What do you think of when asked about effective leadership?
- A bold, charismatic communicator?
- A trusted, wise counselor?
- A group of quiet, behind-the-scenes collaborators?
All are valid attributes as history shows successful leadership has come in many different styles.
Similarly, who comes to mind as a model of an effective leader?
- An experienced, respected diplomat like General Colin Powell, the former U.S. Secretary of State and Chairman of the Joint Chiefs of Staff?
- An unassuming grassroots organizer like Rigoberta MenchÃº, the liberator of Guatamalans?
- Or is it an impassioned activist like the late Paul Wellstone, Minnesota’s former U.S. Senator?
Now consider advancing a new vision for health and health promotion. What comes to mind when you consider success stories in creating broad reaching change?
- An upstart corporation that transforms an industry like Ted Turner achieved with CNN?
- The glacial but inexorable women’s rights movement?
- Or the astonishing impact of the World Wide Web on economic and cultural globalization?
It is clear from the proliferation of leadership books and speakers aimed at business success that no one has cornered the market on leadership. Indeed, leadership and quality improvement programs suffer from a “book of the month club” reputation with the attendant employee cynicism about yet another approach to working smarter. Moreover, meta-analysis of leadership literature shows leadership studies, much like health promotion, to be derived from an eclectic set of theories espoused by a multi-disciplinary range of professions. Nonetheless, there are commonalities that can be gleaned from both the academic and the popular wave of interest in leadership. Principles of authenticity, service to others and shared power all offer insight for health promotion leaders intent on affecting positive, sweeping, measurable and memorable improvements in society.
Creating and achieving a new vision for health in America will require broad professional readiness to abandon practices with marginal or no scientific merit, and to instead mobilize passionate, dedicated advocacy for studying and implementing evidence-based health promotion practices.
These concepts have been shared in more detail in the American Journal of Health Promotion. 2003 Nov-Dec;18(2):162-7, iii.
The Diet Debacle: A Case Study in the Need for Leadership in Health Promotion
There is no more conspicuous example of failed health and medical policy in America in the past decade than the emergence of our obesity epidemic. The controversies about what should and shouldn’t be done to prevent and manage obesity has been simmering for nearly as many years as it’s taken for the epidemic to take hold. The alarming scale and disturbing implications of the obesity trend are coming to a boil at about the same time the public is being exposed to the troubling lack of agreement among health promotion professionals about what can be done to reverse, or even slow present rates. Perhaps the most widely discussed report on the subject in years came not from a health professional but from a journalist. Gary Taube’s New York Times expose entitled “What if it’s all Been a Big Fat Lie?” created more layperson water cooler discussions, practitioner soul searching, researcher angst and editorial response than any health article in recent memory. Perhaps it was simply an example of writing about the right topic at the right time in the right place, nevertheless, Taube’s newspaper story likely produced more scientific reaction than any journal article on the subject. That a journalist, not a leading health promotion professional, set the terms of the debate is but one dimension of the profession’s leadership failings that Taube’s diatribe about scientific discrepancies reveals.
Taube’s “Big Fat Lie” describes the often contested differences between the effects of the Robert Atkin’s high protein diet compared to the low fat diet more generally prescribed by dietitians and health agencies as well as popular practitioners like Dean Ornish. What was more inflammatory than Taube’s premise that the much-maligned Atkins diet may be effective was his investigative reportage about the prospect that low fat diet recommendations not only don’t work, but may actually be the culprit in spawning today’s overweight populous. An examination of the merits and shortcomings of Taube’s story is beyond the purview of this post, besides, rebuttals have already been done much more ably by others. What is relevant to this discussion of leadership is the byproduct of this latest calamity over what works or doesn’t work in health promotion: a befuddled, exasperated and increasingly cynical public.
Clearly, weight control program providers have a long and growing history of offering programs without proven results. When most developing countries struggle with a gross national product less than what Americans spend to lose weight, finding effective interventions transcends the need for better science. Focusing on, and confining service offerings to, evidence-based interventions requires an ethical and moral dimension. Whose role is it, if not that of a profession’s leaders, to align the principles of the field with the conduct of its practitioners?
Regardless of the negative reviews Taube received for his provocative indictment of normative recommendations in weight management, it’s undeniable he was able to prey on the confusion and fears of the average consumer because they have been subjected to years of a nutrition and fitness education roller coaster. From the perils of yo-yo dieting to the ins and outs of trans fats, hydrogenates and antioxidants and from the thirty minutes of activity most days of the week to the hour of activity everyday of the week, the advice of the health promotion professional may soon rate along side the promises of politicians. To be sure, messages to the public need to change as research changes, so to some extent transient guidelines are a function of a relatively young science. Still, leadership means empowering others with information, not alienating them through equivocation.
The average health leader has the most honorable of intentions. Still, the root cause of our legacy of prevaricating recommendations has been a lack of a clear vision. When health promotion professionals are “promoters” first and scientists second it shouldn’t be surprising that they want to be the first to teach about the latest interesting, albeit incremental, gain in knowledge about health. It is this counterproductive reliance on sparse evidence, as well as the gaps in existing evidence, that underscores the need for a paradigm shift summarized in the table below.
Join me in viewing this blog as a safe place for examining current health and medical leadership challenges and threats. Please comment back with your own “From and To” recommendations and let our dialogue begin!
|Primary focus on individuals||Focus on groups/populations|
|Teaching about health improvement||Creating learning environments, systems for social change|
|Individual behavior change||Social learning and networks|
|Discrete disciplines compete||Inter-disciplines coalesce|
|Isolated problems||Integrated practices|
|Risk based disease management||Assets based community development|
|Market-based programming||Evidence-based health education|
|Health services||Community activism|
|Cost-containment||Value added productivity|