Leadership Trailblazer Spotlight: Mark Levine, MD, Commissioner, Vermont Department of Health

March 01, 2023 | ASTHO Staff

Diversity, equity, and inclusion are at the center of the public health mission. What are tangible steps that leaders can take to make sure these principles resonate across their work?

These concepts definitely need to be front and center in today’s public health mission and conscience. First and foremost, State and Territorial Health Officials (S/THOs) should be prominent mouthpieces for health equity; it’s important to show examples of successes while discussing departmental and state health priorities. In Vermont, this is best illustrated by the development and implementation of our State Health Improvement Plan, which stands on a platform of purposefully addressing inequities and the social determinants of health.

We need to bring to life the concept that, by viewing public health through a health equity lens in our daily work, we are more likely to reach the people and communities most in need of our support.

It is also critical that leaders demonstrate cultural humility while they identify where more work needs to be done or where public health may have fallen down, such as when discussing the astonishing lack of data on race that came to light early on during the pandemic and the historical injustices that contributed to disparities in health outcomes.

State and territorial health agencies can serve as models to inform both the public health workforce and the public about effectively embedding a health equity imperative and equity integration workforce. It’s also critical to highlight the resultant impact on hiring policies and communication/ interpretation practices and services.

You’ve long been a champion of sticking to the science. Do you have a trick for communicating data in a way that tells a clear story and resonates with your audience?

I think we underestimate the public’s appetite for seeing the data and understanding the science. Unfortunately, the current epidemic of misinformation makes it even more critical that public health officials clearly convey basic concepts and be viewed as the credible resource. My lengthy career in medical education in general—and in teaching critical appraisal skills as a specific example—along with my experience educating my own patients have certainly helped me here.

Integral aspects include distilling concepts down to their smaller components, adhering to an evidence-based approach, and understanding the story I want to tell and the message I want to get across ahead of time. I am a big fan of augmenting auditory learning with pictures, graphs, and other visual cues. Healthy doses of empathy, humility, and respect and honestly acknowledging uncertainty are additional parts of my toolkit.

Vermont’s COVID-19 response was lauded as a model of preparedness and successful messaging. For you, what were the keys to this success?

I always begin this response with a focus on Vermonters: a tradition of prioritizing health, always looking out for your neighbors, pride in helping small community life prosper and civic engagement (we are the home of “Town Meeting Day”), and a willingness to be compliant and cooperative even while being discerning. Then layer on to that frequent, consistent, and transparent communication that adhered to CERC principles and was delivered empathetically, with humility, confidence when appropriate and strove to under promise and over deliver. Not only were press conferences regularly scheduled three times per week, but even the smallest journalists from the most remote corners of the state had ability to engage the SHO and governor in challenging conversation.

Trust in leadership is vital, and the governor and I became the trusted messengers and resources, but always part of a larger state COVID leadership team that provided additional levels of expertise, all clearly informed by public health. We constantly articulated relying on the science and a data-driven approach. This was especially illustrated early on by our prioritization scheme for vaccines, which we knew could be controversial and potentially contentious. The value of data informing decision making, simplicity, feasibility, and being non-divisive and relentless led to one of the nation’s most successful initial vaccination efforts.

How did you and your workforce practice selfcare amid the stressors of leading a statewide COVID-19 response?

The answer, initially, was very poorly. It was our moment of selflessness. The problem, of course, was that no one expected it would be as prolonged a response as it became. And after months evolving into years, altruism can turn harmful. So, our late pandemic to current approach has been radically different. We are prioritizing work-life balance, access to mental health resources, encouraging self-management techniques such as mindfulness, and returning to healthier lifestyle choices. We also deliberately developed a focused, more streamlined COVID workforce to allow the rest of the department to once again concentrate on the abundant other public health priorities they originally came here to tackle.

There is an unprecedented opportunity right now to change the public health landscape. What steps can we take today that will have a major impact in the future?

It is critical that we transition from our moment in the spotlight—where public health is receiving funds and attention—to a time when this attention becomes the norm and federal and state leaders make up for the decades of neglect, underfunding, underinvestment, and workforce reduction. Some considerations for the future:

• Invest in public health infrastructure, including data modernization and workforce. Keep legislators focused on not only the present but also the future, beyond an election cycle or pandemic. Emphasize there will be another pandemic, and it will be in less than a century.
• Directly confront the epidemic of misinformation, armed with the fact that survey data indicate public health and its leaders are regarded by most citizens as a highly credible source of information. Seize the moment!
• In a time when chronic diseases remain the costliest drivers of our healthcare system and are straining the capacity of our hospitals—and while “health debt” and lack of a prevention focus are newer root causes—investing in health promotion-disease prevention and healthy aging, which of course helps across the entire age continuum, is essential. Let public health approaches be the antidote to the current crisis in healthcare.
• Place renewed focus on the determinants of health: socioeconomic, lifestyle choices, and environmental—long with public health’s newest mantra of health equity. We cannot veer from the very clear messaging about where we see disparities and inequities and how we can make progress. S/THOs need to continually advocate for the power of a health in all policies approach. And here is where consistently framing climate change as a public health emergency and having public health expertise at every table, as the critical convener, is vital.
• Public health still faces longstanding challenges in communicating about the differences between public health with its population focus versus healthcare. Time spent educating political leaders and policy makers will never be wasted and can lead to systemic change.
• Much like healthy aging, other areas that need to find a true home in and ownership by public health include better integrating mental healthcare—and the “diseases of despair” that have had new light shone on them as we exit the pandemic—into primary care. Even when state agencies are created or exist to address mental health and substance use, the lack of an integrated approach can be injurious.
• Prevention, prevention, prevention: public health’s true calling. We risk further harming an already fragile future generation of children and adolescents if we fail to highlight the great return on investment of a plethora of maternal child health programs including family support options early in life (e.g., home visiting, regional prevention coalitions and school-based curricula, afterschool and community prevention projects modeled on the Icelandic experience). The positive impact of such initiatives on adolescent mental health and substance misuse, and the social factors impacting the mother-newborn dyad is undeniable. Our advocacy will be essential to the recovery of this generation from the pandemic and their achieving their full potential throughout life.