family duty stations or family cannot accompany them as spouse is working or children are going to school or basic amenities are not available at the place of posting. One may be posted and has to live in the field practice area away from family. A PHP has to undertake frequent travel for project work, attend/facilitate trainings, assignments within the country or abroad. To mitigate anxiety and the impact on children and spouse, one may plan for them to visit the place of work and stay in regular contact with family through telephone and social media such as WhatsApp, video calls, etc. Moving up the leadership ladder with family falling apart is a not true characteristic of real leaders.

Every PHP is a leader, accidental, or learned as they are always leading a team, advocating with their supervisors, bureaucrats, and politicians. Unfortunately, these skills are not imparted during our training in public health. This has been illustrated through my work from PHC to the international level as a PHP. To become a skilled leader one can learn and improve one's leadership skills through formal or informal learning. Three domain models, five levels of leadership in public health, and four steps cycle of fact, reflect, act and review can be used as the effective approaches for developing and conducting trainings in leadership.

It is very important for leaders and those aspiring to become leaders to understand that leadership is a journey and not a destination. One has to reflect on one's action as a leader and keep learning and improving every day. In the absence of this approach, one may become over confident or arrogant and lose out on becoming and remaining a good leader.

This article is based on my JE Park Award Oration on March 1, 2020, at 43 rd Annual Conference of Indian Public Health Association held at AIIMS, New Delhi, India. I acknowledge the inputs received from Prof Neeta Kumar, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, in writing this article and the conceptual framework of Three Domains, Four steps of learning and five levels of Public Health Leadership.

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Putting the public (back) into public health: leadership, evidence and action

Affiliations.

1 Public Health England, London, UK.
2 Leeds Beckett University, Leeds, UK.
3 Health and Wellbeing, Southwark Council, London, UK.
PMID: 29546426
DOI: 10.1093/pubmed/fdy041

There is a strong evidence-based rationale for community capacity building and community empowerment as part of a strategic response to reduce health inequalities. Within the current UK policy context, there are calls for increased public engagement in prevention and local decision-making in order to give people greater control over the conditions that determine health. With reference to the challenges and opportunities within the English public health system, this essay seeks to open debate about what is required to mainstream community-centred approaches and ensure that the public is central to public health. The essay sets out the case for a reorientation of public health practice in order to build impactful action with communities at scale leading to a reduction in the health gap. National frameworks that support local practice are described. Four areas of challenge that could potentially drive an implementation gap are discussed: (i) achieving integration and scale, (ii) effective community mobilization, (iii) evidencing impact and (iv) achieving a shift in power. The essay concludes with a call to action for developing a contemporary public health practice that is rooted in communities and offers local leadership to strengthen local assets, increase community control and reduce health inequalities.

Keywords: community engagement; empowerment; health inequalities; policy; public health practice.

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v.112(3); Mar 2022

The Challenges of Public Health Leadership

My Quest for Health Equity: Notes on Learning While Leading . By David Satcher 240 pp.; $21.95 Baltimore, MD: Johns Hopkins University Press, 2020 (hardcover) ISBN: 9781421438313

Public health leadership is a challenging endeavor. Effective leaders must bridge science, public policy, and politics. At times, they must confront crises that garner massive amounts of public attention, such as the COVID-19 pandemic. More often, public health leaders grapple with issues such as vaccination and social determinants of health, including nutrition, exercise, housing, social structures, and the built environment. These factors shape health outcomes at the population level, cut across policy domains, and do not typically lend themselves to easy solutions.

The challenges and rewards of leadership in the realm of public health are at the heart of former surgeon general David Satcher’s engaging new book My Quest for Health Equity: Notes on Learning While Leading . Written in a straightforward manner, the book explores public health leadership from a perspective shaped by deep experience with the challenges that often occur when public officials work to translate research into practice.

HEALTH DISPARITIES AND PUBLIC HEALTH LEADERSHIP

Across a varied and highly influential career, Dr. Satcher has emphasized the importance of health disparities and sought out approaches to addressing them. After attending Morehouse College, Satcher completed medical training at Case Western and then a residency at the University of Rochester. From there, he moved on to Charles R. Drew Postgraduate School of Medicine and Martin Luther King, Jr. General Hospital, located in South Central Los Angeles. After a period working at Morehouse, Satcher became president of Meharry Medical College. There he led the merger of Meharry’s Hubbard Hospital with the city of Nashville’s public general hospital. 1 In 1993, after serving as an advisor during the development of President Bill Clinton’s health plan, Satcher became the first African American to head the Centers for Disease Control and Prevention (CDC). In 1998, he became surgeon general of the United States Public Health Service.

Rather than detailing these events in a strictly chronological manner, Satcher centers My Quest for Health Equity around the concept of leadership. From his upbringing and from his experiences as an active participant in the civil rights movement, Satcher writes, he came to develop a distinct sense of what it means to be a leader.

The importance of clear communication of responsibilities and goals, Satcher reflects, was demonstrated to him by his parents. Throughout his childhood, they entrusted him with important tasks, ensured that he completed them, and encouraged him to pursue his education. The importance of an overarching mission was made clear to him by the civil rights movement and by the commitment of its leaders to the philosophy of nonviolence. Motivated by a commitment to something larger than oneself, leaders should acknowledge error and embrace opportunities to learn and to continue to grow. Self-aware and generous, they should focus on the achievement of a mission rather than on their own aggrandizement.

POLICY, INSTITUTIONS, AND CONTROVERSY

Satcher complements his discussion of leadership with chapters on obesity, reproductive health, and mental health. These chapters suggest the depth and breadth of the obstacles that public health leaders face. Crucial to the health of communities, public health is often easily overlooked in the popular discourse. Major public health successes such as the creation of a clean water supply, the elimination of malaria from the southern United States, and widespread vaccination against an array of diseases are routinely taken for granted. With time, these successes come to seem like features of the landscape rather than the products of human effort. In the case of vaccination, the absence of many once-common diseases has itself helped to fuel skepticism, indifference, and conspiracy theories.

In the United States, these problems are compounded by fragmented institutions and by practices and priorities that have reproduced disparate outcomes across racial and ethnic groups over time. As director of the CDC and as surgeon general, Satcher emphasized the importance of reaching out to underserved communities and addressing deeply rooted inequalities. Among other notable accomplishments, Satcher helped persuade President Clinton to offer a public apology for the Tuskegee Experiment, an acknowledgment of a historical wrong that plays an ongoing role in shaping vaccine hesitancy in Black communities.

Public health efforts often garner the most public attention during moments of controversy or as a result of emergent threats. In these instances, the political nature of public health leadership is unmistakable. Satcher was nominated to be surgeon general in the wake of the failed nomination of Henry Foster, who met opposition in the United States Senate because of his history of performing abortions. Satcher’s predecessor as surgeon general, Joycelyn Elders, was forced to resign from the position after a controversy over public comments about masturbation and the prevention of HIV/AIDS.

Satcher’s service at the CDC and as surgeon general was marked, almost inevitably, by politics. Just as he became head of the CDC, the agency was engulfed in a controversy about CDC-funded research on gun-related deaths. Published in the New England Journal of Medicine , the study showed that having a gun in the home was associated with a substantially higher risk of homicide by a family member or intimate partner. 2 Ultimately, Congress reduced funding for the CDC’s injury prevention center and prohibited it from spending money to “advocate or promote gun control.” 3 During the administration of President George W. Bush, Satcher found himself out of favor after issuing a report on sexual health that criticized abstinence-only educational programs and acknowledged that safe sex could occur outside of a marriage. 4

Satcher’s book might have been made more powerful with a thorough discussion of the obstacles he faced during the 1990s and early 2000s, an era in which growing party polarization shaped the implementation of public health policies in important ways. Nonetheless, he offers a crisp distillation of his approach to leadership. His reflections on the challenges of leadership represent a needed addition to the public health literature and should be widely read by those who seek to understand and reflect on the intersections of health, policy, and politics.

CONFLICTS OF INTEREST

The author declares no conflicts of interest.

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Personal Stories in Healthcare and Public Health Leadership

Colleen Baumer and Angela Finnegan

Introduction In this chapter we share stories of several great leaders in public health and health care that we have encountered throughout our careers. This topic spoke to both of us, as we wanted to learn from experience and example rather than only text. Some of the leaders we interviewed are people we have worked with directly and can personally attest to their leadership abilities. Other leaders we have watched through the public eye, and we were interested in learning more about their leadership journeys. In working together to write this chapter, we first met to discuss how we wanted to go about choosing our leaders. Do we choose people we know personally, or only ones we had heard about? Do we focus specifically on different areas, or pick people we think might agree to meet with us? Turns out . . . it is a little of everything. We wanted to interview leaders that we admired, that we looked up to and wanted to learn from. We discussed who we admired within the healthcare field which led us to Medicaid leaders, medical directors and physicians between both the medical and the public health field. We discussed different areas of public health that were prominent and that interested us – guiding us to disaster management, tobacco cessation, and state and local level public health.

Regardless of our relationships with these leaders, we hoped to gain a fuller understanding of each of these individuals. We thought it important to learn about their journeys so that we can continue their legacy of great leadership in our own careers and for the future of healthcare and public health. Each leader has a unique definition of and approach to leadership that works for them. This supports the idea that there is not one correct way to be a good leader but an array of different characteristics and traits that are evident in “good” leadership. We hope readers of these interviews will be inspired, educated and motivated to see all the ways one can lead, learn to lead, and model effective leadership which expands far beyond the reach you may expect.

The leaders in this chapter shared with us their journeys to achieve where they are today, including obstacles and hardships that they faced. We hope you enjoy reading their stories and take away the important messages each of them has to share. We begin by sharing an overview of public health in order to frame the context of leadership in public health.

Brief History of Public Health Ask any public health group about personal leadership stories within public health, and you may be met with a resounding ‘John Snow!’ from the crowd. No, not our beloved John Snow from Game of Thrones, although we hope he is up to date on his winter safety tips from his local health department. Public health John Snow of the 1850s studied the local cholera outbreak, and, based on his assessment of illness location and sewer water flow, he was able to conclude how some in the community were falling ill and made necessary changes to manage the outbreak. But before his time, beginning as early as the 1300s, history is filled with many people dedicated to creating theories on the spread of disease, inventing equipment for their studies, and starting the discussions on something that seems as basic as hygiene. We are where we are today because those in our history were willing to ask the needed questions and find the necessary answers. They were true leaders of the profession and for the health of the communities they served (Lamort, 2015).

We can examine other examples of public health leadership that may be more relatable than those of the more distant 1500’s. During the 1980s, the HIV/AIDS outbreak became mainstream news. While something the public knew about and was aware of, many do not know the behind-the-scenes work that took place to determine how the disease was transmitted, methods that could stop it, and interventions that could treat it. Don Francis was an epidemiologist that was part of the team working on managing the AIDS epidemic. Don worked tirelessly to overcome barriers in funding, educate an administration that was resistant, and fight stigma that kept many from remaining safe or having access to safety measures (Frontline, 2006).

Another modern-day example is that of Michelle Obama’s Let’s Move! program which she championed as First Lady. Michelle (we’re on the first name basis) focused on creating a healthy path for ALL children in the early years of their life. She did this through helping make healthy choices available, providing schools with healthy food items, and ensuring that families have access to healthy and affordable food. The reach of this program spanned from schools to corporations and even the private sector. She was a leader full of grace, strength and confidence in her practice. Oftentimes at the hospital where I work I will hear complaints about the vending machines not carrying ‘good’ (healthy) food. Thanks, (Michelle) Obama! (Let’s Move, 2016) By studying these historical examples and advances in public health, we can see how leadership has developed over time and how individuals have made advances for populations worldwide. When asked about the definition of leadership, popular answers are ‘leading by example’, ‘making changes for the greater good for all people’, and ‘positive energy to keep people motivated’. We have men and women starting back in the 14th century recognizing that changes can be made for their communities and beginning the problem-solving process for poor hygiene and the spread of disease. They took initiative to increase the quality of living for themselves and their communities. While we may not know much about their trials and tribulations to reach these goals, one can assume the path was not easy with a lack of resources and technology; much of which we have today is due to their steps in leadership. We have seen people within the science community and those in positions of great power and influence use their roles to push forward with widespread challenges, like the AIDS epidemic and childhood obesity. Leadership does not have to come in the form of an election or well-known title; it can come in the form of advocacy for those that cannot always advocate for themselves, passion for a cause, persistence to see the fight through, and the knowledge to create an effective and realistic plan of action.

Below we have captured more personal stories of those within our own Ohio State and Central Ohio community who are leaders within the world of public health and healthcare. Each has had their own path, education and experience which they have graciously shared for this chapter.

Leaders in Health Care Dan Bachmann, MD Dan Bachmann is a Medical Team Manager for Ohio Task Force 1, leading the medical side of a search and rescue team that operates under the Federal Emergency Management Agency (FEMA). He manages the medical rescues and ensures safety of the team, works side by side with others that manage logistics, technical search and rescue, K-9 missions and materials. Each of the team members are specifically trained within their own scope of practice, ready to hand the reins over when best suited for the rescue. Dan highlights that each leader has something to offer, each complimenting the other members and providing a level of support that keeps the team functioning. This team deploys to some of the worst natural disasters our nation has seen, witnessing the deep human aspect of loss and catastrophic change. This kind of work calls for leaders with insight, quick and thoughtful decision making, and the ability to make tough decisions. During Dan’s ‘day job’ as an Emergency Department physician these traits are part of team leadership theory built on real-life group work. As an ED physician, Dan often has to make timely decisions that affects both the treatment team and the patient outcome. These skills are directly transferred to his role leading rescue missions with TF-1. On each mission, Dan discusses how hard it is to ‘sit back’ and ‘wait your turn’. In this atmosphere, sitting and waiting, rather than doing and working, is the hardest part. Logically, he and the other leaders are aware that resting and creating a well thought out mission is ultimately the most important and efficient way to function, as with so many moving parts and aspects to their team, an ill thought out plan could cause more damage.

Team Leadership Northouse highlights team leadership as having a flatter organizational structure, not operating from the top down, allowing the team to communicate across the plane and enhancing decision making and problem solving. Dan provides a great example of a leader being able to shift the power around to create the most positive outcomes, and in this case, saving lives. Team leadership also allows for full assessment of both internal and external circumstances which will come into play within a rescue event, creating an environment of assessing ability and determining what control exists in the current climate. As one of the leaders, Dan will need to assess internally the skills of his team, communicate the goals of the mission for the team, and advocate for input from other perspectives to ensure a successful mission. Externally, Dan will communicate with those outside of the direct mission to determine next steps for the group and report back what was successful or challenging to better inform outside sources of circumstances for the team.

Susan Moffatt-Bruce, MD, PhD, MBA For Dr. Susan Moffatt-Bruce, leadership is a ‘state of mind’ that is cultivated with experience and vision. True to her definition, Dr. Moffatt-Bruce has a vision and a lot of experience in leadership. She currently serves as the Executive Director of University Hospital at The Ohio State University Wexner Medical Center (OSUWMC). Prior to being named the Executive Director, she was the Chief Quality and Patient Safety officer at OSUWMC for six years. Along with the leadership roles she has held, she is also a practicing cardiothoracic surgeon and has a PhD, MBA, and MBOE. Nationally, Dr. Moffatt-Bruce is the Chair of the Board of Directors for America’s Essential Hospitals and sits on a committee at the National Quality Forum. In all of these roles she has had a common vision, to improve the quality and safety of patients. The importance of having a common vision is explained in an article by Oliver (2006) in which she argues that a true leader has the ability to explore and define personal and team motives to accomplish change and achieve a shared goal. Dr. Moffatt-Bruce’s ability to set a common vision, mission, and goal is evident in her work and part of what makes her a great leader.

Adding to her definition of leadership, she recognizes that leadership is different for each individual . . . so the key is for each person to make it ‘real’ for them. She views her particular leadership style as servant leadership. As defined by Parris and Peachey (2013), servant leadership theories emphasize service to others and recognize that the role of an organization (or a leader) is to create people who can build a better tomorrow. She is not a dominant leader but rather a facilitator and prefers to lead by consensus. She recognizes that there are different leadership styles and points out that regardless of one’s leadership style, the main goal of leadership is the same, “the leader needs to create a vision and pull people together, the leader is the connector” (Northouse, 2018). A leader needs to be able to reach out to all the stakeholders and get everyone on board to be successful long term. She notes that one can have all the funding in the world for a project, but without pulling a team together to achieve the vision, they will fail.

When looking back, Dr. Moffatt-Bruce did not think she would become a leader of this scale. She came from a traditional background; her mom was a nurse and her dad was a police officer, and she always knew she wanted to be a doctor. When she got to Ohio State there were a lot of opportunities for leadership and she took an interest in quality and patient safety. She invested a lot of time and effort in leadership development, including taking a strength leaders survey, and her results indicated that she is heavily an achiever. She says this strength has helped leverage her to always excel and climb up the ranks.

