Georges Benjamin, MD

benjaminrgbDr. Georges Benjamin has served as Executive Director of the American Public Health Association (APHA) since 2002.  Although he initially pursued a career in medicine in order to learn enough biology to become a gene splicer, he quickly fell in love with the field of medicine.  He attended the University of Illinois College of Medicine on a military scholarship and specialized in Adult Medicine.  Dr. Benjamin joined the army upon graduation, fully planning a career as a practicing physician.   However, an unexpected opportunity to run an army medical center launched his lengthy career in health management.  Dr. Benjamin worked in city and state government, and led organizations through a number of health crises, before assuming the top position at the APHA.  Dr. Benjamin believes he has been able to enjoy such a varied career because he chose an education that prepared him to do a variety of things.  Truly, his career trajectory is a testament to the power of seizing unexpected opportunities!

Career in Profile:

  • 1973: Completed Bachelor of Science at the Illinois Institute of Technology – Chicago, Illinois
  • 1978: Completed M.D. at the University of Illinois College of Medicine – Chicago, Illinois
  • 1981: Internal Medicine internship & Residency – Brooke Army Medical Center – San Antonio, Texas
  • 1981 – 1983: Chief, Acute Illness Clinic – U.S. Army Department of Emergency Medicine at Madigan Army Medical Center – Tacoma, Washington
  • 1983 – 1987: Chief, Emergency Medicine – Walter Reed Army Medical Center, Washington, D.C.
  • 1987 – 1990: Chairman, Department of Community Health & Ambulatory Care, D.C. General Hospital
  • 1990 – 1991: Acting Commissioner for Public Health, Department of Human Services Washington, D.C.
  • 1990 – 1991 & 1994 – 1995: Director, Emergency Ambulance Bureau, D.C. Fire Department
  • 1991 – 1995: Health Policy Consultant
  • 1995 – 1999: Deputy Secretary for Public Health Services, Maryland Department of Health and Mental Hygiene
  • 1999 – 2002: Secretary of the Maryland Department of Health and Mental Hygiene
  • 2002 – Present:  Executive Director of the American Public Health Association

 

Are there some points in your career that you are particularly proud of?

In every job you find something you think is really neat.  When I was in D.C., the HIV/AIDS epidemic was a major problem. We spent a significant amount of time and effort addressing AIDS in D.C.  We really focused a laser on HIV/AIDS, in particular among substance abusers and pregnant women, because we were beginning to see the impact of AIDS on women, especially in the black community.  In the early 1990s we responded to the shifting epidemiology and built on our Maternal and Child Health work to address HIV/AIDS.

My years as Maryland Health Secretary were likewise transformative.  We had outbreaks in new diseases like West Nile virus and the Anthrax letters. Tragically, we had a severe drought and we had a tornado! When I was there, in terms of the health statistics, everything that was up, was up, and everything that was down, was down.  I had an amazing staff.  Maryland has a combined health department, which means that everything was in the health department, except Occupational Health and Safety and the Insurance Commissioner.  This meant I could push a lot of people into the same room, I had all the levers.  Very few Health Officers have that capacity!  The 9/11 tragedy brought different types of partnerships together that were new and interesting.  Even though it was a tragedy it created a lot of partnerships and friendships.

What about any challenges?

D.C. was tough!  The economy was in a recession, and we had a tough time balancing the budget.  Many say that D.C. is recession proof, but it’s not.  As Maryland Health Secretary, our Medicaid program grew while we simultaneously moved the financing mechanism from volume-based (e.g., fee-for-service) to value based (e.g., capitation, paying for quality, etc.).  We were successful but it was tough to change the mindset of the people outside government.  We had to push people to accept that we are in the business for health, not managing resources.

When it comes to public health, being where you are now, what matters to you and why?

At APHA, we believe it’s important to be effective. There are a lot of issues on the table so trying to pick the ones that are most important and that you can have the most impact on is most important to us. It is important to be heard on the right issue where we can uniquely make a difference, versus shouting at the rain, and being against or for a lot of important things. If you are not for and against the right things then you are not going to be effective.

I hate to make you pick a problem, but in the landscape, what do you think is still a persistent public health problem that concerns you?

