Leading population health


Leaders are people that others follow. If no one follows, one cannot be a leader.1 2

Leadership is a relationship. Good leadership means people willingly follow a leader who is working to further the common good. Leadership is a relationship that cannot be handed off to anyone else. In contrast, management is a collection of functional tasks to carry out, monitor, and achieve strategic objectives. Unlike leadership, management functions can be delegated.

Administration “is the process or activity of running a business, organization, etc.”3 The usual source of power available to leadership, management, and administration comes from relational, expert, and positional authority, respectively.4 While these are not mutually exclusive, we focus only on leadership.

Global leadership scholar Roger Gill argues that leadership practice boils down to six core themes of leadership:5

  1. Values (What’s important to us? to our staff? to our customers?)
  2. Vision (What does the desirable future look like?)
  3. Purpose (Why do we exist?), or Mission (What do we do?)
  4. Strategy (How will we get there?)
  5. Engagement (Involve staff at every step; e.g., visioning)
  6. Empowerment (Give staff the training and tools to succeed.)

Based on this, here is a longer definition of leadership:

Leadership is modeling the way of inspiring a shared vision of the future; promoting clear purpose and mission, core and supportive values, and intelligent strategies; and engaging and empowering all those concerned to pursue this vision.

Public health leadership is “the practice of mobilizing people, organizations, and communities to effectively tackle tough public health challenges.”6 A competency is the “effective application of values, traits, knowledge, and skills in complex situations.”6 Leadership competencies can be divided into three categories: how to be, what to know, what to do.

How to be: values and character traits

The values of effective public health leaders include:6

  • social justice and equity,
  • moral and ethical compass,
  • reliance on evidence,
  • interdependence,
  • respect,
  • community self-determination,
  • requisite role of government, and transparency.

The character traits of effective public health leaders include:6 - humility, - integrity, - initiative, - empathy and compassion, - comfort with ambiguity, - passion, - courage, and - persistence.

What to know: knowledge base

Public health knowledge is evidence-based, dynamic, prevention-focused, trans-disciplinary, and value-laden. The public health knowledge base of effective public health leaders includes:6

  1. Public health science: analytic / assessment; basic public health sciences (biostatistics, epidemiology, environmental health, health policy and management, social and behavioral sciences); cultural competency (see cultural humility); communication; community dimensions of practice; financial planning and management; leadership and systems thinking; policy development and program planning
  2. Understanding people: motivation, and social and emotional intelligence
  3. Understanding complex systems: systems thinking, and complex adaptive social systems.
  4. Changing people, organizations, and communities: change management, culture of innovation, and positive deviance.

What to do: five competency sets (25 competencies)

  1. Invigorate bold pursuit of population health:
    • assess the current state of your program or organization;
    • articulate a compelling agenda;
    • enlist others in the vision and invigorate them to drive toward it;
    • pursue the vision with rigor and flexibility; and
    • marshal the needed resources.
  2. Engage diverse others in public health initiatives:
    • assess local conditions, in ways relevant and credible to the local stakeholders;
    • search widely for the right partners;
    • apply a social determinants perspective to planning;
    • take time to build relationships, teamwork, and common understanding; and
    • clarify roles and governance.
  3. Effectively wield power to increase the influence and impact of public health:
    • understand and strategically use positional authority and informal influence;
    • analyze public health problems and proposed solution in “campaign” terms;
    • build coalitions of core supporters, new partners, and issue-specific allies;
    • deal effectively with opponents; and
    • be strategically agile.
  4. Prepare for surprise in public health work (e.g., disasters):
    • promote resilience in individuals and communities;
    • develop and critique an emergency response plan;
    • communicate effectively during surprises;
    • execute emergency response plans with flexibility; and
    • learn and improve after surprises.
  5. Drive for execution and continuous improvement:
    • build accountability into public health teams;
    • establish metrics, set targets, monitor progress, and take action;
    • proactively demonstrate financial stewardship of public health funds;
    • employ the methods and tools of quality improvement; and
    • encourage innovation and risk-taking.


Leading public health is distinct from other forms of leadership. In my mind the major differences are due to a focus on:

  1. pursuing social justice and equity;
  2. mobilizing coalitions and communities;
  3. changing policies, systems, and environments;
  4. crafting legislation, and enforcing laws and regulations;
  5. balancing community vs. individual rights with ethical decisions; and
  6. transforming complex social systems (organizations and communities).

Not everyone is “cut out” for public health leadership. For example, “comfort with ambiguity” is necessary when dealing with complex social systems that adapt, resist, and are often unpredictable. Leaders who lack this trait may become insecure and they adapt by micromanaging subordinates in order to control circumstances and mitigate risk. Fortunately, people can change through hard work, feedback, and personal transformation. To learn more, see the Leading Population Health Framework.


  1. Maccoby M, Norman CL, Norman CJ, Margolies R. Transforming health care leadership: A systems guide to improve patient care, decrease costs, and improve population health. 1st ed. Jossey-Bass; 2013. ^
  2. Maccoby M. Strategic Intelligence: Conceptual Tools for Leading Change. 1st ed. Oxford University Press; 2015. ^
  3. Source: Oxford English Dictionary. Online. Accessed 2017-10-30. Available from https://en.oxforddictionaries.com/definition/administration. ^
  4. Administrators have positional authority by appointment (e.g., government bureaucracy) or by legal status (e.g., business owner). These authorities are not mutually exclusive, ^
  5. Gill R. Theory and Practice of Leadership. 2nd ed. SAGE Publications Ltd; 2012. ^
  6. Begun J,Malcolm J.Leading Public Health: A Competency Framework. 1st ed. Springer Publishing Company; 2014. ^
Tomás J. Aragón
Health Officer, City & County of San Francisco; Director, Population Health Division