As she was describing her journey she also pointed out that she ‘always says yes’ when she sees an opportunity to improve the health care system, which is evident by the numerous roles that were described earlier. Her willingness to take on new roles and projects has a positive effective on the people who work with and under her. In the couple months that she has served as Executive Director of University Hospital at OSUWMC, employees have noticed the email updates she sends out highlighting progress being made on projects and invitations to forums being held to share what is going on in the hospital and where it is heading. People appreciate these updates and the availability of her leadership because it helps create a positive culture which helps them feel more confident, hopeful, and optimistic about their work (Woolley, Caza, & Levy, 2011). Her openness and willingness to take on change are just a couple of the characteristics that make Dr. Moffatt-Bruce a great leader.

When Dr. Moffatt-Bruce took on the position as the inaugural Chief Quality and Patient Safety Officer at OSUWMC, she did not feel prepared. She recalls that she went from being responsible for her own work to being responsible for a team of individuals. This was a big change but she credits her role models and mentors for helping prepare her for the position. When she stepped into her role as the Executive Director of University Hospital and became responsible for even more people, she realized delegation, trust, and prioritization become more important the more you take on. She has also learned that including her family and support system in her work decisions is important, which is not something she previously emphasized. She says she now includes her family in decision making processes and that it has had a positive impact.

‘Change’ is common to the nature of improving quality and patient safety, so she is familiar with leading change within an organization. Although difficult regardless of how you go about it, she says there are a couple different ways you can approach organizational change. She believes you need to have a strong will for change or an attitude of ‘if there is a problem we are going to fix it.’ In her view, leaders are responsible for establishing a burning platform and defining the problem. Once the problem is defined, a team should be pulled together to come up with a solution, measure the change, and then evaluate to determine if an improvement has been made.

When gathering a team and getting people on board with a change, she says it is important to understand why some people are not on board and meet them in the middle when possible. She also sees resonating importance with people, relating to them, and appealing to their sensitivities as approaches to getting people on board. One example she recalls is leading the change requiring surgeons to mark surgical sites prior to entering the operating room. She remembers receiving pushback from the surgeons because they believed this was a job that could be done by residents. To rally support, she had them meet a patient who was part of a wrong surgical site event to make the issue more real and appeal to their sensitivities.

Dr. Moffatt-Bruce’s steps to leading change are similar to those outlined in Osland, Turner, Kolb, and Rubin (2011). Osland et al outlines eight steps to managing change in an organization as: 1. Increase urgency 2. Build the guiding team 3. Get the vision right 4. Communicate for buy-in 5. Empower action 6. Create short-term wins 7. Don’t let up 8. Make change stick

Although these steps are slightly different, as I was reading this chapter, I was very much reminded of Dr. Moffatt-Bruce’s approach to leading change and based on her success in leading different aspects of the OSUWMC. I am not surprised that her method is so well aligned with those that are in the literature. In her final thoughts about leadership, Dr. Moffatt-Bruce says that, “ultimately leadership is a privilege and it is earned, you have to work at it and earn the right to lead people.” Leadership is a privilege she has indeed earned.

Jim Allen, MD Jim Allen has been the Medical Director of the University Hospital East (UHE) location for just over three years, having taken over in 2014. Leading up to this position, Jim states that he had taken various leadership positions over time, beginning with his time as chief resident during residency. Since then he has taken on a number of positions on councils and committees throughout the hospital, even requesting formal training for physicians in leadership to better prepare himself. While he knows that he has made mistakes and will continue to make some mistakes, his goal is to only make them once, learn from them, and keep moving forward.

Currently, UHE is applying to become a Level 3 Trauma center, something that will affect the entire hospital in multiple ways. When asked how he is leading the change he speaks of ‘cultivating change’. These changes come from a consensus, but the impact will be both positive and negative for others depending on their role and changes they will face. How does he do it? Clear communication. He recommends ‘communicating’ often to ensure the correct message is shared. He likens a lack of communication to a game of telephone – soon it is all rumors and incorrect versions of changes that are spreading like wildfire. He also believes in sharing the vision and reason for the change which is to meet the healthcare needs of the community, not just to advance careers.

Presence is a theme that continued to appear throughout our discussion. When asked how he encourages sharing of ideas and advancement of newcomers, he returns to this act of presence. He attends department staff meetings and rounds daily to not only speak to the staff but to be in their environment, to see what they see, experience their experiences, and give staff the comfort of sharing their ideas and feedback on their own turf. When asked by new doctors “How can I become a medical director?” his advice is NOT to “go get a Masters of Business Administration (MBA).” Rather, his answer is leadership ‘presence’. This means joining committees, speaking up at meetings, and communicating with colleagues. This also means attending different departmental meetings and becoming an active part of the organization. While earning an MBA might help you secure your first job, early ‘involvement’ and ‘presence’ will lead to new opportunities and advancement.

We also read about ‘transformational leadership’ in Northouse which is focused on leaders inspiring followers (Northouse 2015). In this case, physicians and staff working together to accomplish positive outcomes while also focusing on the needs and motives of the staff. Much of what Jim states in how he leads fits perfectly with ‘transformational leadership’. He plays off of the goals of the hospital and those that are choosing to work for the community, modeling positive patient care and acting as an engaged leader. His goal of clear communication creates trust which is another important trait of a transformational leader, making him an ideal candidate for this position.

Transformational leadership also includes role modeling for followers and empowering everyone to work to their fullest potential. Jim meets with staff in their comfort zone and works to see experiences through their perspectives to better support and advocate for not only the staff, but the hospital and community. Personally, I have seen Jim at my monthly staff meetings since he took over his role of Medical Director. He invites and welcomes feedback and innovative ideas but also uses corrective criticism and the occasional reality check, setting limits and boundaries. He is kind and confident in his communication, and thus, garners respect from staff (Northouse, 2015).

Mary S. Applegate, MD At the Ohio Department of Medicaid, Dr. Mary Applegate is at the forefront of the leadership team. She currently serves as Ohio’s first medical director for the Department of Medicaid. Dr. Applegate is a board certified pediatric physician in both pediatrics and internal medicine and continues to see patients in the clinic one day every week. Dr. Applegate has also served in other leadership roles throughout her career, including Medical Director of Pediatric Services at Memorial Hospital of Union County, Medical Director of Loving Care Hospice Program in Union County, and Deputy Coroner of Union County. In response to how she came into the numerous leadership roles she has held throughout her career, Dr. Applegate said, “I always saw a need and I stepped up to the challenge. I never set out to be a leader, I set out to do the best I could.” Dr. Applegate stepped up to almost every leadership position she has held because she saw a challenge and knew that she could handle it.

Dr. Applegate describes herself as a ‘servant leader’. She believes that one of her roles as a leader is to recognize people’s skill sets and to help them by getting them what they need to be successful. While listening to her describe herself as a servant leader and hearing the passion she has for helping patients, especially children and the underserved, I thought of part of the definition by Sendjaya (2015) who describes servant leadership as an “approach that reflects an internal orientation of the heart to serve others.” Along with making sure people have what they need to succeed, she also sees importance in letting people learn. Her example comes from her time as a resident medical school. She recalls some of her mentors allowing the residents to work through tough cases on their own and only stepping in to help as a last resort. She says that letting people figure things out on their own is a great way for people to build their skill set and knowledge for the future.

One of the things that people need to be successful is a good team. The people on a team and members’ skills can affect the results that the team ultimately achieves. Manz, Pearce, & Sims (2009) write that having an empowered team helps produce more quality outcomes, causing the organization to be more effective. Manz et al point out that sharing leadership among teams can have a powerful impact on the team’s performance and empowers different team members to exercise leadership in different ways at different times. This can help make a team more successful and willing to take on more projects in the future. Dr. Applegate believes that finding those people is accomplished by defining the goal and then letting people bring their voice and passion to the vision. This will give the group a sense of ‘owning’ the project and then, when they are successful, they will want to tackle another project. The dynamics of the team are also very important. Diversity among the group, whether it be skills, careers, gender, cultures, etc., will build a richer product. Obtaining input from a diverse group of people will bring in many perspectives and ideas that a homogenous group likely would not have.

Dr. Applegate sees a lot of importance in good leadership. She believes that, “anytime we do something that is not the status quo, leadership is important.” The leader is there to help guide the team toward a common goal, a key responsibility of the leader also mentioned by Dr. Moffatt-Bruce in her interview. Once that goal is set, the leader should help guide the team but never tell people what to do, as that is not motivating. If the group is passionate they will decide how to get to the goal. The leader should also be just as passionate about the goal as the group. She recalls one point in her career when her boss was leaving and she was worried about what direction the organization would go with a new boss. She remembers one of her coworkers saying, “we will be okay, it matters if you leave because you’re the heart of the organization.”

Another important responsibility for leaders is creating a positive work culture. Dr. Applegate believes that, “leaders help shape (or change when needed) the culture of organizations by practicing consistent behaviors that support priority values.” Among these values she listed honesty, integrity, and fairness. Honesty as a leader is seen by many people as being transparent in your processes and open to sharing your beliefs. Integrity is important as a leader because it gives people trust that their leader will do what is right and stand for what they believe in. Having a fair leader is critical for followers because they want to know that everyone has the same opportunities. These things are evident in how people are treated, how promotions are handled, and how work is performed, creating a safe environment in which can people can feel free to be heard and show their best selves.

In leading change from the bottom, Dr. Applegate believes that one of the most important things one can do is learn as much as possible about the issue at hand. She says that in order to develop a good plan, one needs a deep understanding of what the problem is, how the organization is currently functioning, and a clear vision of what outcome is desired. There also needs to be an understanding of systems that already exist surrounding the issue because it would be inefficient to begin building something that is already established. Once the issue is understood and a vision is produced, there needs to be a large enough group of people who believe in the cause and want to help create a solution for the issue. She said of people who lead these types of bottom up changes, “they often do not realize they are leading something until they have followers.”

Ericka Bruns, MSEd, LPCC-S Ericka is a personal friend and mentor, and I have been lucky enough to see her journey into leadership firsthand. She was an incredible wealth of knowledge for me when I was fresh out of grad school, practicing community social work, thinking I would easily change the world with my newly acquired skills. Her confidence and brilliant skill level led me to often asking her for help and being in awe of all she knew. She eventually became the supervisor to a very small crisis team of which I was a part (3 employees, including her!), and to be completely transparent, I could have been a better subordinate. This was her first taste of leadership; she was no longer my co-worker but now my supervisor. Our dynamics had shifted, and I did not know if I had a new boss or an old friend. I did not know how to communicate through the change, and we both continued to try to learn. Let’s just say we both learned a few things about leadership and followership.

She now supervises 73 staff members over six programs, including coordinators and entry level staff. Over time, she has championed funding for additional staff and resources to address the growing psychiatric need of our community’s children, as well as advocating for herself for appropriate advancement, compensation and well-deserved respect. Ericka created this empire and made the department what it is today by confidently stating what was needed, not backing down at wrinkles in the plan, and following through with fighting the good fight. Not only do these traits make her someone you want with you when you buy a car, they make her someone that you want with you when you are learning and developing skills in your new career, empowering your team, and advocating for the community.

Ericka says she had no plans to become ‘a leader’ when she was completing her schooling, but she was approached for the small team and accepted the position. She believes she was chosen because she was a good therapist, not a good leader. I would argue that her level of knowledge, confidence in her craft and desire to address the needs of the community made her more of a leader than she was aware. She is currently back in school working on her MBA, learning more skills to help her with the business of leading to continue the success of the department.

Completing assessments on leadership style, learning what that style meant and how to build upon it are steps Ericka has taken to grow in her leadership role. What was the most important thing she has learned? How important emotional intelligence and transparency are to leadership. Emotional intelligence, or EQ, embodies self-awareness, empathy, social skills and motivation. She has learned more about her own EQ and has been able to build on her strengths and address her weaknesses. She firmly believes that without EQ one will fail at leadership. Ericka also deeply believes that transparency with staff is important. Staff can tell if they are being kept in the dark, and this will create tension and remove respect from the equation. She acknowledges that you must be humble and take accountability of your team, but each team member also has a level of responsibility.

After interviewing Ericka and being privy to her story from both experience and friendship, she slides easily into the authentic leadership role. She carries herself as genuine, doing right for her team and for the community, trusting that she will educate herself and listen to the needs of her staff, and responding to the needs and values of those around her. She seeks out ways to improve herself, listens to feedback from her team and actively problem solves to create balance and good outcomes. Ericka shows her purpose and value through her dedication to the team and community and has worked with a number of different departments and services to build strong relationships to achieve goals. She has the self-discipline to focus on the end game and weather the storm along the way, none of which can be achieved without compassion for those that she works for and side by side within the field. (Northouse, 2015).

Leaders in Public Health Lois Hall, MS To know Lois Hall, is to love Lois Hall. To be in the midst of Lois Hall, is to LOVE public health. Upon meeting this champion of public health and a radiating woman that encompasses the idea of practicing for the greater good, we quickly see how she is a leader within the public health community. While declaring the hard truths, she follows up with thoughtful solutions backed by research and experience, making one certain that only good will prevail. She encourages the sharing of ideas, inviting them to be shared and developed, as one of them could one day make great advancements in public health.

Lois believes leaders are born with the innate ability to lead, however these skills can be cultivated and built upon over time with being reflective. A natural leader, Lois is able to recognize if another might be better suited or has a different air of passion regarding a certain cause. Lois supervised the AIDS and cancer programs with Ohio Department of Health, followed by becoming the executive director of the Ohio Public Health Association (OPHA), and she is now easing into retirement, advocating for proper grief recovery services for all. When falling into the ED position with OPHA, Lois did not feel qualified but operated by the motto, ‘They won’t care how much you know, until they know how much you care’. Yes, one must have skills and knowledge, but the best leaders have genuine interest and heart, and this is easily conveyed as her truth.

Lois is a delightful mix of ‘trait leadership’ and ‘authentic leadership’ styles. Being around her, it is amazing how naturally she can lead, educate, and move a group into genuine excitement about public health. She possesses a natural awareness of herself, her surroundings and her company, and is open to feedback and discussion to enhance her skills. She will make exclamations of joy when endearing and honest moments are shared, further making those around her buzz with energy (Northouse, 2015). Her sincerity is easily unquestioned when in discussion with her. It is clear that she is not only hearing what is said, but she is listening. She offers advice, references current literature, and makes suggestions on connections for advancing an idea. Lois highlights the characteristic of secure relationships by the strong connection she continues to have with past co-workers, colleagues and students (highlighted by the immediate acceptance to be interviewed for this book). She values sincerity, trust and purpose, all of which become clear within the first minutes of meeting her (Northouse, 2015).

Vince Caraffi, RS, MPH Vince Caraffi is currently a supervisor with the Cuyahoga Board of Health, overseeing the Environmental Health Service Area for the last 16 years. He came into the role after observing a strong leadership team, and through this, he felt prepared to lead by what he had seen in the past. Although not perfect, Vince is aware that acknowledging and apologizing for mistakes can go a long way – we are all human. He experienced this first hand after a moment of heated interaction between himself and a TV reporter, an experience that Vince draws from in his leadership style.

Maintaining a trusting and a respectful relationship through active listening and open communication has been an important base for Vince in his time with the Board of Health. This again aligns with authentic leadership (Northouse, 2015). Vince values those that work for him as people, their ideas and input, and will listen to identify what needs they might have from him and their career. If he is leading others to achieve goals, this leadership style expresses commitment not only to that goal, but to his followers, as well. Sharing failures and successes with those that are looking to advance provides them with additional knowledge so they can avoid unnecessary challenges. He also understands the benefit in talking with staff, listening to their ideas and perspectives and giving others the chance to succeed.

In talking with Vince, he often alludes to listening to those that he works with and building relationships with all levels of staff, giving an air of ‘appreciative inquiry’ to the way he manages his role. Like ‘appreciative inquiry’, Vince believes in creating dialogue that can generate change and advancements, and much of this transformation can take place within the people he is working with and guiding (Rothwell, Stavros & Sullivan, 2016).

Mary Ellen Wewers, PhD, MPH With over 30 years of experience in the field, Mary Ellen Wewers, PhD, MPH is a leader in the area of tobacco cessation research. Dr. Wewers started her career as a nurse working in an intensive care unit and quickly became the head nurse for her unit. During her time as a nurse, she became increasingly interested in primary care and disease prevention, so she decided to return to school to get her Master of Science in Nursing. While getting her MSN, she discovered her interest in research and ultimately decided to continue her studies and earn a PhD in Nursing. After working in the field of public health for several years, she then decided to go back to school one more time and earned a Master of Public Health with a specialization in Health Care Management and Policy.

Dr. Wewers has held many different leadership positions throughout her career, for each of which she felt increasingly prepared. When she was first asked to be the head nurse in the ICU, she said she did not feel prepared and thought there were more experienced people for the position. She ultimately accepted the position, however, because she was encouraged by leadership to apply for the job and decided she was up for the challenge. After going back to school and completing her degrees, Dr. Wewers became an associate professor at The Ohio State University in the College of Nursing. She eventually became the PhD program director in the College of Nursing and the Co-Program Director of Cancer Control at The Ohio State University Comprehensive Cancer Center. Her next career move was into the field of public health as a professor and the Interim Director at the Center of Health Outcomes, Policy, and Evaluation Studies. She later became the Associate Dean for Research, served as the Acting Dean, and served as the Interim Chair of Epidemiology. She pointed out that much of her success at The Ohio State University could be credited to the opportunities for leadership development at the university. She recalls receiving good mentorship from her peers and formal leadership training provided by OSU to all deans and chairs across the university.

