Leadership, Part 2
A friend asked if I could expand on my concept of leadership. The New York City Commissioner of Health is a tough job. You have responsibility for the health and welfare of 8.6 million people and millions more commuters and tourists. It is not position that should be given as a prize or reward to a political donor or their friend. You shouldn't take the job to enhance your career options and the job title does not automatically come with respect, that has to be earned. No amount of experience in academia or the private sector can adequately prepare you for the job and you must check your ego at the door. In the past several years people with scant public health experience have been hired and promoted into leadership positions at DOHMH.
I've worked for seven different health commissioners, the first five, Neil Cohen, Tom Frieden, Tom Farley, Mary Bassett, and Oxiris Barbot, all had meaningful on the job public health experience. Good leaders aren't insecure and admit when they don't know something. Debate and discourse lead to better decisions. I may not have agreed with every decision prior commissioners have made, but I knew each was made with deliberation and learned consultation. Perhaps a 2021 quote from a neighborhood coffee barista says it best (roughly, and second hand paraphrased): Dr. Farley was a gentleman, Dr. Bassett was elegant and always asked after my family, this one treats us like we are his servants.
DOHMH has been a political target and in decline for several years. Good people have left in droves leaving us with a 30% vacancy rate. The pandemic has been hard on people, but that isn't the only reason for the exodus. Leadership support is more than platitudes, and certainly more than gifting a bottle of foul-smelling hand sanitizer on people's desks. People don't mind working hard or the extra hours if they know their leader has their back and will stand up to bullying and denigration from politicians. If you care more about keeping your job than doing it, you might as well resign. Too often public health policy has cared more about optics than data. Take school testing for COVID-19. It didn't take long to show that few kids were testing positive and that transmission in schools was not a major contributor to the pandemic. Yet we still continued to force it upon children and families. Several of us in the bureau said contact tracing wasn't likely to work and the pandemic flu plan didn't include this activity. And did any of our testing and contact tracing have much of an effect? All you need do is look at the waves, particularly the Omicron wave (https://www1.nyc.gov/site/doh/covid/covid-19-data-totals.page ). We had no shortage of testing and a fully staffed contact tracing operation, and we still had a peak of > 60,000 cases per day. We were using teaspoons (expensive ones) to bail out a gash like the one that sunk the Titanic. Test and Trace shut down this spring and there has been no contact tracing for the current BA.5 wave. Last I heard the cost of the program was in excess of $1 billion dollars.
There is little chance that I will be reinstated with the Bureau of Communicable Disease. And I believe the department would prefer that I depart quietly. Like Navalny is to Putin, I am perceived as a threat to power. I can see that the emperor isn't wearing any clothes and I am not afraid to say it. That's my first amendment right.