MMM and the Iowa Department of Public Health

With Governor-elect Branstad’s appointment of Mariannette Miller Meeks (MMM) as director of the Iowa Department of Public Health (IDPH), Blog for Iowa will have more reason to post about the state of public health in Iowa. As we said in our only post on the topic this year,  “Most Iowans don’t think about much about public health. The truth is they wouldn’t think about it at all if there weren’t a pressing need.”

For the past six years, the author served as a member of a local board of health, gaining an understanding of many of the major public health initiatives in Iowa. At the same time, I covered the congressional campaigns of the nominee during the 2008 and 2010 election cycles. This history with both topics should serve as MMM faces a budget gap in the IDPH that was filled last year with stimulus funds.   Some tough decisions will need to be made and her character will manifest itself as she makes them. Viewing the former candidate in action should be engaging for our readers, at least that’s what we hope.

Change is needed in the IDPH. What BFIA said in April holds true today,

“While the more radical among us would suggest that Iowa’s public health system be completely re-engineered, it seems an unlikely undertaking. The current approach is through legislation and incremental change using the techniques of formal quality improvement processes. The author’s view is that to the extent we administer programs initiated at the federal and state level, that administration could be consolidated, instead of dispersed among our 99 counties. When there is an epidemic, like the H1N1 influenza, the Centers for Disease Control and the state take a dominating role anyway, so couldn’t other entities like hospitals, community health organizations and doctors’ offices be leveraged to ramp up and cover the needs dictated by state and federal authorities? While public health has had a lot of recent practice in emergency response, is there another way to formulate the emergency response plan to reduce the number of public health employees and achieve the same results?”

My view of the state of public health and the potential for change in that post was a bit harsh and cynical, “on a sunny afternoon in Ames, as we dined, chatted and learned about each other, the idea of radical change was not on the menu. It seemed like the afternoon would continue forever, with good food, a schedule for the day, friends and sponsorship by a government that could perpetuate our roles unendingly. In this environment, it is difficult to think outside the box, which may be what public health in Iowa needs most.” Based on what we know about MMM, the IDPH should prove to be much less comfortable for government public health employees as BFIA predicts she will stir things up. That is not all bad.

Where Iowa’s public health is likely to suffer under a MMM directorship is in developing an understanding of the relationship between Iowa’s agricultural and energy systems with public health. In “Iowa Coal & Health: A Preliminary Mapping Study” by McCue, Deaton, Nost and Rachow the authors point to inadequate collection of data in Iowa regarding adverse health events. While the IDPH does collect data used in the study, the quality of data was a constant source of criticism by geographers who collaborated on the project who were familiar with similar data in other states. It seems unlikely that MMM will invest in data collection improvements despite affirmation of support for the methods of scientific inquiry during her congressional campaign. At the same time, as a proponent of nuclear power to control toxic emissions from coal fired power plants and concentrated animal feeding operations in the state, she is expected to kick the ball down the road for the decades it would take to bring adequate megawatts of nuclear energy on line.

One of the issues in the congressional campaign was that MMM stated in one of the debates that she did not have health insurance. Now that she will be a government employee that problem is resolved for the ophthalmologist and maybe she will stay in the state for the time being. This appointment is one to watch.

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