Dr. Wewers defines leadership as having both a formal and an informal aspect. She says that the formal definition of leadership is an appointment with a title in which there are job responsibilities, people or an agency to oversee, and goals and objectives that must be met. The informal definition of leadership is when a person within a group steps forward with their opinion, behaves in a way to be viewed as credible, and is genuinely interested in achieving a goal. Her definitions of formal and informal leadership are very similar to the definitions described by Pielstick (2000). He differentiates the two by stating that formal leaders are those who are in positions of power and informal leaders are those who do not hold formal positions but are still recognized as being leaders (Pielstick, 2000).

She describes her leadership style as a combination of many different things but her strengths include listening, being respectful, and keeping people’s faith alive when working toward a goal . She believes that when leading, it is important to get a consensus from your team and have a clear vision of what you want to do moving forward. After clearly defining the vision, she says the leader needs to identify where team members stand in terms of supporting or opposing the vision. For those team members who are on board and those who have neutral opinions on the topic, she helps them move toward achieving the end goal. For those who oppose the vision, she says it is important to hear them out, listen to their concerns, and address those concerns. Ultimately, she says you will never get everyone 100% on board, but the goal is to get the majority.

When it comes to following, Dr. Wewers believes it depends on the boss. Some bosses will welcome the opinions of subordinates and let them weigh in, while others will not be so welcoming, so it is all about learning how your boss leads. She says she is fortunate that she has always had good bosses that are willing to listen to others’ ideas. This willingness to listen has been shown in the literature to help raise one’s self-perception on what he or she does well or poorly and helps a leader notice when there is a discrepancy between their own self-awareness and how others perceive them. This can help leaders adjust their behavior and makes followers more apt to provide feedback (Oc and Bashshur, 2013). Along with learning a boss’s leadership style, Dr. Wewers believes it is important for people to ‘do their homework’ on a topic when they want to make a case to their boss so that they seem credible and their boss is more likely to listen. She says ultimately if you want to make a change within your organization, you need to get your boss on board, and if you show passion for the issue, that will likely happen.

Karen Fields, MS, BSN, RN Karen Fields has been a Sexual Health Clinic Manager for over 10 years for Columbus Public Health, taking over a role that previously had not had a manager stay for more than two years. She credits being able to read her team, make tough decisions, give credit, and encourage laughter and lightness. Karen has taken a leadership course and relates to servant leadership, a role that emphasizes attentiveness to the needs of her followers, empowering them and helping them develop to their full capacity (Northouse, 2015).

While Karen does not necessarily see herself as a follower in any regard (she reports she was always taught to lead), she recognizes that, at times, someone else needs to ‘drive’. She gives the example of geese flying, taking turns leading the group in the direction of their goal. She is part of a team, but the team will not let one member get too worn out before reaching the destination.

Karen also discusses some of her most difficult times as a leader, in dealing with toxic co-workers, both to themselves and to the team, as well as ethical concerns that have led to letting go a beloved team member. From these experiences, she can say that she would have liked to manage the co-worker differently, but has learned more about her own integrity and developed her leadership ability because of experiences such as these.

These kinds of experiences and Karen’s response to them pull from Positive Organizational Scholarship, and have taught her how to look at situations through a new scope and create an atmosphere of resiliency for herself and those working in her department. Keeping laughter and hopeful outlooks have served Karen well on her path to leadership (Bakker, 2013).

Mysheika Roberts, MD, MPH Although new to her current position as the Health Commissioner and Medical Director for Columbus Public Health, leadership is nothing new for Dr. Mysheika Roberts. Prior to her current appointment, Dr. Roberts served as the assistant health commissioner at Columbus Public Health and has held positions at the Center for Disease Control and Prevention and at the Baltimore City Health Department. She is also a participating member of the community, active on boards at Columbus Medical Association Foundation, Young Women’s Christian Association (YWCA) of Columbus, Mid-Ohio Foodbank, Lifeline of Ohio Minority Advisory Group, and OhioHealth’s Faith, Culture, and Community Benefit Committee.

Dr. Roberts views leadership in many different ways. Individually, she says leadership is believing in something , being confident to take a stand, and acting so that your actions reflect what you believe. From a team standpoint, she sees the leader as someone who will give people the tools they need to be successful and then giving them space and flexibility to work on the task at hand. When leading her team, Dr. Roberts leads by example and never asks anyone to do something she would not feel comfortable doing herself. She also likes to be motivational, giving people a vision and challenging them to execute, something she believes allows people’s skills to shine. When co-leading with another individual, Dr. Roberts sees value in a ‘divide and conquer’ approach. She explained that she likes to take a task, divide it up and reconvene at a later time to gauge progress and either finish or decide the next steps for the project. She says sharing the responsibility, meeting in the middle, and being confident in your colleague are important when working with others.

Leadership has been a part of Dr. Roberts’ life since she was in high school. She recalls she was the class vice president during high school and held a similar role during medical school. She says she always had a leadership ‘vibe’, but she never thought that she would have such high roles as the Health Commissioner at CPH. Due to her natural leadership characteristics, she has never taken any formal leadership courses but admits she is drawn to leadership articles. Her awareness of her own strengths and weaknesses as a leader, desire to uphold her moral values, and ability to communicate the importance of change for the health of the community are some of the characteristics of her natural leadership style that would lead me to describe her as an authentic leader (Woolley et al., 2011). Authentic leaders also recognize the importance of developing a relationship between leaders and followers, so it is no surprise that Dr. Roberts has an open channel of communication with her staff. She also values the perspectives of other leaders she has encountered throughout her career and appreciates their perspectives on things, such as making teams thrive. Her mentors, especially the women, she says, have also helped her build the skills required of her to be a great leader.

Early in her career, many of the challenges she faced were related to race, age, and gender. Being a young, African American female, she felt like people did not take her seriously. She says from this she learned that she needed to “always be prepared, make sure her voice was heard, and to be confident but not cocky.” Now, challenges in her career are more centric to her work. She says there is always a lot to be done and high expectations. She also pointed out that as you move up the chain of command, there is more responsibility to ‘take the heat’ for things that do not go well for the organization but the flip side is that there are rewards for when things go well. She says this is something she is learning from her transition from assistant health commissioner to health commissioner.

Leading change is something she recognizes is hard for most people. Much of the challenge is due to feelings. Osland et al (2011) argue that “people change what they do because they are shown a truth that influences their feelings and less because they are given analysis that shifts their thinking.” This is similar to what Dr. Moffatt-Bruce noted about appealing to people’s sensitivities to lead change and what Dr. Applegate emphasized about finding people who are passionate to make ideas for change reality. Dr. Roberts also says rallying the troops or team to understand that change is good is often the first step and then gathering everyone’s ideas should be next. It is also important for everyone to recognize that just because a change is being proposed does not mean something is being done poorly, rather that it can be done better. She says it is also important for everyone to know that they have the ability to lead change no matter their position. For someone at the bottom, they should have a clear vision, communicate it with the chain of command, and show a sense of leadership and willingness to go above and beyond. She says managers see potential ‘self-starters’ and are usually willing to support their passion.

Concluding her thoughts on leadership, Dr. Roberts says, “Leadership is a journey, leaders are always learning and being challenged. No one should ever feel that their challenge or journey is over.” It is evident by her passion for public health that Dr. Roberts journey is nowhere near being over.

Conclusion What makes a great leader within health care and public health encompasses a number of different characteristics, behavior, and traits. The case studies we have described reveal a range of approaches to leadership, from those who seek out their own training and education, to those who learn as they go, learning from successes and failures and making changes along the way. When we look at what we can do as health care and public health leaders, we are reminded that a good leader within the field has the ability to assess team and individual performance capabilities and uses a critical eye when necessary. A leader will be able to address barriers head on, such as limited financial support, other economic limitations, and changing agendas due to changes in political leadership. Leadership is also being encouraged to use horizontal connections rather than leading from the top down to encourage all to work together at local, national and world levels (Popescu, G.H, Predescu, V., 2016).

Many of the leaders that were interviewed, including Ericka, Lois, Vince, and Dr. Roberts, exhibited ‘authentic leadership’ (Northouse, 2015). This is telling, highlighting that this leadership style makes a leader approachable, respected, and open to sharing an experience with others willing to learn. Approaching someone that does not value guidance and relationships may very well receive a different response. This makes us hopeful for the future of our healthcare and public health systems that we can choose leaders that lead out of genuine desire for those they serve, rather than for self-serving reasons.

‘Servant leadership’ was also exhibited by several of the leaders interviewed for this chapter, including Dr. Moffatt-Bruce, Dr. Applegate, and Karen. Servant leaders tend to put their followers first, organization second, and their own interests third. This type of leadership fits well with the nature of work that comes with a public health or healthcare career. These types of careers focus on helping improve the health and well-being of patients and the community, so having a leader willing to serve those people first is important. A combination of authentic and servant leadership theories were seen in almost all of the leaders interviewed, which is evident in their approaches to creating and working toward a vision of a healthier population.

‘Teamwork’ was another common topic of discussion in many of our interviews. The leaders we interviewed highlighted the importance of building teams with the skills and abilities to work together to work toward a common goal. Teams allow for the workload to be divided up among many different people and for many different perspectives and ideas to be added to the project, creating a richer product, as pointed out by Dr. Applegate. The ability to create a successful work team also encourages the team members to perform their jobs better and increases the chances that the team will want to work together on projects again in the future.

The willingness of people to want to work together on projects is important in an ever-changing world of health care and public health. Nearly all of the leaders we interviewed had something to say about the importance of change and how to manage it. ‘Leading change’ is something they recognize is not always easy but requires persistence, communication, and the development of a clear vision. As Dr. Roberts pointed out, making changes does not always mean something is being done wrong, but that it could be done better, a truth we in health care and public health know very well, as we are always working toward a healthier population.

Through the wealth of knowledge that was gained in doing these interviews, we are happy to realize that we have come away knowing that working together, listening to one another, and acknowledging that we cannot manage this world of healthcare and public health alone was an overarching theme. We heard about the importance of ‘listening to others’, ‘encouraging ideas’, and ‘giving credit where credit is due’. The leaders we interviewed are the leaders that can bring positive changes to our healthcare and public health systems. These are the leaders we can and will learn from over time. These are the leaders that want us to learn, and in that revelation alone confirms that we have wonderful leadership here in Central Ohio.

We will leave you with the idea behind ‘Public Health 3.0’, as it is gaining steam and becoming increasingly popular within many professional and leadership circles. This idea is encouraging local leaders to serve as Chief Health Strategists, partnering with multiple sectors across the community. We see this as our leaders are working with grief specialists, multiple specialties in hospitals that provide direct patient care in different modalities, and the community directly. This data will be used to address social, environmental and economic conditions affecting health and equity. Our leaders want this data to invite new ideas and strategies to address the needs of our communities and those that we serve. A new mindset is being promoted to get ahead of public health concerns, becoming preventative instead of reactive (DeSalvo, K.B. et al, 2017). Leadership is beginning to take an upstream approach, acknowledging that we may not have all of the power from the top down, but we can use the abilities we do have and make positive changes given the ever-changing policies of current national leadership. In reviewing what our current leaders are doing now and what they can do for the future of healthcare and public health, it is safe to say we are in good hands to begin our path to Public Health 3.0.

Leadership in Healthcare and Public Health Copyright © 2018 by Colleen Baumer and Angela Finnegan is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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The master’s essay is the culminating project for students in a master’s degree program in PFRH. The goal of the essay is for scholars to apply the skills and knowledge they have acquired during their coursework and fieldwork to a public health issue of interest to them. Students select their topic and identify a faculty essay advisor. Students also choose an essay format, such as a research report, structured literature review, program evaluation, research proposal, or legislation position paper. In addition to the written essay, students present their findings in 10-minute presentations to faculty, staff, and other students in PFRH. Many students publish their master’s essays in peer-reviewed scholarly journals. The master’s essay is completed in the last two terms of enrollment in the master’s degree program.

2024 Master's Essays

Violence Against Transgender Women and Transfeminine People in Hostile Legal Environments: A Scoping Review and Ecological Analysis in Low- and Middle-Income Countries

Navigating Identity and Understanding Barriers: A Comprehensive Examination of Mental Health Challenges and Current Policies Surrounding LGBT Youth in the United States

Contraception and Sexual Activity in Transgender Males: A Scoping Review

Youth-Led Reproductive Health Work at a Global Scale: A Case Study with USAID/Jhpiego Affiliates

Prenatal Melamine, Aromatic Amine, and Psychosocial Stress Exposures and Their Association with Gestational Diabetes in a San Francisco Pregnancy Cohort

Maternal Mediterranean-style diet adherence during pregnancy and metabolomic signature in postpartum plasma: Findings from the Boston Birth Cohort

The Vegan Diet During Pregnancy and the Implications for Fetal Growth and Development: A Scoping Reivew

The Evolution and Analysis of the US Food and Drug Administration’s Regulation of Mifepristone Through a Risk Evaluation and Mitigation Strategy Program

Population-level Estimates of Equitable Gender Norms:

The impact of green space valuation on depression among adolescents in Baltimore, Maryland

Pre- and postnatal maternal psychosocial factors and children’s cardiovascular health: a systematic review

A Scoping Review of Telemedicine-Provided Abortion Care: Evidence on Efficacy, Safety, and Patient Satisfaction

Abortion in Muslim-majority countries: a scoping literature review

Interplay Between Sickle-Cell Disease and Uterine Fibroids

Disparities in Cervical Cancer Prevention for Black women

Gaps in the Family and Medical Leave Act and the Need for Paid Leave Expansion in the United States: A Legislation Position Paper

A Qualitative Exploration of Experiences Related to Receipt of Pre-Abortion Ultrasound in United States Crisis Pregnancy Centers

Addressing economic violence and intimate partner violence among vulnerable young women in Kenya: A qualitative study

Maternal Health Issues in New Jersey: An Analysis of the Changing Landscape

The Association between Young People’s Adversity and Their Sexual & Reproductive Health Based on the Adverse Behaviors and Experiences Survey

The Association between Women’s Perception of Community Support for and Utilization of Maternity Healthcare Services in Ethiopia

Risk Factors Associated with Custody Loss of Opioid-Exposed Newborns during Delivery Hospitalization

School-Based Mental Health Interventions: Recent Advancements and Best Practices

Scoping Review: Violence against Women and Girls Response Interventions in Conflict Settings

Systematic Review and Meta-analysis: Perinatal Oral health and Pregnancy Complications in the United States (2003 - 2023)

Breastfeeding Practices and Guidelines in High-Risk Pregnancies: A Scoping Review

Post-Dobbs Reproductive Landscape: Addressing Maternal Morbidity & Mortality Alongside

Exploring Challenges and Opportunities to Enhancing Support and Care in Abortion Services: Evaluating Training Gaps, Counseling Disparities, and Referral Systems Within Healthcare Assistance Programs

Quality of family planning care among women wishing to delay or space pregnancies in Rajasthan, India

Evaluating the Implementation of a Personal-Agency-Based Youth Sexual and Reproductive Health and Rights Curriculum and Its Effect on Personal-Agency Outcomes Among Out-of-School Young People (Ages 10-25) in Masindi, Uganda: A Proposal

Paternal involvement and its influence on the social, cognitive, and emotional development of children from birth to pre-k: A Systematic Review

Reforming Labor Laws to Reduce Stunting in Ecuador

Mobilizing Healthcare: A Narrative Review and Conceptual Framework For Mobile Health Clinic Advocacy

The Integration of Men into Ante-Natal Care (ANC) in Sub-Sharan Africa: A Case Study of Nigerian Context

Lived definitions of Intersectional Stigma, Discrimination, and Violence: Findings from cognitive interviews with gay men and other men who have sex with men, and transgender women

Shifting Paradigms: Examining Gender Roles Among Nairobi Youth

Better for All the World: Understanding the Present and Historical Reproductive Subjugation of Disabled Americans Through Forced Sterilization and Imagining a Better Reproductive Future for All

Nurturing Roots: A Process Evaluation of “Show Me Strong Kids,” a Grassroots Child Health Initiative that Relies on Local Collaboration

Sudden Infant Death Syndrome and Maternal Drug Use: A scoping review

2023 Master's Essays

Feasibility pilot of Ecological Momentary Assessment (EMA) to understand micro-environments on college campuses

Child Marriage, Displacement, and the Perceived Impact of Family Planning on Marriage Dynamics among Adolescent Women in Yemen

Health Professional PAC Campaign Contributions to Members of Congress – Voting Patterns on Abortion and Contraceptive Bills

Conflict and Consent: Factors Associated with Marriage Decision-Making for Adolescent Girls in Yemen's Humanitarian Crisis

Scoping Review of Implementation of Technological Interventions Addressing Gender-based Violence: Learning from the Dissemination/Implementation of a Web-Based Safety Planning Tool in Nairobi

An Assessment of the Influence of Comprehensive Sex Education Programs on Public School Students in the United States

A scoping review on the measurement of contraceptive preferences

Y2CONNECT.org Baltimore- A Mobile Friendly Youth-Focused Solution to Connect Adolescents to Local Cross-Sector Resources

