The Change Agent 

Can Dr. Herman Ellis reinvent public health in Richmond?

The lack of fanfare hasn't bothered Ellis much. After more than 30 years in the grueling public-health business, he knows to expect little attention.

Answer this: What does the public health department do? If you said enforce funny hairnets and hand-washing for restaurant workers, you know more than 57 percent of Americans polled by the Centers for Disease Control (CDC).

What's really sad about such collective ignorance is that this is the very same health system credited with beating such epidemics as TB and influenza (the top killers in Virginia in 1900). Thanks to this system, we stretched our average life expectancy from 47 in 1900 to today's record 77 years.

None of that glory, it seems, makes a difference now.

But this might be about to change in Richmond.

After six months of digging and analyzing with his employees, after painstaking efforts to talk to citizens, school nurses, politicians, doctors — everyone with a stake in the city's health — it's almost showtime for Ellis. At the end of the summer, he plans to announce a new vision and mission for the health department — the way he thinks a health department in the 21st century ought to work.

But will the plans sink like so many other grand schemes for change in our city? Or will this low-key intellectual with a passion for community lead the overhaul of the health behemoth that seems to have been forgotten?



I never did believe that people who worked in public health didn't have the skills that people working in the private sector had," explains Ellis, leaning over a round table in his office.

We are talking about the misperception about public health: the image that second-rate health providers work there, that it's another way of saying "health for the poor."

Ellis is a tall, slim man with salt-and-pepper hair. He's soft-spoken, occasionally dipping into "agency speak" (departmental priorities and change agents). Still, he's easy to be around, unassuming and warm. And most of all, he's clear in his talk about heady topics like health. It's an ability that immediately comes in handy for helping visitors trying to make sense of a world of statistics, social needs and city government.

Ellis' office is on the third floor of 900 E. Marshall St., tucked in past the labyrinth of cubicles and bulletin boards that are plastered with cheap flyers about health fairs, walk-a-thons, pregnancy prevention seminars, and child abuse. People walk in and out of the maze, clipboards and files in hand, their identification badges swinging like necklaces.

The complicated physical setup makes it easy to imagine how difficult it is to get information in, through and out of such a place.

Everything that has to do with the city's health gets digested here, and there's enough of it to give anybody cramps. An organization chart isn't too helpful, either. For example: There's Animal Control, Vital Medical Records and Environmental Health — pretty straightforward. But then the Division for Family and Child Health is separate from Women, Infants and Children. There's Community-Based Case Management (basically epidemiology, nursing outreach, satellite clinics, and health education) that's separate from Chronic Disease Prevention and Clinical Services. Then there are the programs that people use. Programs to make sure kids get immunized, to help teens understand birth control, to reach boys before they become sexually irresponsible, to get information out about TB and other communicable diseases, to bring fitness to low-income families, to stop the spread of sexually transmitted diseases. The list goes on. And it's all accompanied by memos, field workers, binders of data, and, most of all, countless needs to be met. The task is gargantuan and clearly not for those who give up easily.

Here's what they've got to do and what they're up against:

1. Ensure clean water, primarily by inspecting local springs to make sure the water is clear to drink and making sure public pools aren't contaminated.

2. Inspect all the city's restaurants (more than 1,000, the health department estimates) and ensure that state and city regulations are met. Eight inspectors are onboard and they visit each place at least twice a year. They also inspect the big milk plant off of I- 95, school cafeterias and the places where your friendly street food vendors make your hotdog.

3. Oversee animal control with six officers who last year handled more than 3,500 stray animals in the city, half of which had to be put down.

4. Stop serious infectious diseases, with everything from flu shots to plans for handling bioterrorist horrors like smallpox and anthrax.

5. Educate and implore the public to eat better and exercise to prevent cancer and heart disease — which accounted for more than half of all deaths in Richmond according to preliminary stats for 2000. That's to say nothing of bracing for ever-increasing rates of diabetes, now considered to be an epidemic by health professionals nationwide.

6. Continue to improve prenatal care and infant-mortality rates, which are striking in their disparity along racial and socioeconomic lines. Thirty-eight Richmond babies died in 2000. Of those, 32 were black.

7. Prevent people from getting lead poisoning. Seventy-two percent of the housing units in the city are considered lead risks, and three fourths of children younger than 6 who live in Richmond are at risk for lead poisoning. It's the No. 1 environmental hazard in the United States according to the CDC, and it causes birth defects and retardation, among other things — at much-lower exposure rates than experts once believed.

