While many across the country look at the public health care system’s handling of the COVID-19 pandemic as a failure, John Hellerstedt, MD, says in many ways it was a success in Texas.
Dr. Hellerstedt, whose term as Texas Department of State Health Services (DSHS) commissioner coincided with the onset of the pandemic in 2020, says much of his experience during that time revolved around learning how to navigate the public response and guide Texans through the challenging time.
He attributes that success, in part, to the relationship DSHS has forged with the Texas Medical Association.
“We had daily discussions with TMA,” in coordination with the association’s COVID-19 Task Force, he reflected. “They were a great resource for getting out information to other physicians. It was extremely helpful to have that [coordination] and be able to have regular in-depth conversations with medical professionals.”
TMA’s ability to disseminate details to members quickly put Texas in a position to navigate the crisis as well as any other state in the nation, adds Dr. Hellerstedt, who prior to his DSHS term had served as a consultant to TMA’s Council on Public Health.
“In many cases we came close to a collapse of the medical system, close to failing, but we did not,” he said. “It came down to crisis communication at all levels across the state, multiple agencies working with one another and educating [the public].”
Like her predecessor, current DSHS Commissioner Jennifer Shuford, MD, says the chemistry between TMA and the public health agency is vital for the health of Texans.
“TMA has been an extraordinary partner during my time as commissioner,” said Dr. Shuford, who served as the state’s chief epidemiologist during the pandemic and was front and center during TMA’s COVID Task Force meetings. More recently, she attended TMA’s Leadership Conference in January to address the state’s syphilis epidemic.
“The benefit is mutual, and I can say that having been a member of TMA before [becoming commissioner]. Seeing everything that they can do to improve the lives of patients through public health is great,” said the infectious disease specialist, who has served as a consultant to TMA’s Council on Science and Public Health and Committee on Infectious Diseases.
“I had no idea they were such an advocate for public health until I was in this role.”
With such physician leadership and collaboration, Texas has remained a nationwide leader during major public health events.
That’s according to five DSHS commissioners Texas Medicine had the opportunity to interview, who have served over the past 30 years and worked with TMA along the way. At the same time, these leaders have leveraged their public health roles and expertise to inform and influence medicine in the state as it struggles in some areas of disease prevention. And they continue to inform medicine, sharing their expertise with TMA.
As with medicine, one of the expectations of the job as commissioner is to never stop learning and preparing for what challenge could be next, says Eduardo Sanchez, MD, who served from 2001 to 2006. No commissioner escapes public health emergencies or natural disasters, and no commissioner sees two identical situations.
Few public health crises will rival the panic that instantly came across the nation on Sept. 11, 2001. For Dr. Sanchez, that was two days after he was named DSHS commissioner.
Had those events not taken place, however, the state of Texas would not have been as prepared to handle other natural disasters and public health issues that would follow in the next 23 years, he says.
“My favorite quote is, ‘Chance favors the prepared mind.’ I think it describes the role of commissioner. Without preparation we will always work less efficiently in our job,” said Dr. Sanchez, a chief medical officer for the American Heart Association and a consultant to TMA’s public health committee. “After these events, we were called to testify and explain our level of preparation as a state. [It forced us] to have plans, to simulate events that could happen in the future. It caused us to think: What would we do if ‘fill in the blank?’”
The tools of public health are also important to the overall practice of medicine, says Patti Patterson, MD, who served as commissioner from 1996 to 1997. “Each informs the other.”
The professor of pediatrics at the Texas Tech University Health Sciences Center School of Medicine participated in TMA’s Distinguished Speaker Series in January 2019, along with Drs. Hellerstedt, Sanchez, and David Lakey, who served as DSHS commissioner from 2007 to 2015.
While medicine provides a background as to why people get sick and how to treat them after the fact, public health addresses how people get sick, says Dr. Lakey.
“There is a saying that about 20% of what makes you healthy is delivered through the physician’s office; the other 80% or so are your daily behaviors. As physicians we are looking at the overall health of people; then [from a public health standpoint] you must also try to figure out how to address those broader issues,” he said.
The vice chancellor of health affairs and chief medical officer at The University of Texas System also emphasizes the importance of having a physician in a public health leadership role when it comes to maintaining credibility with other physicians and the public’s trust throughout public health crises and responses. He oversaw the state’s response to several hurricanes and to Ebola and Zika virus outbreaks and has served on TMA’s public health and education councils as well as the COVID-19 Task Force.
Public health and organized medicine also have the shared goal of educating lawmakers and the public about the importance of state public health initiatives.
A driving force for Dr. Shuford to pursue her public health degree was finding a better way to explain situations and understand them beyond medicine.
“Before stepping into the public health world, I was used to talking to peers. But once I became a commissioner, I needed to become comfortable talking to legislators about [the health of others],” she said.
Dr. Patterson, the first female DSHS commissioner, says the support system from TMA allows her and other physicians to flourish in their respective fields.
“They have a strong voice with our state policy makers, speaking for thousands and thousands of doctors, making us stronger than we are as individuals in our specialties,” she said. “TMA comes together for us.”
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