Understanding and Addressing Postpartum Depression in the United States

Racial and Ethnic Disparities in Postpartum Morbidity

Maternal Stress And In-Utero Autoimmune Disease Programming: Implications for Racial Health Inequities

The Multi-level Predictors of Adherence to Nutritional Supplementation During Pregnancy in Low- and Middle-Income Countries

Factors and Barriers Informing Male Engagement in Fertility and Family Planning Decisions in Sub-Saharan Africa: A Systematic Literature Review

Exploring the Experiences of FGM/C Affected Migrant Women in Western Nations: A Scoping Review of Accessing Sexual and Reproductive Health Services

Empathy Training As A Means For Provider Behavior Change In Private Family Planning Clinics In Burkina Faso: A Qualitative Analysis Of The Provider’s Perspective

The Bridge: Promoting Clinical research participation among Black pregnant and postpartum birthing people

Where there are no Data: A Case Study on Adolescent Pregnancy Prevention in Nicaragua

Quality of Contraceptive Counseling and Person-Centered Care: A Cross-sectional Study Among a National Sample of Women in Ethiopia

Does current contraceptive choice affect what other methods women are told about? A secondary analysis of counseling comprehensiveness in Ethiopia

Addressing the Role Slavery and Racial Stereotypes Play in the Low Occurrence of Initiation and Continuation of Breastfeeding Among Black Mothers

Bumps in the Road: Assessing Facility Preparedness to Address Intimate Partner Violence During Pregnancy in Ethiopia

Identifying Community Strategies to Promote Breastfeeding Practices among American Indian and Alaska Natives: A Systematic Review of US and Canadian studies

Scoping Review: Child Marriage and Childbearing among Adolescent Girls under Humanitarian Setting of LMIC

Use of Misoprostol to Prevent Postpartum Hemorrhage in Low-Resource Settings

Can expansion of nurse-midwifery care improve birth outcomes of marginalized populations in the United States: A Systematic Review

Exploring the prospective relationship between psychosocial beliefs in adolescence and later parenting in Baltimore City

Fetal and Infant Mortality Review Quality of Care Checklist: A Pilot Project in Baltimore City

Police Violence and Youth Traumatic Stress: A Systematic Review

Do covert contraceptive users engage with the health system differently? Understanding women’s care experiences in Kenya

A Scoping Review about the Effect of Abortion Access on Women’s Wages and Employment

Impact of testosterone therapy with and without oophorectomy among transmasculine and gender diverse individuals: A scoping review

A Systematic Review of Acceptability of STI Self-Sampling and Self-Testing in Young Adults in the United States

Missed Opportunities in STI Screening of Pregnant Women: A study of the literature and practice patterns concerning STI and perinatal infections

Determinants of Young Women’s Contraceptive Knowledge and Services in Nigeria Tanesha Mondestin Haitian Women's Birth Equity: A Case Study of the Maternal Health Crisis for Black Migrants in the United States

Barriers to Proper Nutrition on College Campuses and its Contribution to Malnutrition among Undergraduate Students

Process and Outcomes of the HIV Hard-To-Reach Study in Uganda

Vaginal microbiomes and risk of preterm Birth in HIV positive women: A scoping review

Evaluation of the Quality of Online Asynchronous Humanitarian Health Education

Lessons Learned Around Pediatric Home Equipment Decisions: From Social Context to Technological Platforms

2022 Master's Essays

Variation and Correlates of Psychosocial Wellbeing Among Women with Preeclampsia in the nuMoM2b Cohort

Picture This: Identifying Barriers in the Home Environment Among Families of Children with Medical Complexity

Summarizing the Evidence for Screening and Prevention of Postpartum Depression in Rural Women in High Income Countries

Illinois Crisis Pregnancy Centers: A Public Health Case Study on State-Sponsored Reproductive Coercion

Future directions for sexual and reproductive health: A scoping review of evidence on utility and use of online-to-offline interventions in low- and middle-income countries

Literature Review on Barriers Associated with WIC Participation and How COVID-19 Related Changes Impacted the Program

Preterm birth and the vaginal microbiome: a literature review

Assessing pre-exposure prophylaxis (PrEP) awareness and its association with PrEP uptake within nine sub-Saharan African countries using Google Health Trends and PEPFAR data

Assessment of Data Systems Utilized by USAID’s Key Populations Program in South Africa: An Evaluation of Barriers and Facilitators Guided by the Consolidated Framework for Implementation Research

Improving Family Economic Well-being through Home Visiting: The Moderating Effects of Maternal Motivation on Program Impacts

Maternal and Child Health Promotion in Ceará, Brazil: A Field Observation Using the Health-Promoting Family Conceptual Framework

Social Environments of Sexual Violence on College Campuses in the United States: Rethinking the Value of Bystanders

Prioritizing Warning Signs Education in Home Visiting Programs: A Qualitative Evaluation of the EMPOWER Moms Pilot

Utilization of Critical Race Theory in Public Health Research

Patterns of contraceptive use and unmet need in late reproductive age in Southeast Asia

Evaluating the Reproductive Autonomy Scale in Egypt: A Qualitative Approach

Barriers to contraceptive use among adolescent girls in Sub-Saharan Africa and insights on how to address the barriers

Machine Learning & Predictive Analytics for Children’s Public Health and Social Services Using Administrative Data

Women’s Empowerment as a Pathway to Improving Maternal Health in sub-Saharan Africa

Communication Strategies for the Title V Maternal & Child Health Block Grant: A Case Study

Substance Use and Breastfeeding: A systematic review on cannabis, buprenorphine, and methadone use during breastfeeding

Perceived Barriers to Post-Partum Weight Loss: A Scoping Review and Lived Experiences of Participants in the Healthy for Two/Healthy for You Study

The Impact of Bodily Autonomy Violations on HIV Partner Disclosure: Results from the PLHIV Stigma Index 2.0 in Ukraine

The Steel Frame of India: Training the Indian Administrative Service Officers to Strengthen the Public Health System

Characterizing the Hereditary Risk for Aggressive Prostate Cancer

Assessing Teachers’ Experiences in Implementing Trauma-Informed Approaches in School-Based Sex Education in Baltimore City: A Qualitative Analysis

A Qualitative Analysis of Health Teachers’ Experiences with, and Perceptions of, Condom Programming in Schools

A Qualitative Exploration of Reproductive Coercion Experiences in Geo-culturally Diverse sub-Saharan African Settings

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Africa Leadership on a New Global Public Health Convention

In Eswatini , Eswatini , Ethiopia , Global Advocacy , Global Featured , Kenya , Lesotho , Malawi , Mozambique , Nigeria , Rwanda , Sierra Leone , South Africa , Uganda , Zambia , Zimbabwe by Fiona Ip December 7, 2021

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Incentives and Habit Formation in Health Screenings: Evidence from the Illinois Workplace Wellness Study

We study habit formation in annual biometric health screenings using a field experiment that randomly assigned financial incentives to 4,799 employees over three years. Completing the first screening raised subsequent screenings by 32.4-36.0 percentage points (84%-90%) annually. Habit formation was similar whether employees were offered screenings as part of a comprehensive wellness program or just screenings alone, suggesting such habits can develop without frequent interactions. We rule out inattention as an explanation, using a subsample assigned more salient incentives. The long-run effect stems from the initial decision to participate, indicating a habit formation process with a one-shot mechanism.

This research was supported by the National Institute on Aging of the National Institutes of Health under award number R01AG050701; the National Science Foundation under Grant No. 1730546; the Abdul Latif Jameel Poverty Action Lab (J-PAL) North America U.S. Health Care Delivery Initiative; Evidence for Action (E4A), a program of the Robert Wood Johnson Foundation; and the W.E. Upjohn Institute for Employment Research. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

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Health systems response to climate change adaptation: a scoping review of global evidence

Edward Wilson Ansah 1 ,
Mustapha Amoadu 1 ,
Paul Obeng 1 &
Jacob Owusu Sarfo 1

BMC Public Health volume 24 , Article number: 2015 ( 2024 ) Cite this article

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The health system plays a critical role in safeguarding the well-being of communities in the face of health risks associated with climate change. This review maps evidence on health systems' adaptation to climate risk and barriers to effective adaptation.

This review followed the recommendations by Arksey and O’Malley for conducting scoping review. Search for records was conducted in PubMed, Central, Web of Science, JSTOR, Google, and Google Scholar. Only peer-reviewed papers published in English language were included in this review. All the 63 included studies were critically appraise d.

We found that efforts are being made to create resilient health systems by incorporating climate change into health policies. Investments are being made in innovative technologies, climate-resilient health infrastructure, enhancing healthcare delivery, developing the capacity of climate specialists and agencies to provide high-quality evidence for resilient health systems. We also found that several obstacles prevent health system adaptation to climate risk, including poor policy implementation and evaluation. The obstacles are further exacerbated by financial constraints, including poverty, a lack of political commitment, inadequate data, and deficient healthcare systems, especially in developing countries. There is also a lack of integration of climate change into mental health actions and the health and safety of healthcare workers.

Efforts to develop resilient health systems against climate risks are underway, but persistent obstacles, including inadequate policy implementation, resource limitations, and a lack of integration of climate change into critical health domains, hinder comprehensive adaptation measures, particularly in developing nations.

Peer Review reports

Introduction

Climate change is one of the most critical global defining phenomena of the 21 st century [ 1 , 2 ]. According to World Health Organisation (WHO) climate change is the greatest threat to global health of our century [ 3 ]. Thus, anthropogenic climate change poses significant threats to various aspects of human life, including health, food security, sanitation, livelihoods, essential service delivery such as health service delivery, which impacts biodiversity loss and environmental degradation which also impacts human health through different pathways [ 3 ]. It is important to note that climate change is not just an environmental crisis, it is also a health crisis that demands global actions, effective partnerships and innovative solutions [ 4 ]. The health crisis from climate change has become increasingly evident in recent decades [ 2 , 5 ]. Increased heat-related illnesses, altered disease patterns, compromised food and water security, and mental distress are some effects of the changing climate [ 4 , 6 , 7 ]. Higher risk populations, including the older population, pregnant women, migrants, newborns, children, those living in low-income communities, indigenous people and people experiencing homelessness, are disproportionately affected by the climate crisis [ 4 ].

There is an urgent need to protect these at-risk population via public health adaptation to climate change, and the health system plays a key role [ 8 ]. Thus, effective mitigation and adaptation strategies are needed. Climate change mitigation refers to efforts aimed at reducing or preventing the emission of greenhouse gases into the atmosphere or enhancing their removal from it. This includes actions such as transitioning to renewable energy sources, improving energy efficiency, and implementing policies to reduce deforestation [ 1 , 2 , 3 ]. On the other hand, climate change adaptation involves actions taken to minimise the negative impacts of climate change and to build resilience to its effects. This can include measures such as constructing flood defenses, developing drought-resistant crops, and implementing early warning systems for extreme weather events [ 1 , 2 , 3 ].

The health system plays a crucial role in safeguarding the well-being and resilience of communities in the face of health risks associated with climate change [ 9 ]. Health system comprises a wide range of health institutions, policies, and resources that collectively deliver healthcare services [ 10 ]. It includes not only healthcare providers and facilities, but also extends to environmental and sanitation services, health promotion and education initiatives, public health function and services, community health, healthcare supply chains, long-term care, health financing mechanisms, and other supporting elements. Additionally, the health system involves various stakeholders such as governments, regulatory bodies, non-governmental organisations (NGOs), community health workers, and healthcare professionals, all playing critical roles in ensuring effective healthcare delivery and improving population health outcomes. By addressing the broader determinants of health and incorporating a holistic approach, a comprehensive health system strives to provide not just accessible, equitable, and quality care to individuals and communities, but quality preventative and public health services [ 11 ].

The health system, positioned at the forefront of safeguarding and promoting public health, is an indispensable component of broader climate action strategies [ 11 ]. The health system plays a critical role in all climate actions due to its interconnectedness with various climate-related issues such as public health risks, disease prevention, emergency response, and healthcare delivery to at-risk populations [ 3 ]. Hence, building a resilient health system globally may play a pivotal role in safeguarding and promoting public health. The WHO [ 3 ] Health System Resilience Framework defines health system resilience as "the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and, informed by lessons learned during the crisis, reorganise if conditions require it” [ 3 ]. The WHO Health System Resilience Framework [ 3 ] and the new Operational Framework for Climate Resilient and Low Carbon Health Systems [ 2 ] encompasses several key components vital to understanding and fortifying health system resilience to the climate crisis. These components typically include sustainable financing, governance and leadership, health workforce and service delivery, health information systems, medical products and technologies, community engagement and reduction in carbon emission. Understanding these elements is crucial for evaluating a health system's resilience, inducing the ability to adapt and respond effectively to various challenges, including those posed by climate change.

Resilient health systems can absorb and adapt to the challenges posed by climate change while ensuring the provision of essential health services, protecting high risk or vulnerable populations, and promoting sustainable well-being [ 2 , 3 ]. By examining how health systems respond to the challenges posed by climate change, this review aligns with the WHO framework's emphasis on a system's capacity to prepare for, respond to, and recover from climate crises [ 3 ]. Highlighting the impacts of climate change on public health, such as heat-related illnesses, altered disease patterns, and compromised food security, underscores the urgent need for health systems to enhance their resilience [ 3 ]. Understanding how health systems worldwide adapt to these challenges becomes pivotal in formulating evidence-based strategies that align with the core principles of health system resilience outlined in the new operational framework by WHO [ 2 ]. With this new WHO operational framework, we have a dual responsibility to build health systems that can withstand climate-related shocks, while at the same time reducing their carbon footprint [ 2 ].

Mapping climate adaptation strategies by health systems globally may be an essential effort in providing evidence important to inform evidence-based decision-making, identify best practices, and address the gaps and challenges in current responses to climate change. Hence, this scoping review seeks to identify health system response, and barriers or challenges of the current responses to climate change within health systems. This review aims to contribute to the development of robust and context-specific policies that enhance building climate resilient health systems and the communities they serve. In developing countries where health system adaptation faces significant challenges, this review seeks to provide valuable insights for developing efficient, and cost-effective solutions. Thus, solutions that align with the WHO's resilience framework, ensuring the continuity of essential health services amidst climate-related crisis.

This scoping review followed the guidelines of Arksey and O'Malley [ 12 ]. The guidelines include identifying research questions or objectives, searching for relevant studies, selecting studies, extracting data, summary of data and synthesis of results, and consultation. This review adheres to PRISMA-ScR guidelines of conducting and reporting scoping reviews. Arksey and O'Malley's framework provides a systematic process for scoping reviews, ensuring comprehensive coverage of research areas and structured methodology. Moreover. PRISMA-ScR guidelines offer standardised reporting criteria, enhancing transparency and replicability of scoping review findings. Two research questions guided this review: (1) what are the health system adaptation strategies to climate change? and (2) what are the barriers to health system responses to effective adaptation to climate change? The search for relevant studies was conducted in four databases (PubMed, Central, Web of Science, and JSTOR). The search was initially conducted in PubMed with Medical Subject Headings (MeSH) terms (see Table 1 ). These MeSH terms were then modified to suit the search in other databases (Central, Web of Science and JSTOR). An additional search was conducted in Intergovernmental Panel on Climate Change (IPCC) library, WHO library, Google, and Google Scholar. The last search in all databases was conducted June 30, 2023.

Relevant records were then transferred to the Mendeley software to remove duplicate papers. Titles and abstracts of papers were screened for relevance. This was done by 20 trained graduate students and supervised by the authors. The 20 trained graduate assistants were put into two groups, each made up of 10. These two groups screened the titles and abstracts independently using the eligibility criteria. The students were supervised by M.A and JOS. Weekly meetings were used to resolve inconsistencies and disagreements by the help of EWA. Reference lists of full-text records were further checked for other relevant papers. Full-text papers were then screened based on the eligibility criteria, presented in Table 2 . Full-text records were screen independently by MA and PO and reviewed by JOS and EWA. Data were extracted independently by MA and PO and reviewed by JOS and EWA. This was done to ensure that extracted papers were reliable and accurate. Moreover, authors (JOS and EWA) resolved inconsistencies between extractors during regular meetings. Furthermore, an independent researcher, review and subject expert reviewed the extracted data for accuracy. We extracted the data based on authors, year of publication, the purpose of study, study design, health system response to climate change, barriers to adaptation and critically appraised the studies.

Briggs’s Critical Appraisal Tools, developed and updated by Joanna Briggs Institute in 2020 were used to appraise reviewed studies. These tools were very recently employed in a similar study [ 13 ]. The aim was to appraise all selected and reviewed studies. This tool comprises checklists for evaluating the quality of qualitative studies, cross-sectional studies, mixed-method designs and reviews. Mixed Method Appraisal Tool (MMAT) version 2018 was used to appraise all included mixed-method studies [ 14 ]. Appraisals were conducted by MA, PO and JOS, supervised by EWA. Extracted data was analysed using thematic content analysis, summarised and qualitatively synthesised as recommended Arksey and O’Malley [ 12 ]. The main purpose was to map existing evidence and hence qualitative synthesis was appropriate. This scoping review was registered with Open Science Framework [ https://doi.org/10.17605/osf.io/kt7bq ].