8. Curb teen pregnancy, of which there were 882 cases in Richmond in 2000, according to preliminary data, marking the fourth-worst rate in the state.

9. Reduce an array of sexually transmitted diseases, such as gonorrhea, for which Richmond tops the nation in infection rates at 1,752 cases.



How do health departments usually begin to deal with such a mountain of health threats? Inefficiently most of the time, according to Ellis.

The mangled communication channels must change, he says.

"Most health departments operate in a top-down model," Ellis says. "It's usually hierarchical. Animal control here. Environmental health there. Women-infants-and-children in one place, no connection with STDs. No big picture. No strategic plan. No idea at all of how to bring those services together — or even how to talk with each other and share ideas and resources."

His goal is to figure out new ways of communicating, teaming up and sustaining programs that work.

"I want to move people away from thinking 'my own little division, my silo,'" he says. "I want to move them away from thinking they can go to one little corner, get information on just that one topic and feel they've done a good job."

In the first few weeks on the job, Ellis asked his executive team to think about customer service — business terminology that is making its rounds at all levels of government these days. How would they continue to develop staff to improve service? How would they measure their effectiveness?

Unfortunately, the early reports were pretty much a rehash of business as it had always been. So he shifted the question:

"I decided to ask them: If this organization had no divisions, what would it look like? What would be the most efficient way for it to work?"

Now, he says, the real thinking has begun.

Tracy Causey, one of Ellis' former students, now manages a nonprofit Catholic health system in St. Louis. He says Ellis' leadership style resonates with people.

"He wants you to grow and try new ideas," Causey says. "He wants people to test their thinking and be creative in the position as much as possible. You do have to be good, though. You have to be bright. You never want to approach him without the background facts; he wants those. But he is about setting sights on outcomes and making people find a way to get there."

It's a way of problem solving Ellis applies to all areas of his life, Causey says. Back when Causey was struggling with policy issues at Meharry School of Public Health, Ellis made sure his student didn't give up his studies.

"He took an interest in me trying to lead my class in doing things. He wanted me to get out of school. He always told me, 'Don't forget the reason you're here is to get an education and make society better. Stay focused on the outcome.' He'd always bring me back to what outcome I wanted and how I could chart my way to get there."

Ellis' tendency to grow people into leaders has been a lifelong quality, according to Dr. Reginald Parker of Tallahassee, Fla., who met Ellis while doing an internship at the Massachusetts Institute of Technology. During the last 12 years, Ellis has mentored him as a fellow African-American in the health and science field. He's watched Ellis do lots of "turnarounds" of troubled organizations.

"He enjoys smart people working with him," Parker says. "He's very fair. He believes in empowerment, and sometimes people aren't really used to taking on responsibility and really taking on power as he means it. The challenge is always to get people to relinquish control about small things and get truly empowered about the things that matter."

As generous as that all sounds, though, Parker insists Ellis is no pushover: "Whatever training you need to do your job well, get it. At the end of the day, he wants the job done."

But helping people talk and share information within the department is only part of the problem.

Public health has always been like a platypus — an unlikely mix that relies on medicine, government and citizens to be successful. It's one part medical experts who know data; one part elected officials who control the budget funding; and one part everyday people who see things like HIV and infant mortality as somebody else's problem, and who still want to eat bacon-double-cheeseburgers and engage in unprotected sex — no matter how much information is thrown at them.

"What makes the work so difficult is a combination of three things," says Dr. Mohammad Akhter, executive director of the American Public Health Association (APHA). "And it doesn't matter if you're in New York, L.A. or in Richmond. First, there is never enough money. If there are a thousand mothers who need prenatal care, we'll have money for only 800. There is always a lack of resources. Second, our work deals directly with people, and it's extremely difficult to change people's behavior. … We see women coming back again and again pregnant. Alcoholics treated and then returning in a short while. Third, as time has gone by, it has become very political. We in public health want to do the best thing, but politics gets into the mix. The frustrations come from this. It's always a variation of this theme."



Fortunately, this line of work is more like a calling to people who could make a lot more money in the private sector.

Or at least it was for Herman Ellis.

