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Estelle Richman: Keep the Client Front and Center

For Estelle Richman, health policy is personal.  Throughout her career she has earned a reputation as someone who advocates for individual well-being and dignity—as Philadelphia’s Commissioner of Public Health and Managing Director, Pennsylvania’s Secretary of Public Welfare, and Chief Operating Officer for the U.S. Department of Housing and Urban Development.  The College of Public Health is excited to welcome Richman as its 2016 commencement speaker, and we spoke with her about her beginnings, her career, and the issues she sees as most vital to the future of public health.  

Why do you care about public health? 

I think it was my upbringing.  I come from a family of doctors and teachers, and I grew up in an environment where health—particularly for poor people—was always very important.  What really grabbed me was the concept of working with people to help them out of poverty.  In Lynchburg [Virginia, where Richman grew up] many African Americans were very poor, very destitute, and as a doctor my father saw it all.  It was the days when doctors did house calls a lot, and I used to ride with him while he was visiting patients.  I could see how poor the families were.  I could see it in school.  I knew I had a whole lot more than they did, and it just didn’t seem fair.  So my goal from a very early age was to see if I could make things more equal. 

Your push is to make our healthcare system equal on a systemic level.  How?

As you move up, you realize that health comes in the form of policy.  I wanted to be part of the group who creates that policy and figures out how to implement it.  The biggest thing I’ve learned is that you have to include the people whose lives will be most impacted by the policy—if I’m going to create a policy that affects your life, I need to have you in the meeting and talking about it.  That’s one thing I’ve always preached.  Because I don’t think that those of us who have never experienced it can always create the right policy.  It’s an opportunity to give people a chance to voice their opinion, to disagree, to have a debate.  Just because you’re at the table doesn’t mean you get everything you want—but it means that people take your voice seriously.   

You’re known as someone who has brought down silos, integrating departments and operations at the agencies you’ve led.  Why is this important?

It didn’t take long for me to realize that many of our most vulnerable people don’t come with isolated challenges.  Mental health may be one, but food or housing may be another.  It’s hard to talk to someone about taking care of themselves or getting immunizations for their children when they’re trying to figure out if they’ll be sleeping inside or outside.  If you treat their mental illness but you aren’t asking them about other things in their life, you miss that, and as long as we stay in silos we will never solve those problems.  I’m not sure we’ll ever get rid of those silos—but that doesn’t mean we have to exist within them.  If we really want a healthy population, if we want people to respect themselves, we have to get up on the balcony high enough to be able to see what’s missing in our scope of the public health world.

What should this year’s graduates understand about the future of public health?

Public health is about more than just understanding a specialized area.  Whether it’s traditional public health fields, nursing, physical therapy or occupational therapy, it comes down to the fact that we need an integrated system that respects the person.  Those in research should understand that they aren’t doing research for its own sake—they’re doing it to show that changes in policy can help people.  Those in traditional public health fields should ask themselves:  how does this fit into the real world?  And those in allied fields should know that we often don’t end up with people with just one problem—so they need stand with the rest of the medical and social services fields.  The more interdisciplinary you are, the more you support the client.  Start seeing your job through the lives of people—public health touches all aspects of our day-to-day lives, every second. 

Posted:  April 25, 2016