Right now, the issue is maintaining funding for public health. Public health is getting whacked!  All over the place, funds are getting dramatically cut. There is a general view that our government spends more than we can afford. I understand that concern, and we want to be fiscally conservative as well. On the other hand, there are some things you have to spend money for and other things you don’t need to spend money for. Public health is one of the things where we ought to be spending more and more.  It’s a major challenge to push for enhanced resources to move our nation towards prevention and wellness, at a time when you have to balance spending for emergencies and other things.  It’s hard to try and make that argument amongst people who cringe when you ask for another dollar.

So in your ideal world, what is the solution to this problem?

We have to do a better job of defining public health’s “value add” to the public.  Public health always talks about how our best work is done when nothing happens, and that’s true. But when nothing happens you don’t get funded! There are no incentives to put resources behind something that didn’t occur.  If you forget the fact that it didn’t occur because there were resources there in the first place, then you get in a circular argument. What we need to do is put a face to it. I think we need to find the resources to measure public opinion on a regular basis, so that we can craft public opinion.  We do this by getting our message out to people so that they can understand the trade offs and the value of public health.

Reflective: Looking Back On Volumes 1-3

Every four months we pause from interviews with public health leaders and true heroes to reflect on lessons learned from their varied careers, and insights into persistent and emerging public health challenges.

Our first set of interviews included late career reflections from pioneers who expanded the field, including Dr. Len Syme, the “father of social epidemiology” (later referred to as the social determinants), and Dr. Quentin Young, activist physician, who pushed for the field of health to embrace the principles of social justice and human rights.  Other interviewees shed light on the critical importance of community partnerships and grass-roots efforts, in order to improve the conditions in which communities live, work, pray, and play.  Dr. Renee Canady integrates health equity into her leadership role for the Ingham County Department of Public Health; In her career, Susan Avila brought deep commitment to her role as public health nurse in inner-city Chicago; Angela Reyes addresses youth violence and other issues affecting Latinos in Detroit; and Causandra Gaines has worked in partnership with other community leaders and residents to improve the health of Detroit residents.  Finally, a trio of public health leaders mused on the importance of institutional, state, and national policies and priorities in improving the public’s health and reducing and eventually eliminating health inequities.  These include Dr. Linda Murray, Chief Medical Officer of the Cook County Department of Public Health; Dr. Georges Benjamin, Director of the American Public Health Association; and Dr. Anthony Iton, Senior Vice President of Health Communities at the California Endowment.

A common theme across all interviews is the need to address the root causes of health inequities that affect marginalized populations throughout the US.  Poverty, violence, racism, segregation, oppression, a lack of hope and power all negatively affect the health of communities.  So does outright disenfranchisement, whether it occurs along social, political, or economic lines.  Current political debates attempt to police marginalized groups.  They do this by denying them pathways to citizenship, a living wage, quality educational opportunities, social safety nets, equal marriage, among others.  However, as our public health heroes point out, often it is community members, and not necessarily policy makers, who are intimately familiar with both the issues and the potential solutions.  As such, we need to create a way for the community to participate in the decision-making process surrounding the policies that affect their communities.  Furthermore, our heroes highlighted the need for action at the community, state, and national levels.  To do so requires the political will do live in a more just society.

The issues highlighted in this volume – poverty, violence, racism, segregation, oppression – are not new issues for the field of public health.  While the face of the forces that have created, perpetuated, and re-perpetuated these inequities may have evolved over time, these root causes remain.  And while the nature of the problems may have evolved over time – from the explosion of HIV/AIDS in the 1990s to chronic disease epidemic of the 2000s, the populations most severely affected by these public health problems remain the same.  The health problems may have shifted, but the structural processes affecting health remain largely unchanged.  Despite this, we find reason for optimism in innovative, creative, passionate collaborations currently underway at the community and state level, and applaud these heroes for their persistence and conviction in the face of so many obstacles.

Given the forces working to undermine our public health, how do we, in Dr. Iton’s words, counterbalance strong political and economic forces that overshadow the needs of disenfranchised groups? How can we ‘organize people and marshall their collective power, within these democratic processes, to advocate for a different set of priorities and a different approach to sharing these resources”?

We invite you into a discussion in the comments.  Please also like our Facebook Page and follow us on Twitter as we continue this conversation.  Stay tuned next month for a next volume of We are Public Health!