Search results

Search conducted in PubMed, PubMed Central, Web of Science and JSTOR produced 24,663 records. Additional 41 records were retrieved from other databases. These records were saved in the Mendeley software, and 4866 duplicate records were removed. Titles and abstracts of remaining records were screened for eligible full-text papers. This resulted in the removal of 19,719 records that were considered not eligible. There were 119 remaining eligible full-text papers for further screening. Reference lists of these records were further checked for additional records and 6 full-text papers were identified. Through consultation with the digital library department at Sam Jonah Library, additional 3 full-text records were retrieved. Hence, 128 full-text papers were assessed. Finally, 63 full-text papers were included in this review. Details of search records and screening process are presented in Fig. 1 .

PRISMA flow diagram of search results and screening process

Characteristics of reviewed studies

Most (46) of the reviewed studies were conducted on policy documents and studies that explored health systems' response to climate change in various countries and regions. The reviewed studies included 46 reviews, eight mix-method design studies, seven qualitative design studies and two cross-sectional design studies. Furthermore, we retrieved studies conducted in 85 countries globally, with the United States of America recording the highest number of studies (9). Figure 2 shows the countries and continents where these studies were conducted. The characteristics of the studies reviewed are presented in Supplementary File (Table S1).

Countries where reviewed studies were conducted

Findings are presented in themes based on the research questions.

Health system response to climate change

Forty-six (46) included studies with varied designs (cross-sectional surveys, qualitative, mixed-method and document review) presented findings on health system response to climate change. Through thematic content analysis, health system responses to climate change were grouped into 15 themes. Frequency counts were assigned to each theme based on the specific adaptation actions and the number of studies that explored such actions. For instance, there are 23 specific climate adaptation actions under the theme “climate change policy and planning”. Studies that explored each action are then added to give counts to the theme. For example, a study that explored five specific actions under a theme were counted as five. Figure 3 presents the themes generated from the reviewed studies and the assigned counts. Table 3 presents the themes and specific climate actions by health systems highlighted in reviewed studies.

Weights assigned to themes generated from the included studies

Health policy and planning

There are efforts being made especially in developed countries and some developing countries such as Vietnam [ 23 ], and some countries in SSA such as Ghana, Nigeria, Ethiopia, Namibia, Kenya and South Africa [ 45 ] to refine and establish regulatory frameworks for climate change actions in health policy [ 8 , 22 , 23 , 24 , 45 , 46 ]. Furthermore, efforts are been made to mainstream climate considerations into all healthcare policies [ 25 ] and planning [ 9 , 15 , 16 , 48 , 55 , 56 , 59 ] at national and local levels. The importance of integrating hospitals into urban planning [ 16 , 17 ] and incorporating climate change education into school curricula and graduate studies [ 16 , 25 , 26 , 45 ] have also been highlighted. Studies have also emphasised the importance of climate change mitigating measures taken by the health systems, including reducing greenhouse gas (GHG) emissions from anaesthetic gas usage, promoting energy conservation in health facilities [ 30 ] and developing policies to improve transportation systems [ 60 ]. Moreover, evidence suggest that health systems are implementing essential policies aimed at heat risk adaptation [ 27 ], undertaking sea defence projects to protect coastal population and health infrastructures situated along the coastal areas [ 28 , 29 ], and developing national electronic databases for climate change actions [ 9 , 31 , 46 , 55 ] and ensuring universal healthcare access [ 18 , 49 ] in responses to climate crisis. Policies aimed at facilitating effective climate change mitigation and adaptation within health systems rely on several key elements, including long-term planning [ 22 , 66 ], collaborative efforts with non-health sectors [ 9 , 10 , 27 , 28 , 33 , 35 , 38 , 39 , 43 , 47 , 51 , 52 , 55 , 58 , 60 , 61 , 65 , 69 ], sufficient funding and resources [ 18 , 26 , 33 , 46 ], regular policy evaluation [ 6 , 15 , 22 , 28 , 49 , 50 , 69 ] and enforcement of policy regulations [ 9 , 28 , 34 ].

Health promotion

Health systems are making a strong case for investment in health promotion [ 48 ], by creating health promoting communities that fosters knowledge sharing on climate change and support health systems in several ways, including empowering local response and support at-risk populations [ 9 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Health systems are focused on educating communities [ 8 , 15 , 17 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] and health professionals [ 27 , 29 , 45 , 46 , 47 ] on the impact of climate change on human health and health systems. Promoting climate-informed health programmes [ 6 , 18 ], facilitating communities' access to health programmes [ 18 , 26 , 29 , 46 ] and communicating co-benefits and actions to protect the health of individuals and communities [ 10 , 18 , 49 ] are among important health promotion interventions adopted by health systems. Co-benefits encompasses additional health benefits derived from implementing climate-informed health programmes [ 18 , 49 ].

Risk assessment, disaster preparedness and response

Health system response through risk assessment, emergency planning and preparedness were reported in the literature [ 9 , 19 , 21 , 29 , 31 , 36 , 40 , 41 , 50 , 51 , 52 , 53 ]. For instance, vulnerability assessments for health systems [ 18 , 28 , 33 , 48 , 50 , 53 , 54 , 55 ], assessment of health impact [ 15 , 54 ] and the use of an integrated assessment model [ 54 ] are adaptation strategies by health systems reported in included studies. Moreover, emergency risk communication, especially for high risk population and communities [ 9 , 29 , 50 , 53 , 55 ], including health messaging during extreme events [ 9 ] and rapid disease-specific emergency response are also essential health system adaptation strategies [ 29 ]. However, disaster response actions are more useful when they are well coordinated [ 38 ], planned based on reliable information [ 48 ] and adequately financed [ 9 , 56 ].

Surveillance and monitoring of climate-sensitive diseases

Routine epidemiologic surveillance [ 9 , 15 , 18 , 19 , 20 , 22 , 24 , 25 , 28 , 29 , 34 , 36 , 37 , 39 , 41 , 52 , 55 , 57 ], which enhances existing surveillance programmes to include climate-sensitive diseases [ 18 , 32 , 45 , 56 , 58 ], and the implementation of early warning systems [ 6 , 8 , 9 , 10 , 13 , 16 , 17 , 18 , 21 , 22 , 26 , 29 , 31 , 32 , 33 , 36 , 38 , 40 , 41 , 45 , 59 , 60 , 61 ] including innovative technologies like remote sensing [ 54 ] have been identified as valuable approaches. Many developed nations also emphasise disease-centric approaches, technological advancements, and are integrating climate change events into public health policies and planning [ 19 , 20 , 39 ]. Evidence emphasises particular disease and vector programmes [ 58 , 62 , 63 ], such as vaccination [ 25 , 28 , 36 , 40 ], mosquito control [ 9 , 55 ], and screening of pathogens at border or entry points [ 8 ], as effective actions within health systems which address climate change vulnerability. Immunisation programmes for at-risk communities and children, especially under-5 children, have been reported [ 64 ]. The importance of targeting at-risk communities and high risk populations through initiatives such as enhanced testing and diagnosis of climate-sensitive diseases [ 44 ], the utilisation of mobile devices for surveillance purposes [ 30 ], and the implementation of robust diagnostic methods for food and waterborne diseases [ 27 , 40 ] have also been reported.

Furthermore, both developed and developing countries recognise the urgency of surveillance, research, and monitoring efforts in tackling climate-related health challenges. Developed nations are leveraging on advanced technology and resources for these purposes [ 39 , 68 ], the developing countries are emphasisng capacity building and resource optimisation for effective surveillance and monitoring [ 25 , 33 , 64 ]. While these approaches differ based on resources and priorities, the common goal remains the adaptation and resilience of healthcare systems to address the impacts of climate change on public health.

Health service delivery and mental health

Improving health service capacity to deliver quality care [ 18 , 33 , 34 , 44 , 49 ], strengthening healthcare delivery in climate hotspots [ 8 , 53 ] and preparing health services for emergencies [ 27 , 64 , 66 ] are effective ways to respond to the changing climate. Facilitating healthcare access [ 22 , 49 , 58 , 64 ],including outreach that target at risk populations [ 19 , 39 , 44 , 58 , 63 ], telemedicine [ 30 ], and strategic allocation of health resources [ 66 ] are some essential climate change adaptation actions. Providing culturally appropriate [ 34 , 41 , 49 , 64 ], community-oriented [ 34 , 47 ] and patient-centred care [ 17 , 34 , 49 ] are effective means the health system deals with climate crisis. Also, developing community-based models for the management of children with acute malnutrition [ 52 ], improvement in the management of climate-sensitive diseases [ 23 ] and early treatment of infections [ 58 ] have been reported by included studies. In addition, providing resources and information for mental health adaptation [ 65 ], including monitoring of psychosocial resources and skills [ 44 , 65 ] and creating awareness about the impact of climate on mental health, especially in high risk communities and healthcare workers [ 67 ] are essential to reduce the effects of changing climate on health systems.

Health infrastructure and supply chains

Across developed countries like the UK, USA, Australia, Poland, Canada, Germany, Japan, etc. notable similarities in health system responses to climate change emerged. These nations prioritise sophisticated infrastructure development and improvements, such as implementing early warning systems [ 15 , 17 , 21 , 24 , 27 , 29 , 55 , 60 , 70 ], developing comprehensive healthcare facility plans [ 68 ], and integrating the climate crisis into various healthcare programmes [ 17 , 24 ]. Conversely, in developing nations like India, countries in SSA, and Southeast Asian, including Indonesia and Vietnam, the focus revolves around community-oriented approaches [ 19 , 23 ]. These countries prioritize public education, access to clean water, sanitation, and collaboration across sectors [ 25 , 33 , 45 , 57 , 58 ]. Their adaptation strategies often revolve around building resilience in public health infrastructure, addressing poverty, and enhancing traditional healthcare systems [ 25 , 33 , 51 , 58 , 64 ]. Additionally, they highlight the importance of localised solutions and training healthcare workers to adapt to climate change impacts.

Health system response to climate change includes improving health infrastructure and facilities such as upgrading emergency response units, ensuring the resilience of medical equipment to extreme weather conditions, and establishing backup power sources for uninterrupted healthcare delivery during climate-related events [ 8 , 10 , 14 , 45 , 26 , 28 , 29 , 60 , 18 , 67 , 61 , 21 , 38 , 43 , 53 , 54 ]. Others include modernisation of laboratories for early diagnosis [ 9 , 20 ], building social infrastructures such as community health centers, support groups for at-risk populations, mental health hotlines, neighborhood networks that promote health education, and community-based organisations that support care systems [ 21 ] and supporting off-the-grid solutions for hospitals [ 31 , 33 , 47 ]. Ensuring thermal comfort [ 17 ] through improved ventilation [ 10 , 17 , 20 , 30 ] is vital in healthcare facilities in rising temperatures. Health systems are prioritising improvement in health supply chains [ 29 ] that are less pollutant through rapid assessment to identify needed supplies [ 19 ] and stockpile medical supplies and pharmaceuticals [ 20 , 27 ].

Social support systems and equity

Developing poverty alleviation programmes [ 18 , 41 ], provision of alternative employment opportunities [ 8 ] and improving housing systems for lower-income families [ 25 , 29 , 41 ] are relevant social interventions that aid health system adaptations. Moreover, evacuation of high risk populations [ 19 ], including timely relocation of displaced people and migrants [ 29 , 57 ] and provision of temporary shelter for displaced people [ 19 ] are actions needed for the protection of vulnerable people for improved health outcomes. Extreme weather events necessitate neighbourhood support schemes [ 36 , 39 ], improved social networks [ 10 ] as well as relief programmes for the population at risk of climate change events [ 10 , 38 ], including people living in hard-to-reach areas. Efforts are being made to preserve social structures for populations facing forced migration [ 29 ], to enhance legal and effective migration [ 8 , 32 ], facilitate organised relocation [ 8 ] and provide migrants with adequate nutrition and access to healthcare [ 8 ]. Health system adaptation to climate change may help reduce issues of inequity and ensures equitable access to healthcare [ 44 ] through equitable distribution of health resources [ 8 ].

Research, training and development

Health system adaptation to climate crisis includes improving scientific research [ 22 , 23 , 25 , 33 , 34 , 48 ], provision of funding for quality research [ 16 , 20 ] and vaccines [ 40 ] and the translation of research into practice [ 18 , 69 ] for quality health services. Besides, policy-oriented research is essential in supporting effective health system adaptation to climate change [ 64 ]. Nations are training and building the capacity of their health workforce on climate change and its impact on health [ 6 , 8 , 9 , 18 , 20 , 22 , 23 , 28 , 33 , 36 , 45 , 47 , 50 , 55 , 57 ], preparing frontline health workers to manage heat stress [ 44 ] and strengthening network and capacity of experts and institutions [ 18 , 27 , 28 , 53 , 68 ].

Sanitation, water and food

Efforts are being directed towards improving sanitation through improving waste management [ 9 , 25 , 30 ] and hygiene infrastructure [ 10 , 28 , 52 , 56 , 61 , 63 ], as well as promoting community clean-up campaigns [ 9 ]. Increasing access to clean food and water [ 41 , 56 ] through maintaining and improving water systems and sources [ 9 , 24 , 28 , 30 , 52 , 61 , 63 ]. Others are investing in clean water technologies [ 25 ] and enforcing proper food handling regulations systems [ 9 , 24 ].

One health refers to an interdisciplinary approach that recognises the interconnectedness of human health, animal health, and the environment [ 8 ]. Thus, one health emphasises the interdependencies between the health of humans, animals, and ecosystems and recognises that their well-being is closely intertwined. The importance of health system adaptation to climate change through one health has been emphasised [ 8 , 66 ]. One Health emphasises the interconnectedness of human, animal, and environmental health, advocating for collaborative approaches to address the impacts of climate change on health systems [ 66 ].

Occupational health and safety (OHS)

The importance of incorporating climate change effects into OHS assessment [ 31 ] and increased research on OHS implications of climate change [ 27 ] are paramount to health system adaptation to climate change. Ensuring safety and well-being of healthcare workers involve implementing measures that protect workers from heat stress [ 20 , 31 , 60 ], optimising workplace ergonomics [ 17 ], enhancing staffing levels [ 17 ] increasing staff insurance policies [ 31 ], and adopting work processes that are adapted to the challenges posed by climate change [ 17 ].

Our findings encompass a broader spectrum of strategies implemented by health systems in response to climate change. While the WHO framework primarily focuses on specific categories like governance, leadership, health workforce, service delivery, information systems, essential medicines, financing, and research, our research delves deeper into additional areas such as social support systems, One Health strategies, and OHS. These expansions transcend the defined categories of the WHO framework, showcasing a more comprehensive understanding and implementation of health system responses to climate change across various interconnected domains.

Barriers to health system response to climate change

Twenty-nine included studies reported on barriers to effective adaptation to climate change by health systems. The thematic analysis of the included studies yielded nine distinct themes on the barriers to health system adaptation to climate crisis. These themes include inadequate climate policies and disaster preparedness, resources constraints, poor policy implementation and evaluation, low-risk perception, lack of expertise and evidence, inequity and problems in healthcare delivery. These themes are presented in Table 4 and Fig. 4 .

Barriers to health system adaptation to climate change

Inadequate climate policies and disaster preparedness

Lack of a supportive policy environment [ 19 ], inadequate prioritisation of climate change adaptation actions [ 71 ], and limited integration of climate and health issues into planning [ 22 ] were policy issues that make health system adaptation to the changing climate difficult. Furthermore, there were limited plans and programmes to address health risks associated with climate change [ 59 ], and existing adaptation initiatives often did not target these risks [ 59 , 72 ]. For instance, a lack of adaptation policies for mental health [ 59 ] was reported. Evidence indicates that uncertainty surrounding climate projections and the best adaptation options [ 9 , 48 , 54 ], along with fragmented policies and contradictions [ 72 , 73 ], present further challenges to health system adaptation. Moreover, the indication is that unclear long-term planning [ 64 ], and national adaptation plans do not prioritise health [ 72 ]. Few adaptation policies were found concerning OHS [ 62 ], but climate change was not integrated into the mainstream curricula of medical schools [ 62 ], indicating a narrow framework of climate policies [ 26 ] that may affect climate action implementation and evaluation. Furthermore, lack of preparedness for the burden of climate migration [ 64 ] and insufficient surveillance and assessment of vulnerabilities associated with climate change impacts [ 59 ] are challenging health system attempt to adapt effectively to the climate crisis.

Resources constraints

Insufficient financial resources [ 9 , 26 , 35 , 48 , 54 , 61 , 71 , 72 , 73 ] coupled with the challenge of securing long-term funding [ 15 ] hinder health system adaptation to climate change. Moreover, slow disaster preparedness in health facilities [ 30 ], lack of resource planning for disaster response [ 59 ], and limited efforts in preparing for extreme weather events were also reported [ 62 ]. Inadequate political will or support [ 35 , 62 , 64 ] further exacerbates this situation, which limits the allocation of resources and impedes the implementation of effective strategies. The difficulty in mobilising resources [ 6 , 15 ] and the dearth of investments in the health system [ 64 ] amplify the constraints faced in responding to climate-related health risks. Additionally, the presence of poor infrastructure [ 59 ] and the introduction of underdeveloped and expensive new technologies [ 30 , 54 , 68 , 73 ] pose significant barriers, that hinder the ability of health systems to effectively adapt to the challenges posed by climate change.