Back in the early 1970s, the Division One track-and-field athlete had taken leave of absence from medical school and was filling his days by teaching pregnant teen-agers in the Bronx. After a friend sent him an application to the University of Michigan, the 22-year-old applied to the public health program — something he knew almost nothing about. All Ellis had known since the fifth grade, he says, was that he wanted to help people and work in medicine.

"As soon as I got there, I said, 'This is what I was meant to do with my life.'"

Ellis would go on to finish medical school at Boston University. He got his first medical license in Virginia — taking the exam at the old John Marshall hotel. Since then, he's been the chief epidemiologist for the Atlantic Fleet; a corporate medical director for Rohman-Haas, a Fortune 500 company where he had international responsibilities, and most recently, chair of Occupational and Preventive Medicine and graduate director of the Public Health Program at Meharry College in Nashville, Tenn.

For all that intellectual brawn, though, people who've worked with him say he has the Midas touch for the one quality that counts these days: He knows how to bring odd partners together — public and private — to mix a more potent tonic for health troubles.

"He's a degreed professional, but that doesn't get in the way of talking to all people," observes former student Causey. "He makes no distinction between an M.D. and a person without an M.D. He understands everybody. He has a way of finding commonalities and spotting the differences. Then he works to the goal of bringing things together. He has a way of communicating so that everyone understands the complex issues."

City Manager Calvin Jamison, to whom Ellis ultimately reports, is all too aware of the pressing health needs of the city, particularly as it applies to children, but bristles at the idea of just pointing out the problem. Just peruse the 2001 Kids Count report on Virginia and you'll get the picture.

Richmond received the lowest rank in an array of indicators for quality of life for children — including poor prenatal care (25 percent of women did not receive such care), low-birth-weight babies (12.5 percent), founded child abuse and neglect (572 cases), delinquency (3,297 cases), births to teens (204 cases), and kids in foster care (866 cases).

"It's easy to point out what's not working," Jamison explains. "The sign of a great city is one that says, `Here's what I have, now how do I change it? How do I make the bold steps I need to change?'"

Jamison wants to drop Richmond's poverty level — now at 25 percent — to no more than 15 percent over the next 10 years, and he wants the needs of children younger than 6 to be the priority. Jamison says the big task for top city executives like Ellis will be to cover the entire area.

"This is one city," Jamison says. "Whether you live in Chesterfield or Henrico or Hanover, it doesn't matter. Richmond is your city. And what happens in it impacts you directly or indirectly. If the city is having a health issue, it's eventually going to surface elsewhere. [Richmond] is going to be fine as we move forward, but we won't do it by ourselves. It's going to take aggressive partnerships and bold steps in public health and education and human services."

For his part, Ellis says he is done with turf wars and short bursts of effort that fizzle when the funding dries up.

"Personally, I'm getting out of the business of reducing this rate or that rate. I want to partner at critical points with other people who want to bring these numbers down as much as we do and then keep them down. We need partners in order to solve problems that may not just be strictly health. They may be largely social. So we need to say, 'OK, how will we keep teen pregnancy down?'We need 10 percent new resources. But more importantly, we may need to make meaningful partnerships in the schools and work with Planned Parenthood. Because that is what our best evidence shows is necessary. We need to be evidence-based in public health, rely on research and on what works."



Of course, there's never any way to tell in the early stages if these ideas will bloom. (Think about downtown development hot air, for example). And Ellis will be the first to tell you that changing health behaviors is a tough arena.

A telling example: Even getting his own health department employees to walk 30 minutes three times a week is tough. The City Strutters program is part of ROCK Richmond, possibly the department's most successful attempt at bringing exercise and good eating habits to inner-city families. But while City Strutters got off to a bang — T-shirts and a lunchtime walk with colleagues — only a few months later it's already sorely in need of a booster shot to get people walking again.

Still, Ellis insists he's in it for the long haul. Certainly, Richmond can do health better. And making people release their fiefdoms and focus instead on overarching health goals is the only way to do it. The trick is to stick to goals tenaciously — through budget cuts, through public opinion backlash and through the emergence of threats and problems that they can't yet imagine.

"When it's all said and done, I want to be able to say I made a difference," Ellis says. "I don't want to just say, 'Well, the job was interesting.' I want to say, 'When I was in Richmond, I started these programs, and they're still going. And Richmond's quality of life is better for it.'" S

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