1. Nicola, Ray M. MD, MHSA, FACPM

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One hundred one years ago, a group of health officers, the leaders and managers of yesteryear's fledgling health departments, founded the all-male physician Municipal Health Officers' Section of the American Public Health Association (APHA). At the time these health officials were facing waves of infectious disease caused by crowding, unsanitary conditions, and limited prevention technology. When these APHA members presented scientific papers at the annual meeting, there were titles that reflected the major killers of the day: problems with quarantine in contagious disease work; disinfection of rooms; and management of infectious disease in rural municipalities (V. Henry, unpublished data, 2008). The section underwent three name changes in the first decade alone, resulting by 1916 in the Public Health Administration Section. The current Health Administration Section reflects the section's membership: the leaders, managers, and students of public health and health services organizations and those interested in effectively organizing people to achieve an improvement in the health status of the community by advancing the quality and practice of health administration.


Is the area of administration, management, and leadership still important in improving population health? More than ever. Since management is defined as the process of getting things done through and with people, this field provides essential ingredients for all health improvement and disease prevention efforts. Compare US society of 100 years ago with today for complexity in the number of stakeholders, the legal frameworks, the number of different public/private/quasi-public models, the financing mechanisms, and most other societal system components. Here is a sample of titles from the Section's scientific papers presented in 2009 at the 137th APHA annual meeting: Developing a Cost Model for Local Public Health; Putting Public Health Into Health Care Reform: Massachusetts' Chronic Disease Integration Pilot Project; Using Resources Wisely: Prioritization Criteria for Decision-Making in a Local Health Department; Linking Healthcare Facilities, the US Food and Drug Administration (FDA) and Manufacturers Collaborate in a Proactive and Preventive Patient Safety Operation; and Collaborative Leadership Strategies and Tools That Assist Communities to Achieve Public Health Outcomes.


Today's health problems have increased in complexity. Although we are still facing infectious disease challenges like H1N1 influenza and HIV/AIDS, we now have complex treatment and vaccine technologies that raise sophisticated questions about the correct course of action and lead to the need for multiple coordinated systems necessary for effective implementation. Chronic diseases are frequently multifactorial with no simple path to primary prevention. Health problems related to emerging issues such as climate change and increased population provide even more challenges.


Classic management functions of planning, organizing, leading, and controlling remain critical to achieve our organizations' best functioning.1 As managers/administrators and leaders (sometimes both at once), we seek to achieve the objective of a healthier community population. We do this by identifying specific goals and objectives and developing specific, detailed plans (the planning function). We break the work down into components and group-related work activities and units; we define authority relationships and develop position descriptions (the organizing function). We communicate the organization's goals to staff and the public, we train and supervise, and we integrate new staff into the organization (the leading and motivating function). We measure our accomplishments against stated goals and improvement in our performance by developing feedback mechanisms (the controlling function).2


There are several new areas of management science and thinking that are providing the tools for dealing with complexity. One example is the move to create learning organizations that take a systems approach to our problems. Senge's3 central message is that our organizations work the way they work, ultimately, because of how we think and how we interact. An example of a current problem area that has benefitted from systems thinking is the accurate prediction of the timeline and spread of the H1N1 epidemic in the United States and other parts of the world using software that simulates real space and time.4


Current leadership theorists posit that strategic leadership must be grounded in the interactive principles of complexity theory and must act as networked, interactive behaviors among actors in an organization and in the environment by fostering cooperation and adaptiveness where strategy can come from the bottom of the organization.5 This is contrasted with top-down, vision-led, centralized strategic leadership. Improving health by tackling the socioeconomic determinants of health, for example, can be better approached by using the combined wisdom of people throughout the organization to implement a "health in all policies" strategy through shared community vision with other parts of the community.


This Journal issue has articles that illustrate classic management functions, new management techniques, and educational approaches to our workforce among others. Colleague specialists with expertise in different programmatic areas and different professional backgrounds can all benefit from the current knowledge base in health administration. Join us in our quest for better health through better administration and leadership.




1. Schermerhorn JR. Management. 8th ed. Danvers, MA: John Wiley & Sons Inc; 2006:19. [Context Link]


2. Liebler JG, McConnell CR. Management Principles for Health Professionals. 5th ed. Sudbury, MA: Jones and Bartlett Publishers; 2008:54. [Context Link]


3. Senge PM. The Fifth Discipline. New York: Doubleday; 1994:xiv. [Context Link]


4. Longini IM, Nizam A, Xu S, et al. Containing Pandemic Influenza at the Source. Science. 2005;309(5737):1083-1087. [Context Link]


5. Marion R, Uhl-Bien M. Complexity and strategic leadership. In: Hooijberg R, Hunt JG, et al, eds. Being There Even When You Are Not: Leading Through Strategy, Structures, and Systems, Monograph in Leadership and Management Number 4. Amsterdam: Elsevier; 2007:273-287. [Context Link]