Poor policy implementation and evaluation

The effectiveness of health system adaptation programmes and policies is significantly hindered by inadequate coordination mechanisms among stakeholders [ 6 ], resulting in a lack of synchronised efforts to address climate-related health challenges. This lack of harmonisation does not only constrain the smooth execution of adaptation initiatives, it also leads to fragmented and disjointed actions that limit the overall impact of these programmes [ 6 ]. Furthermore, the absence of robust monitoring and evaluation systems creates a substantial barrier [ 6 , 72 ], impeding the ability to comprehensively assess the efficacy of implemented strategies and make informed decisions based on reliable data. This deficit in evaluation mechanisms undermines the adaptive capacity of health systems and constrains their ability to respond effectively to emerging climate risks. Moreover, limitations in organisational capacities within healthcare structures pose additional challenges to the successful implementation of health system adaptation strategies [ 54 , 61 , 73 ]. The inadequate infrastructure and organisational frameworks within these systems contribute to inefficiencies, hindering the prompt deployment of adaptive measures which impedes their effectiveness. Additionally, insufficient collaborative efforts across regions exacerbate these constraints [ 64 ], limiting the exchange of critical knowledge, resources, and sharing of best practices needed to bolster adaptation efforts. This lack of cohesive regional collaboration restricts collective ability to address climate-induced health risks comprehensively and compromises the overall resilience efforts of the health systems in the face of evolving challenges associated with climate change.

Low-risk perception and lack of expertise and evidence

Low-risk perception and lack of expertise are also barriers to health system response to climate adaptation. Low climate risk perception [ 15 , 26 , 35 , 73 ], lack of knowledge and awareness about health risks from climate change [ 9 , 26 , 74 ], wrong perceptions about the health impacts of climate change [ 15 , 54 , 58 ], and a lack of awareness about heat stress among healthcare workers [ 59 ]affect perceived urgency for climate actions. Perceived lack of urgency [ 15 ], as well as expertise [ 39 , 64 , 71 ], and education make health system adaptation challenging, especially in developing countries [ 30 ]. Insufficient research [ 51 ], training [ 9 ], and access to climate data and models further hinder effective climate change response efforts of health systems [ 48 ]. Limited institutional capacity [ 48 ], gaps in reporting [ 6 ] and information [ 33 , 68 ], and a lack of guidelines for reporting the health impacts of climate change [ 69 , 72 ] present further challenges for health system adaptation.

Inequity and problems in healthcare delivery

Social inequality [ 58 ], maldistribution of adaptive capacity [ 54 ], and socio-political inequality [ 68 ] exacerbate existing health disparities. Besides, fragmented services for migrants [ 64 ], and socio-economic challenges [ 54 , 73 ] contribute to further inequities which compromise the health systems’ response to the changing climate. Marginalised and hard-to-reach populations, especially in global south receive little consideration in climate change adaptation efforts [ 62 , 72 ]. Moreover, lack of treatment protocols for illnesses related to extreme events [ 59 ] presents challenges for health system delivery. Shortages of staff [ 6 , 59 ], difficulties in integrating evidence-based practices into healthcare [ 6 ], and a strained health system [ 62 ], especially in developing countries, impede effective health system adaptation to climate change.

We found that efforts are being made to build resilient health systems to climate risk by mainstreaming climate change in health policies and education, especially in developed countries. Investments are also being made in building climate-resilient health infrastructure, new technologies, robust early warning systems and surveillance programmes and quality health and climate research to inform health system climate actions. Attention has been given to improving the health and safety of health workers to improve quality healthcare delivery and access, especially for at high-risk communities and populations, including migrants. Also, investments are being made to train and improve the capacity of climate experts and institutions to produce high-quality evidence and national data systems that support health system adaptation decisions. However, inadequate funding, low climate risk perception, inadequate policy and poor policy implementation and evaluation, socio-economic challenges, lack of political support, deficits in evidence, and compromised healthcare systems, including infrastructure, make health system adaptation to climate risk challenging. Also, climate actions are not yet well integrated into mental health programmes, especially in vulnerable communities and populations.

The evidence produced in this review has significant implications for health systems and their adaptation to climate risk. Health system efforts to build resilience by mainstreaming climate change in health policies, planning and education, especially graduate and medical education, indicate an urgent recognition to address climate-related health impact. The other way is equally important, that health and health systems adaptation measures are incorporated into climate policies in dealing with the climate crisis. Thus, by integrating climate considerations into policy frameworks, health systems can ensure that anthropogenic climate change and its related health impacts are incorporated into planning and decision-making at all levels of governance and policy making [ 1 , 2 ]. Furthermore, building robust health system infrastructures and surveillance systems are essential aspects of building resilience to climate risk. For instance, robust health infrastructures and other facilities can withstand the dangers pose by extreme weather events, ensure continuity of healthcare delivery, and avoid interruptions in health service delivery, especially for at-risk populations [ 18 , 35 , 70 ]. Early warning systems and new technologies, including remote sensing and enhanced testing and diagnostic facilities enable health systems to respond to climate risk promptly, to allow for early detection, prevention and management of climate-related diseases [ 33 ]. For instance, ensuring early detection of climate risk may allow for robust vector control and immunisation programmes [ 58 , 74 ].

Climate change poses a significant risk to health workers, especially in outreach programmes in remote and hard-to-reach areas. Therefore, attention to improving the OHS of health workers is essential in improving access to quality healthcare delivery and helps eliminate all forms of precarious work conditions posed by climate change [ 4 ]. Health systems should thus, prioritise the well-being and safety of their workforce, as they are at the forefront of managing climate-related health emergencies. Thus, improving the quality of healthcare delivery and access ensures that all individuals, especially high-risk populations, including displaced and migrants, have equitable access to quality, culturally sensitive and patient-oriented healthcare services [ 61 ]. Such healthcare services can potentially address patients’ unique needs in the context of climate change [ 50 ]. Then, training and capacity building for healthcare workers, other experts and institutions have far-reaching implications. For instance, by improving institutional capacity to generate high-quality evidence and establish national data systems, health systems can make informed decisions, long-term plans and develop robust interventions that address climate risks [ 33 ]. Perhaps, evidence-based planning may help develop and implement contextually relevant adaptation strategies that are effective in protecting public health against climate risks [ 33 , 47 ].

The co-benefits of climate adaptation through collaborative efforts of the health sector and non-health sectors are diverse [ 10 ]. While the primary focus is to address climate-related health risks, collective efforts can yield additional positive outcomes. For example, investing in climate-resilient infrastructures and promoting the use of renewable energy within the health systems can contribute to reducing GHG emissions, promote energy efficiency, and improve the overall sustainability of healthcare facilities and services [ 10 ]. Integration of climate risk into health policies and education fosters greater awareness and understanding among healthcare professionals, which enable them to advocate for sustainable healthcare practices and educate patients, families, and communities on climate-related health risks [ 10 ].

Health system response in the realm of WHO’s Health System Resilience Framework

The imperative to build resilient health systems against the burgeoning impacts of climate change underscores the urgency to embed climate considerations within health policies, a notion that resonant with the WHO’s resilience framework. Integrating climate-related health impacts into decision-making at all governance tiers heralds a proactive stance in combating the multifaceted challenges posed by a changing climate [ 3 ]. Robust health infrastructures, bolstered by surveillance mechanisms, assumes a pivotal role in this framework, mirroring the WHO's tenet of resilient systems, capable of enduring extreme weather events and ensuring uninterrupted healthcare delivery, especially for vulnerable segments of the population [ 18 , 35 , 70 ]. Early warning systems and cutting-edge technologies, highlighted in this discourse, echo the WHO's focus on preparedness and swift response, essential for detection, prevention, and management of climate-driven ailments [ 33 ]. Furthermore, the emphasis on equitable access to quality healthcare, capacity building for healthcare professionals, and inter-sectoral collaborations to derive co-benefits mirrors the WHO's overarching aim of fostering sustainable healthcare practices, inclusive access, and bolstered readiness against the onslaught of climate risks [ 10 , 33 , 47 , 50 , 61 ].

The broader scope of our findings encompasses domains such as social support systems, One Health strategies, OHS and interventions related to sanitation, water, food, and mental health. The inclusion of One Health strategies underscores the interconnectedness of human, animal, and environmental health, recognising their interdependency in reducing climate-related health risks. Our study expands into the domain of social support systems. We highlight interventions targeting poverty alleviation, housing improvements for higher risk populations, and community-based support schemes. These interventions, albeit not explicitly outlined in the WHO framework, are vital for bolstering the adaptive capacity of health systems, especially in the face of climate-induced challenges. Furthermore, the attention to OHS in our research accentuates the significance of protecting healthcare workforce and adapt work processes to climate-induced stressors, to offer a comprehensive viewpoint beyond the WHO's workforce and governance components. In essence, our research extends the WHO framework by encompassing other critical dimensions and interventions crucial for health system resilience in the context of climate change. These expansions enrich our understanding and approach to addressing the multifaceted challenges posed by climate-related health risks, and pave the way for a more robust and inclusive response frameworks.

Barriers to health system adaptation to climate risk

Inadequate funding, low climate risk perception, and poor policy implementation and evaluation are posing considerable challenges to health system adaptation to climate risk [ 73 ]. For instance, inadequate financial resources and political will limit the ability to invest in climate-resilient infrastructures, including new technologies and training programmes [ 27 ]. Moreover, low climate risk perception undermines the urgency and priority given to adaptation strategies in healthcare policy and planning [ 25 , 63 ]. Unfortunately, inadequate policy and poor policy implementation and evaluation compromise the effective execution of climate-related health interventions while diminishing their impacts and potential co-benefits [ 10 ]. Meanwhile, socio-economic challenges including poverty and economic inequalities impede health system adaptation and push vulnerable people into extreme vulnerabilities. Displaced populations and migrants face disproportionate risks because they are less equipped to cope with climate-related health risks [ 8 , 64 ]. Perhaps, inadequate funding and low climate risk perception hinder the integration of climate actions into OHS programmes, which compromise health workers’ well-being, safety and ability to respond effectively to climate-related emergencies [ 4 ]. Besides, lack of integration of climate actions into mental health programmes and services further suggests neglect of the potential psychological impacts of climate change. This situation reduces the resilience of high risk communities and populations facing climate crisis [ 75 ].

Barriers in the realm of WHO’s Health System Resilience Framework

The identified barriers of health system adaptation to climate risk are intricately tied to the WHO 2015 Health System Resilience Framework, which reflects vulnerabilities across its core domains. Inadequate funding and limited financial resources align with the framework's pillar of Sustainable Financing. Insufficient funds impede investments in critical areas such as climate-resilient infrastructure, technology, and training programmes, directly affecting a health system's ability to withstand and respond to climate-related challenges [ 27 ]. Low climate risk perception resonates with the preparedness and emergency response domain of the framework. A diminished understanding of climate-related risks undermines the urgency and priority given to adaptation strategies in healthcare policies and planning [ 25 , 63 ]. This lack of awareness hampers proactive measures, that hinder the system's readiness to effectively respond to climate-induced emergencies [ 3 ]. Poor policy implementation and evaluation directly impact the Governance and Leadership dimension of health system resilience. Moreover, ineffective policy execution limits the implementation of climate-related health interventions, reducing their potential benefits and co-benefits [ 10 ]. This inadequacy in policy implementation and evaluation compromises health system's ability to adapt and respond efficiently to the changing climate, also highlighting governance gaps and leadership deficiencies.

Moreover, socio-economic challenges, including poverty and economic inequalities, are closely related with the Social Protection and Equity element of the framework. These challenges exacerbate vulnerabilities, particularly among displaced populations, communities, and migrants [ 8 , 64 ]. Such marginalised groups face heightened risks from climate-related health issues, because they may lack adequate resources and support structures proper resilience and access to quality healthcare [ 3 ]. Furthermore, the lack of integration of climate actions into OHS and mental health programmes underscores the need to bolster health workforce and service delivery within the resilience framework. Neglecting these aspects compromises health workers' well-being, safety, and ability to manage climate-related emergencies [ 4 , 75 ]. Additionally, the oversight in addressing the psychological impacts of climate change reduces the resilience of high-risk populations, which highlights a critical gap in service delivery [ 75 ]. These barriers collectively underscore the intricate interplay between various dimensions of health system resilience, emphasising the necessity of comprehensive approaches outlined in the WHO framework to create a robust health system against climate risks and crises.

Linkage between barriers and health system response to climate change

Understanding the intricate relationship between health system responses to climate change and the myriad challenges impeding such responses globally is imperative in comprehending the complexities faced in this arena. Examining the proactive measures adopted by health systems reveals a multifaceted approach which encompassess policy formulation, infrastructure enhancement, and community-focused initiatives [ 1 , 10 , 15 ]. These response strategies are in alignment with the guidelines provided by the WHO which aimed at fortifying and building robust health systems [ 3 , 4 ]. However, impediments of substantial magnitude hinder these efforts significantly. A notable hurdle resides in the dearth of supportive policies, that render the implementation of response plans arduous [ 19 , 71 ]. This critical gap also translates into a lack of emphasis on mental health concerns within these strategic frameworks [ 19 , 59 , 72 ].

While developed nations tend to prioritise disease-centric approaches and technological advancements [ 20 , 39 ], they currently grapple with policy inadequacies, limited public awareness, and constraints in resource availability [ 15 , 19 , 27 , 35 , 71 ]. Conversely, developing nations place greater emphasis on community-driven strategies, educational initiatives, and cross-sectoral collaborations [ 33 , 45 ]. Despite the divergence in their approaches, both categories of nations encounter similar challenges, notably the scarcity of financial resources and limited access to other vital resources [ 6 , 15 , 33 , 45 , 54 , 71 ]. These challenges underscore the urgent need for sustained financial support and unwavering commitment from governments globally [ 9 , 15 , 26 , 33 , 35 , 54 , 61 , 62 , 71 , 73 ].

Synthesising these diverse responses with the challenges at hand necessitates the formulation of comprehensive strategies that address these pressing issues [ 15 , 19 , 27 , 71 ]. This comprehensive approach involves not only refining policies and enhancing financial resources, but also bridging the knowledge gap and fostering public awareness [ 15 , 19 , 27 , 33 , 71 ]. A holistic strategy that integrates these response initiatives while effectively navigating the barriers is pivotal in building resilient health systems to withstand the escalating impacts of climate change [ 15 , 19 , 27 , 71 ].

Recommendations for building resilient health systems

Recommendations for creating resilient health systems have been summarised in Fig. 5 . These recommendations significantly bolster health system resilience, which align with the WHO’s Health System Resilience Framework of 2015. Such recommendations foster the capacity of health systems to prepare for, respond to, and recover from the adverse events of climate change [ 3 ]. Adequate and sustained financial backing is fundamental for health system resilience [ 3 , 68 ]. For instance, allocating funds for climate-focused healthcare initiatives, infrastructure, research, and workforce training is pivotal. Such financing supports the development and maintenance of climate-resilient health systems, to ensure continuity in healthcare provision during climate-induced crises [ 2 , 3 ].

Integrating climate considerations into healthcare services ensures responsiveness to climate-related health challenges. This involves creating services that are equipped to address climate-sensitive diseases, incorporate climate risk assessments into healthcare plans, and tailor health interventions according to changing climate patterns [ 3 , 6 , 15 , 27 , 39 , 45 , 68 ]. Robust emergency plans, that encompasses early warning systems, rapid response strategies, and community engagement, are vital components of resilient health systems [ 3 ]. Preparedness entails developing protocols for handling health crises linked to extreme weather events, infectious disease outbreaks, and other climate-related emergencies [ 3 , 15 , 45 , 51 , 68 ].

Effective governance structures and leadership are essential to foster resilience health system [ 3 , 15 , 24 , 27 ]. This includes clear policy guidelines, coordination mechanisms across sectors, and the integration of climate and health priorities into national health agendas [ 3 , 45 ]. Interdisciplinary collaborations across sectors are crucial. Engaging various sectors such as environment, agriculture, and urban planning facilitates a holistic approach to health system resilience [ 3 , 35 , 39 ]. This ensures shared responsibility and collective action in addressing climate-related health challenges.

This strategy ensures the comprehensive management of health risks arising from climate change, laying emphasis on the interdependence of health in different sectors. Ensuring the well-being of the health workforce involves addressing climate-induced health risks they may face [ 3 , 15 , 39 , 70 ]. Providing adequate training, protective measures against climate-related hazards, and fostering a conducive work environment are pivotal. Moreover, infrastructure that can withstand climate-related stressors is vital [ 3 , 27 , 33 ]. Designing and maintaining climate-resilient healthcare facilities, equipped with adequate resources and utilities, ensures the uninterrupted delivery of health services during climatic disruptions. These recommendations collectively reinforce health system resilience that aligns with the WHO framework. It further focuses on the interconnectedness of health system components and emphasis preparedness, response, and recovery in the face of climate change challenges.

