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Friday, 26 October 2012

Intimidation: Politicians and public health professionals.

The Ford brothers in Toronto have openly done what many, perhaps smarter, politicians routinely engage in – Intimidation and harassment of those invested with non-partisan responsibilities for in the public good.  Central to this debate are comments about the Medical Officer of Health (MOH) for Toronto, David McKeown.  The epitomy of a style of public health worker who is humble, thoughtful and a considerate gentleman. Globe and mail reporting of radio broadcast and   Wellsley Institute commentary 

Perhaps there are thanks to be directed to the Fords, for openly stating in a public forum, what often occurs behind closed doors.

Where kind-hearted and truly invested individuals migrate towards public health, successful politicians must by necessity invoke multiple personalities.  One of those personalities is hard nosed, ruthless and dispassionate.   Hence we have a butting of heads that could occur.  For the Toronto case, perhaps the lack of credibility of the Fords can make the situation laughable.

The more challenging situations are the backroom discussions that place MOHs in conflict with governance people, where expectations are linked to performance and resourcing, a form of insidious blackmail and clearly personally intimidating.  Some MOHs can ride the situation easily, in particular those that have stability in a community that has longevity that exceeds the current political regime. 

One has to assume that the relatively inability to speak out of our Chief Public Health Officer Dr. David Butler-Jones is linked to implicit expectations on towing the government’s line as much as possible, and speaking rarely where public policy may compromise the public’s health. The CPHO situation is also echoed by stories that slip out of the chief provincial health officers. 

In fairness, butting heads constantly leads to resource reductions making doing the job more challenging. While a skirmish may be won, the battle can easily be lost.  Strategic posturing is essential and rarely is a fight worthwhile that leads to succumbing and lost of a job worthwhile. We have seen many a CPHO and MOH fall to the side as they have fought their way on the mountain.    Sometimes groveling or dancing to the political piper can be rewarded with the tools to make a difference in another area. 

While the current issues seem to relate to censoring the mayor and his brother, the reality is the issue is much broader than a public spat.

The job of the Medical  Officer of Health or other senior leader in Public Health is not a job for the faint of heart or fragile egos.  It is also not a job for those that are stubborn or overinflated egos.  In the end, our better public health leaders are rarely accumulators of friends, or of enemies. They are also infrequent recipients of expressions of gratitude or offers of personal support.

So thanks to Dr. McKeown for his leadership and foresight, and our expressions of condolences for his current challenge of having to work with such disrespectful politicians.  

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