Developed countries should prioritise sustained investment in climate-informed healthcare services. This involves integrating climate change events into healthcare policies, to foster climate-resilient infrastructure, and conduct vulnerability assessments that address potential health risks from changing climate patterns [ 2 ]. Robust climate surveillance systems, akin to those recommended by the WHO [ 3 ], are essential to track and manage the health impacts of climate change. Early warning systems, informed by evidence-based research [ 3 , 15 ], aid in proactive response measures against climate-related health hazards. Meanwhile, collaborative efforts, with various sectors, including environmental and urban planning agencies, are critical to ensure a comprehensive approach to a resilient health system [ 5 ].

In developing nations, enhancing health system resilience to climate change involves addressing resource scarcity and capacity gaps [ 6 ]. This includes increased funding for climate-resilient healthcare infrastructure [ 7 ], emphasising community-oriented healthcare services [ 8 ], and implementing adaptation strategies that consider local contexts and traditional healthcare systems [ 9 ]. Collaborative approaches to building resilient health systems, as advocated by the WHO [ 2 , 3 ] require investments in workforce training and technology adoption [ 2 , 27 , 33 ]. Moreover, bolstering healthcare access for marginalised populations, tackling poverty and investing in social support systems are imperative in ensuring equitable health outcomes amidst climate challenges in developing countries [ 2 ].

Limitations in the current review and recommendations for future studies

This review used only peer-reviewed journal papers published in English, which might affect the volume and depth of evidence retrieved. Excluding grey literature may affect the comprehensiveness and depth of evidence found in this review. Including grey literature such theses, policy documents, and other form reports could have given us a comprehensive data and findings. While we acknowledge this limitation, we attempted to minimise it by carrying out extensive consultations with key stakeholders in public health and health promotion. In addition, we thoroughly screened the reference lists of the full-text selected articles for other relevant records. Moreover, biases and other limitations inherent in the included articles may be carried in this review. However, the authors retrieved papers from 85 countries, including small island nations. We also failed to cover how health systems strengthening is included in the climate literature and climate policies. There is the need to explore how health systems strengthening is being integrated into climate policies. Furthermore, future studies should concentrate on using mixed-methods and grey literature to understand health system response and barriers, especially in developing countries where evidence remains scarce. Future research initiatives should prioritise investigating the responses of health systems to climate-related shocks, particularly focusing on areas such as 'One Health,' inequalities, and mental health. These facets have been relatively underexplored in current research and warrant attention due to their potential impact on healthcare resilience in the face of climate change.

Efforts toward building resilient health systems, especially in developed nations, have seen promising strides by integrating climate change into health policies. Substantial investments in innovative technologies, early warning systems, and climate-resilient infrastructure reflect proactive measures in response to the climate risks. Concurrently, there is a concerted focus on enhancing healthcare delivery and access for high-risk populations, prioritising the well-being of healthcare workers, and fostering institutional capacity that generate essential evidence and robust data systems to navigate the challenges posed by climate change. However, significant obstacles persist in the adaptation of health systems to the climate risks. Challenges include a low perception of climate risks, inadequate policy implementation and evaluation mechanisms, and socioeconomic disparities. Particularly concerning is the limited integration of climate change into OHS programmes and mental health actions. These obstacles are predominant in developing countries due to resource constraints and weak healthcare infrastructures, which exacerbate vulnerabilities, and impede effective response to climate-related health risks. Addressing these multifaceted challenges is pivotal to create a resilient health system against the impacts of climate change and ensure the resilience of healthcare workers and at-risk populations. These pursuits resonate strongly with the WHO's health system resilience framework, which emphasis the importance of integrating climate change events into health policies and planning, strengthening healthcare delivery, fostering community engagement, and enhancing leadership and governance to navigate uncertainties and build resilient health systems against climate change challenges. Integrating climate change into OHS programmes, prioritising mental health actions, and bridging socioeconomic gaps are crucial facets that align with the framework's principles, which ultimately fortify health systems to withstand the complexities posed by the climate crises.

Availability of data and materials

All data generated or analysed during this study are included in this article and its Supplementary file (Table S1). Additional File (PRISMA_2020_Checklist) is also available.

Pörtner H, Roberts D, Tignor M, Poloczanska E, Mintenbeck K, Alegría A, et al. Climate change 2022: impacts, adaptation and vulnerability working group II contribution to the IPCC sixth assessment report citations to the sixth assessment report of the intergovernmental panel on climate change [ to the Sixth Assessment Report of the]. 2022. https://doi.org/10.1017/9781009325844.CITATION .

WHO. Operational framework for climate resilient and low carbon health systems. 2023. https://www.who.int/publications/i/item/9789240081888 .

WHO. Health system resilience framework. 2015. https://www.who.int/publications/i/item/9789241565073 .

Amoadu M, Ansah EW, Sarfo JO, Hormenu T. Impact of climate change and heat stress on workers’ health and productivity: a scoping review. The J Climate Change Health. 2023;12:100249.

Article Google Scholar

Perkins SE. A review on the scientific understanding of heatwaves—Their measurement, driving mechanisms, and changes at the global scale. Atmos Res. 2015;164–165:242–67. https://doi.org/10.1016/J.ATMOSRES.2015.05.014 .

Boyer CJ, Bowen K, Murray V, Hadley J, Hilly JJ, Hess JJ, et al. Using implementation science for health adaptation: Opportunities for pacific island countries. Health Aff. 2020;39:2160–7. https://doi.org/10.1377/hlthaff.2020.01101 .

Moda HM, Filho WL, Minhas A. Impacts of climate change on outdoor workers and their safety: some research priorities. Int J Environ Res Public Health. 2019;16:3458.

Article PubMed PubMed Central Google Scholar

Marcus H, Hanna L, Tait P, Stone S, Wannous C. Climate change and the public health imperative for supporting migration as adaptation. J Migr Health. 2023;7:100174.

Schnitter R, Verret M, Berry P, Fook TCT, Hales S, Lal A, et al. An assessment of climate change and health vulnerability and adaptation in dominica. Int J Environ Res Public Health 2019;16. https://doi.org/10.3390/ijerph16010070 .

Sharifi A, Pathak M, Joshi C, He BJ. A systematic review of the health co-benefits of urban climate change adaptation. Sustain Cities Soc. 2021;74:103190.

Scheelbeek PFD, Dangour AD, Jarmul S, Turner G, Sietsma AJ, Minx JC, et al. The effects on public health of climate change adaptation responses: A systematic review of evidence from low- And middle-income countries. Environmental Research Letters 2021;16. doi: 10.1088/1748-9326/ac092c.

Arksey H, O’Malley L. Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology: Theory and Practice. 2005;8:19–32. https://doi.org/10.1080/1364557032000119616 .

Amoadu M, Ansah EW, Assopiah P, Acquah P, Ansah JE, Berchie E, et al. Socio-cultural factors influencing adolescent pregnancy in Ghana: a scoping review. BMC Pregnancy Childbirth. 2022;22:1–13. https://doi.org/10.1186/S12884-022-05172-2/TABLES/4 .

Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, et al. Mixed methods appraisal tool (MMAT) version. User guide. 2018;2018:1–11.

CAS Google Scholar

Paterson JA, Ford JD, Ford LB, Lesnikowski A, Berry P, Henderson J, et al. Adaptation to climate change in the Ontario public health sector. BMC Public Health. 2012;12:1. https://doi.org/10.1186/1471-2458-12-452 .

Bikomeye JC, Rublee CS, Beyer KMM. Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research. International Journal of Environmental Research and Public Health. 2021;18:2481. https://doi.org/10.3390/IJERPH18052481.

Lenzer B, Hoffmann C, Hoffmann P, Müller-Werdan U, Rupprecht M, Witt C, et al. A qualitative study on concerns, needs, and expectations of hospital patients related to climate change: arguments for a patient-centered adaptation. Int J Environ Res Public Health. 2021;18. https://doi.org/10.3390/ijerph18116105 .

Aracena S, Barboza M, Zamora V, Salaverry O, Montag D. Health system adaptation to climate change: A Peruvian case study. Health Policy Plan. 2021;36:45–83. https://doi.org/10.1093/heapol/czaa072 .

Article PubMed Google Scholar

Keim ME. Building Human Resilience. The Role of Public Health Preparedness and Response As an Adaptation to Climate Change. Am J Prev Med 2008;35:508–16. https://doi.org/10.1016/j.amepre.2008.08.022 .

Błażejczyk A, Błażejczyk K, Baranowski J, Kuchcik M. Heat stress mortality and desired adaptation responses of healthcare system in Poland. Int J Biometeorol. 2018;62:307–18. https://doi.org/10.1007/s00484-017-1423-0 .

Curtis S, Fair A, Wistow J, Val DV, Oven K. Impact of extreme weather events and climate change for health and social care systems. Environ Health. 2017;16:128.

Eidson M, Clancy KA, Birkhead GS. Public health climate change adaptation planning using stakeholder feedback. J Public Health Manag Pract. 2016;22:E11–9. https://doi.org/10.1097/PHH.0000000000000243 .

Tuyet Hanh TT, Huong LTT, Huong NTL, Linh TNQ, Quyen NH, Nhung NTT, et al. Vietnam Climate Change and Health Vulnerability and Adaptation Assessment, 2018. Environ Health Insights 2020;14. doi: 10.1177/1178630220924658.

Bambrick HJ, Capon AG, Barnett GB, Beaty RM, Burton AJ. Climate change and health in the Urban environment: Adaptation opportunities in Australian cities. Asia Pac J Public Health 2011;23. doi: 10.1177/1010539510391774.

Nhamo G, Muchuru S. Climate adaptation in the public health sector in Africa: Evidence from United Nations Framework Convention on Climate Change National Communications. Jamba: Journal of Disaster Risk Studies 2019;11:1–10. doi: 10.4102/JAMBA.V11I1.644.

Gould S, Rudolph L. Challenges and Opportunities for Advancing Work on Climate Change and Public Health. Int J Environ Res Public Health. 2015;12:15649. https://doi.org/10.3390/IJERPH121215010 .

Article PubMed PubMed Central CAS Google Scholar

Austin SE, Biesbroek R, Berrang-Ford L, Ford JD, Parker S, Fleury MD. Public health adaptation to climate change in OECD countries. Int J Environ Res Public Health. 2016;13:1–20. https://doi.org/10.3390/ijerph13090889 .

Ebi KL, Lewis ND, Corvalan C. Climate variability and change and their potential health effects in small island states: Information for adaptation planning in the health sector. Environ Health Perspect. 2006;114:1957–63. https://doi.org/10.1289/ehp.8429 .

Petkova EP, Ebi KL, Culp D, Redlener I. Climate change and health on the U.S. Gulf Coast: Public health adaptation is needed to address future risks. Int J Environ Res Public Health 2015;12:9342–56. doi: 10.3390/ijerph120809342.

Holmner A, Rocklöv J, Ng N, Nilsson M. Climate change and eHealth: a promising strategy for health sector mitigation and adaptation. Glob Health Action 2012;5. doi: 10.3402/gha.v5i0.18428.

Rychetnik L, Sainsbury P, Stewart G. How local health districts can prepare for the effects of climate change: an adaptation model applied to metropolitan Sydney. Aust Health Rev. 2019;43:601–10. https://doi.org/10.1071/AH18153 .

McMichael AJ, Lindgren E. Climate change: Present and future risks to health, and necessary responses. J Intern Med. 2011;270:401–13. https://doi.org/10.1111/j.1365-2796.2011.02415.x .

Article PubMed CAS Google Scholar

Mousavi A, Ardalan A, Takian A, Ostadtaghizadeh A, Naddafi K, Bavani AM. Health system plan for implementation of Paris agreement on climate change (COP 21): a qualitative study in Iran. BMC Public Health. 2020;20:20. https://doi.org/10.1186/S12889-020-09503-W .

Frumkin H, Hess J, Luber G, Malilay J, McGeehin M. Climate change: the public health response. Am J Public Health. 2008;98:435–45. https://doi.org/10.2105/AJPH.2007.119362 .

Syal SS, Wilson RS, Crawford J Mac, Lutz J. Climate change and human health-what influences the adoption of adaptation programming in the United States public health system? Mitig Adapt Strateg Glob Chang 2011;16:911–24. doi: 10.1007/s11027-011-9302-1.

McMicheal A, Nyong A, Corvalan C. Global environmental change and health: impacts, inequalities, and the health sector. BMJ. 2008;336:191–4.

Clarke KL, Berry P. From theory to practice: A Canadian case study of the utility of climate change adaptation frameworks to address health impacts. Int J Public Health. 2012;57:167–74. https://doi.org/10.1007/s00038-011-0292-2 .

Carthey J, Chandra V. The impact of climate change on healthcare facility infrastructure: a preliminary investigation of mitigation and adaptation strategies. 2007:1–13. https://www.researchgate.net/publication/255653998_The_Impact_of_Climate_Change_on_Healthcare_Facility_Infrastructure_A_Preliminary_Investigation_of_Mitigation_and_Adaptation_Strategies .

Martinez GS, Imai C, Masumo K. Local heat stroke prevention plans in Japan: characteristics and elements for public health adaptation to climate change. Int J Environ Res Public Health. 2011;8:4563–81. https://doi.org/10.3390/ijerph8124563 .

Ebi KL, Burton I. Identifying practical adaptation options: an approach to address climate change-related health risks. Environ Sci Policy. 2008;11:359–69. https://doi.org/10.1016/j.envsci.2008.02.001 .

Ford JD, Willox AC, Chatwood S, Furgal C, Harper S, Mauro I, et al. Adapting to the effects of climate change on inuit health. Am J Public Health. 2014;104:104. https://doi.org/10.2105/AJPH.2013.301724 .

Giudice LC, Llamas-Clark EF, DeNicola N, Pandipati S, Zlatnik MG, Decena DCD, et al. Climate change, women’s health, and the role of obstetricians and gynecologists in leadership. Int J Gynecol Obstet. 2021;155:345–56. https://doi.org/10.1002/IJGO.13958 .

Park EY, Park SM, Kim JH. Psychometric properties of the geriatric quality of life-dementia in older adults with dementia or mild cognitive impairment living in nursing homes. BMC Geriatr. 2019;19:1–8. https://doi.org/10.1186/S12877-019-1307-8/TABLES/6 .

Blashki G, Armstrong G, Berry HL, Weaver HJ, Hanna EG, Bi P, et al. Preparing health services for climate change in Australia. Asia Pac J Public Health 2011;23. doi: 10.1177/1010539510395121.

Opoku SK, Filho WL, Hubert F, Adejumo O. Climate change and health preparedness in Africa: analysing trends in six African countries. Int J Environ Res Public Health. 2021;18:4672.

Cai W, Zhang C, Zhang S, Bai Y, Callaghan M, Chang N, et al. The 2022 China report of the Lancet Countdown on health and climate change: leveraging climate actions for healthy ageing. Lancet Public Health. 2022;7:e1073–90. https://doi.org/10.1016/S2468-2667(22)00224-9 .

Lokotola C, Mash R, Naidoo K, Mubangizi V, Mofolo N, Schwerdtle P. Climate change and primary health care in Africa: a scoping review. J Climate Change Health. 2023;11:100229.

Berry P, Enright PM, Shumake-Guillemot J, Prats EV, Campbell-Lendrum D. Assessing health vulnerabilities and adaptation to climate change: A review of international progress. Int J Environ Res Public Health 2018;15. doi: 10.3390/ijerph15122626.

Viveros-Uehara T. Health Care in a Changing Climate: A Review of Climate Change Laws and National Adaptation Plans in Latin America. Health and Human Rights Journal. 2021;23:139–51.

Google Scholar

Fox M, Zuidema C, Bauman B, Burke T, Sheehan M. Integrating Public Health into Climate Change Policy and Planning: State of Practice Update. International Journal of Environmental Research and Public Health 2019;16:3232. https://doi.org/10.3390/IJERPH16183232 .

Mboera LEG, Mayala BK, Kweka EJ, Mazigo HD. Impact of climate change on human health and health systems in Tanzania: A review. Tanzan J Health Res. 2011;13:1–23. https://doi.org/10.4314/thrb.v13i1.10 .

Bowen KJ, Friel S. Climate change adaptation: Where does global health fit in the agenda? Global Health. 2012;8:1–7. https://doi.org/10.1186/1744-8603-8-10 .

Banwell N, Rutherford S, Mackey B, Chu C. Towards Improved Linkage of Disaster Risk Reduction and Climate Change Adaptation in Health: A Review. Int J Environ Res Public Health 2018;15. doi: 10.3390/IJERPH15040793.

Hess JJ, Mcdowell JZ, Luber G. Review integrating climate change adaptation into public health practice: using. Environ Health Perspect. 2012;120:171–9.

Austin SE, Ford JD, Berrang-Ford L, Araos M, Parker S, Fleury MD. Public health adaptation to climate change in canadian jurisdictions. Int J Environ Res Public Health. 2015;12:623–51. https://doi.org/10.3390/ijerph120100623 .

McIver L, Kim R, Woodward A, Hales S, Spickett J, Katscherian D, et al. Health impacts of climate change in pacific island countries: A regional assessment of vulnerabilities and adaptation priorities. Environ Health Perspect. 2016;124:1707–14. https://doi.org/10.1289/ehp.1509756 .

Wirawan IMA. Public health responses to climate change health impacts in Indonesia. Asia Pac J Public Health. 2010;22:25–31. https://doi.org/10.1177/1010539509350912 .

Confalonieri UE, Menezes JA, de Souza CM. Climate change and adaptation of the health sector: The case of infectious diseases. Virulence. 2015;6:554–7. https://doi.org/10.1080/21505594.2015.1023985 .

Dasgupta P, Ebi K, Sachdeva I. Health sector preparedness for adaptation planning in India. Clim Change. 2016;138:551–66. https://doi.org/10.1007/s10584-016-1745-7 .

Article CAS Google Scholar

Loosemore M, Carthey J, Chandra V, Chand AM. Climate change risks and opportunities in hospital adaptation. Int J Disaster Resil Built Environ. 2011;2:210–21. https://doi.org/10.1108/17595901111167097 .

Macassa G, Ribeiro AI, Marttila A, Stål F, Silva JP, Rydback M, et al. Public health aspects of climate change adaptation in three cities: a qualitative study. International Journal of Environmental Research and Public Health. 2022;19:10292. https://doi.org/10.3390/IJERPH191610292.

Chersich MF, Wright CY. Climate change adaptation in South Africa: a case study on the role of the health sector. Global Health. 2019;15:15. https://doi.org/10.1186/s12992-019-0466-x .

Dwinantoaji H, Kanbara S, Widyasamratri H, Karmilah M. Primary Healthcare in Community-Based Disaster Risk Management as Strategy for Climate Change Adaptation. Health Sci J. 2019;13:1–5. https://doi.org/10.36648/1791-809X.13.5.677 .

Negev M, Teschner N, Rosenthal A, Levine H, Lew-Levy C, Davidovitch N. Adaptation of health systems to climate-related migration in Sub-Saharan Africa: closing the gap. Int J Hyg Environ Health. 2019;222:311–4. https://doi.org/10.1016/j.ijheh.2018.10.004 .

Hayes K, Poland B. Addressing mental health in a changing climate: incorporating mental health indicators into climate change and health vulnerability and adaptation assessments. Int J Environ Res Public Health. 2018;15:15. https://doi.org/10.3390/ijerph15091806 .

Hanna EG, Spickett JT. Climate change and human health: building Australia’s adaptation capacity. Asia Pac J Public Health. 2011;23:23. https://doi.org/10.1177/1010539510391775 .

Holmes TJ, Holt A, English DQ. Progress of local health department planning actions for climate change: perspectives from California, USA. Int J Environ Res Public Health. 2022;19:19. https://doi.org/10.3390/IJERPH19137984 .

Ford JD, Berrang-Ford L, King M, Furgal C. Vulnerability of Aboriginal health systems in Canada to climate change. Glob Environ Chang. 2010;20:668–80. https://doi.org/10.1016/j.gloenvcha.2010.05.003 .

Hess JJ, Eidson M, Tlumak JE, Raab KK, Luber G. An evidence-based public health approach to climate change adaptation. Environ Health Perspect. 2014;122:1177–86. https://doi.org/10.1289/ehp.1307396 .

Baugh J, Kemen K, Messervy J, Biddinger P. Beyond the hazard vulnerability analysis: preparing health systems for climate change. R I Med J. 2013;2021(104):55–9.

Roser-Renouf C, Maibach EW, Li J. Adapting to the changing climate: an assessment of local health department preparations for climate change-related health threats, 2008–2012. PLoS ONE. 2016;11:2008–12. https://doi.org/10.1371/journal.pone.0151558 .

Araos M, Austin SE, Berrang-Ford L, Ford JD. Public health adaptation to climate change in large cities: a global baseline. Int J Health Serv. 2016;46:53–78. https://doi.org/10.1177/0020731415621458 .

Huang C, Vaneckova P, Wang X, Fitzgerald G, Guo Y, Tong S. Constraints and barriers to public health adaptation to climate change: a review of the literature. Am J Prev Med. 2011;40:183–90. https://doi.org/10.1016/j.amepre.2010.10.025 .

Negev M, Dahdal Y, Khreis H, Hochman A, Shaheen M, Jaghbir MTA, et al. Regional lessons from the COVID-19 outbreak in the Middle East: from infectious diseases to climate change adaptation. Sci Total Environ. 2021;768:144434.

Siami S, Gorji M, Martin A. Psychosocial safety climate and supportive leadership as vital enhancers of personal hope and resilience during the COVID-19 pandemic. Stress Health. 2022. https://doi.org/10.1002/smi.3192 .

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Acknowledgements

We are thankful to Dr. Kwame Kodua-Ntim of Sam Jonah Library, University of Cape Coast, Ghana, for his continuous support during the paper searching and screening process.

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MA and EWA conceptualised the review. MA conducted data collection and analysis, thematic analysis, reported the findings and wrote the initial manuscript. MA and EWA wrote the final manuscript. MA and PO independently extracted data for evidence synthesis, reviewed by JOS and EWA. MA and PO appraised reviewed studies, reviewed by JOS and EWA. The final draft of the manuscript was read and authorised for publication by all authors.

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Ansah, E.W., Amoadu, M., Obeng, P. et al. Health systems response to climate change adaptation: a scoping review of global evidence. BMC Public Health 24 , 2015 (2024). https://doi.org/10.1186/s12889-024-19459-w

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3.4 Leadership in public health

Published: September 2009
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Imagine that tomorrow you were suddenly appointed into a prominent health leader position in your country—as a Director of Department or perhaps even Minister of Health. Upon taking office, you are presented with the following urgent dilemmas by your chief advisers:

We are suffering perennial outbreaks of water-borne diarrhoea in the urban slums of our largest city, caused by the illegal tapping of water lines. How can we prevent this in both the short and long terms?

Other departments are preventing us enacting any measures to stop smoking in public places. How can we convince them to collaborate on this critical health issue?

How can we take steps to provide anti-retrovirals for the tens of thousands of our citizens suffering from HIV/AIDS?

Our government is in moral opposition to abortion, despite scientific evidence showing that decriminalizing abortion prevents maternal deaths from sepsis. Illegal abortion is high in our country. What action should we take?

How would you proceed to address these issues? Would you be able to think on your feet and respond promptly and effectively to the health needs of your populace? In other words, are you capable of being a public health leader?

These questions are examined below as we explore the nature of leadership and the possibility of learning it.

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Leadership in public health

Public health this own very sensitive aspect of the community let alone being in charge. This would pertain improve the translation of existing knowledge about the prevention and control of disease into policies that lead to longer and healthier lives. Being in such offices calls for a lot of assurance from the general public and being able to take punches in ways more than one. The resources allocated to public health must be earned in competitive political environments.

Admiring legislators who are eager to apply the best science are unlikely simply to bestow more funds and authority on deserving public health agencies and their dedicated staffs. Public health has no stronger claim on scarce resources and attention than, among other matters, medical care, public safety, defense, education, or economic development. What public health does have are compelling claims on resources and public attention that can and should be made more effectively.

This assignment requires the assignee to review certain material that has already been written down by public health professionals concerned about problems of leadership. Each author examined an aspect of a broad subject that would be discussed at the meeting. From the available choices I chase the following papers and their contents are indicated forthwith. Analysis of their contents follows later. a) Goleman D: leadership that gets results. b) Collins J, level 5 leadership. c) Ancona D in praise of the incomplete leader.

The purpose of these projects is to demonstrate ways to create more stable career paths, to mentor younger colleagues, and to assess innovations in governance that could contribute to more effective policy The following are reviews contents of the articles earlier mentioned: Goleman D: leadership that gets results. This article mainly focuses on the mishaps of the current day community that has led to the present adversities. The current crop of the modern generation has derailed according to the author of the article.

Most of public health officials carry a nagging sense of injury, of virtue and dedication unrewarded. The world has not delivered on the promises that we repeated to each other in our youth and worked so earnestly to achieve in our professional careers. The people of the United States are obese, seldom exercise, use tobacco and abuse alcohol, engage in unprotected sex, injure themselves and others, fail to present for prenatal care––and, for their sins, suffer a burden of premature death and functional disability that is extraordinary among industrialized nations.

For more than a decade, these patterns and our attempts to improve on them have been tracked in comparison to the National Health Objectives. Using our current science and technology, each objective could be achieved today. Yet, despite real progress in some areas and mixed success in others, the gaps stubbornly persist between what is and what could be. Americans are ignorant about health promotion and disease prevention, and poorly motivated to change their self-destructive behaviors.

Protecting the health of the public is correctly perceived as an uphill battle against social patterns and economic forces that frequently outweigh our meager efforts. There are several reasons why we should not be held accountable for this lack of progress. For example, why have we not been able to control the increase in syphilis? From lowly master’s student to state program director, we “know” the reasons: multiple sexual partners, drug use, low rates of condom use, and low rates of reporting.

To succeed in controlling syphilis, however, these “excuses” are precisely the behavioral patterns that we must target and change. This include :Ideology or Social Attitudes, Resource Constraints and Economic Interests Leaving behind these and other external barriers to progress in public health, I turn to internal factors, which we can most immediately tackle and which we will have to overcome before we can successfully attack the external ones.

Will public health “miss the train,” hunkering down within the politically correct bunkers of our isolated field and failing to grasp the enormous opportunity before us? We have made progress in some critical battles: there is modest but appreciable support for universal coverage, coverage of clinical preventive services, new investments in the public health infrastructure, a common data system, and shared accountability.

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Distinguished epidemiologist joins Wen Public Health leadership

Welcoming Dr. Simin Liu as our new Chair for the Department of Epidemiology & Biostatistics 

Publication date July 31, 2024

The UC Irvine Joe C. Wen School of Population & Public Health is delighted to announce the appointment of Simin Liu, MD, ScD, as the new Chair and Distinguished Professor of the Department of Epidemiology & Biostatistics, effective October 1, 2024.  

We would also like to extend our heartfelt thanks to Luohua Jiang, MD, PhD , for her outstanding service as Interim Chair over the past two years. Dr. Jiang began her tenure with UC Irvine in 2014 as an assistant professor and was recently promoted to full professor. Over the last ten years, she has demonstrated her value to our School and the larger campus through her active research program, commitment to exceptional teaching, and her recent role as the Interim Chair. Her leadership and dedication have been instrumental in maintaining the Department’s highest standards and during the recruitment process for Dr. Liu. 

Dr. Liu comes to UC Irvine after having spent the last 11 years of his illustrious academic career at Brown University where he held dual appointments in the School of Public Health and the Alpert School of Medicine. In addition, he served as Director of Brown’s Center for Global Cardiometabolic Health. Prior to his tenure at Brown, Dr. Liu was a faculty member at the UCLA David Geffen School of Medicine from 2005 to 2013 where he also held various leadership roles across the larger UCLA campus. Prior to UCLA, he was an associate professor at the Harvard Medical School and School of Public Health.  

In the ever-evolving landscape of scientific research, few individuals stand out as true pioneers who have not only advanced their field but have also fundamentally changed the way we understand the world. Dr. Liu joins us as one such leader whose groundbreaking work has reshaped paradigms and set new standards in scientific inquiry.  

Epidemiology is the foundational science for public health, and biostatistics are employed in every substantive issue of modern biomedical science. The work we do affects the lives of millions of people worldwide.” – Simin Liu, MD, ScD

Dr. Liu’s research cuts across multiple domains and disciplines to help identify risk factors for and distributions of complex diseases. His research portfolio stands at over $20 million in extramural grant funding, 400+ peer-reviewed scholarly publications, and active participation in over 100 committees, advisory boards, and service events. A hallmark of Dr. Liu’s extensive portfolio is when his lab was among the first to define and quantify dietary glycemic load in humans, which helps determine the functional role of dietary carbohydrates in the development of health outcomes. This novel nutritional concept is now widely used in the clinical management of diabetes, nutritional epidemiology, and dietary feeding trials of diverse populations worldwide. 

As a leading epidemiologist and physician-scientist, Dr. Liu has also been a catalyst for change cultivating a global collaborative community for evidence-based clinical and population health precision practice for chronic disease prevention and control. Particularly in China and Brazil, Dr. Liu helped colleagues develop numerous clinical and population studies of cardiometabolic outcomes across individuals’ lifespans and even across generations.  These studies will prove to be unique and invaluable experiences for our young and aspiring Wen Public Health investigators who want to seek answers to some of the age-old questions of biological, clinical and public health significance. His leadership in global health has fostered a collaborative environment that encourages innovation and cross-disciplinary research.

“Epidemiology is the foundational science for public health, and biostatistics are employed in every substantive issue of modern biomedical science. The work we do affects the lives of millions of people worldwide. It is an exciting time to be an epidemiologist and I look forward with enthusiasm to working with and learning from every member of the UCI community and beyond toward,” said Dr. Liu.   

“Dr. Liu embodies Wen Public Health’s spirit of scientific discovery and innovation. His work has not only advanced our understanding of nutrition, epidemiology, and global health but has also changed the paradigm, setting new directions for future research and education initiatives,” added Founding Dean Bernadette Boden Albala.

We are confident that under Dr. Liu’s leadership, the Department of Epidemiology & Biostatistics will continue to excel in its mission of understanding disease patterns, determinants, and health outcomes in populations. Please join us in welcoming Dr. Liu to Wen Public Health.  

For Current Students
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PM 501 Week 1 Leadership in Public Health
Public health leadership to advance health equity: A review summary
Leadership in Public Health
(PDF) Leadership in public health crisis: a review to summarize lessons
Public Health Statement Of Purpose Essay Example

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COMMENTS

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Public health leaders: Demonstrate cultural awareness of the implications of politics, ethnicity, gender, age, socioeconomic status, and religion on health beliefs and behaviours. Demonstrate ability to guide healthy public policy decisions and processes. Recognize the role of public health in political influence.
Leadership in Public Health: New Competencies for the Future
The values underpinning the "new" Vision of public health must include a willingness to change, to collaborate, and to be a central player in the health system of the future. The "Competencies" fundamental to public health leadership include updated Knowledge, Skills, and Attitudes (KSAs).
Leadership in public health
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Reflections on Public Health Leadership. As we celebrate the 25th anniversary of the Journal of Public Health Management & Practice ( JPHMP ), it seems useful to begin with a brief acknowledgement of the central leadership role played by Dr Lloyd Novick in this "labor of love" for public health practitioners.
Leadership in public health crisis: a review to summarize lessons
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Leadership in public health
Leadership in public health Public health this own very sensitive aspect of the community let alone being in charge. This would pertain improve the translation of existing knowledge about the prevention and control of disease into policies that lead to longer and healthier lives.
Distinguished epidemiologist joins Wen Public Health leadership
His leadership in global health has fostered a collaborative environment that encourages innovation and cross-disciplinary research. "Epidemiology is the foundational science for public health, and biostatistics are employed in every substantive issue of modern biomedical science. The work we do affects the lives of millions of people worldwide.
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Leadership in public health

Leadership in public health

41 Citations

Leadership development among public health officials in Nepal: A grounded theory

The collaborative leadership fieldbook : a guide for citizens and civic leaders

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Leadership through the Eyes of a Public Health Professional

INTRODUCTION

ACCIDENTAL AND SKILLED LEADERS

Formal training in leadership

THREE DOMAIN MODEL OF CAPACITY BUILDING FOR LEADERSHIP

Self-domain

Team domain

Environment domain

Interactions between three domains

COMPLEMENTARITY OF ADMINISTRATIVE, MANAGERIAL OR LEADERSHIP ACTIONS

Progressive levels of leadership in public health professionals

Leadership and management program of International Clinical Epidemiology Network for the (LAMP) leadership in health research

Skills for leadership

Family support for public health leaders

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Putting the public (back) into public health: leadership, evidence and action

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The Challenges of Public Health Leadership

HEALTH DISPARITIES AND PUBLIC HEALTH LEADERSHIP

POLICY, INSTITUTIONS, AND CONTROVERSY

CONFLICTS OF INTEREST

Personal Stories in Healthcare and Public Health Leadership

2024 Master's Essays

2023 Master's Essays

2022 Master's Essays

Africa Leadership on a New Global Public Health Convention

Incentives and Habit Formation in Health Screenings: Evidence from the Illinois Workplace Wellness Study

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Health systems response to climate change adaptation: a scoping review of global evidence

Introduction

Search results

Characteristics of reviewed studies

Health system response to climate change

Health policy and planning

Health promotion

Risk assessment, disaster preparedness and response

Surveillance and monitoring of climate-sensitive diseases

Health service delivery and mental health

Health infrastructure and supply chains

Social support systems and equity

Research, training and development

Sanitation, water and food

Occupational health and safety (OHS)

Barriers to health system response to climate change

Inadequate climate policies and disaster preparedness

Resources constraints

Poor policy implementation and evaluation

Low-risk perception and lack of expertise and evidence

Inequity and problems in healthcare delivery

Health system response in the realm of WHO’s Health System Resilience Framework

Barriers to health system adaptation to climate risk

Barriers in the realm of WHO’s Health System Resilience Framework

Linkage between barriers and health system response to climate change

Limitations in the current review and recommendations for future studies

Availability of data and materials

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