By Tricia Todd

Giorgio Piccagli is a well known name in APHA.  After all, he has been around the organization since 1978.  I asked to interview Giorgio in an effort to capture some of his perspectives and wisdom for future leaders in public health.  As one might suspect, the conversation with Piccagli covered a vast array of topics, from how different public health looked in 1978 compared to today, to his own path as a public health leader.

His first experience with APHA was like many -- he came to present a paper on “Social and Environmental Effects of Energy Extraction Activities.”  He became a regular member in 1990, and has been a fully involved member and leader of the organization since that time. Piccagli, now the chair of the Executive Board for APHA, has served in positions from Health Administration Section program chair to Section chair and chair of the Intersectional Council Nominating Committee. He served as president of his own California Affiliate, and went on to serve as chair of the Committee on Affiliates and the InterSectional Council.  All of these experiences in APHA and his extensive professional experiences made him a logical person to be involved in APHA special committees, such as the Task Force for Organization and Governance (TFOG) and Task Force on Association Improvement and Reorganization (TFAIR). The natural progression for Piccagli was Executive Board, and chair of that Board. 

What does this have to do with the Health Administration Section?  Piccagli actually started building his leadership skills and reputation while in the Health Administration Section.  His diverse leadership responsibilities have given him an interesting perspective on leadership.  When asked what qualities he believed were essential to leaders, especially in an organization like APHA, he offered some rather strong opinions.  “We need leaders who are taking on the position with the intention to work, not just as an honor.”   He also challenged leaders to think in the long term despite the structural challenges of year-to-year change of leadership.  In addition to the long view, he advocates for the wide view.  Leaders have to govern for their Section, or whatever the sub-organization is they are leading, and the Association as a whole, not for themselves.  A big challenge Piccagli recognized is leaders' desire to take on too much, to try to do it all in one year.  He encouraged a “Willingness to limit” --  take on only a few strategic directions and work collaboratively with others, particularly their likely successors, to maintain sustained energy on a couple of key items.

Piccagli sees leadership in public health changing as well.  Like many he senses we need a new leadership boom.  Despite the efforts to create leaders in public health through the vast National Public Health Leadership Network, we still see a tremendous need for leaders who can shape a vision for the future, and create the momentum and to make it happen.  I sensed as he talked he was really looking to the next generation of public health leaders to step up in a new way at a new time.  Because the field of public health is inherently both technical and very political, we need people who are technically proficient, and politically savvy, with the emphasis on the politically savvy.  To some extent Piccagli blames the system, saying, “In many ways, we have neither material nor psychological rewards to attract and retain leaders, unless they have a superhuman commitment.  Anyone who enters public health and plans to be a leader needs to be strong enough to “sustain the beatings.”

According to Piccagli, the future definitely looks different from the past.  In 1978 there was a “sense of hope” in public health. The National Health Planning Resource Act was passed to develop a systematic way to monitor and promote population health. The Act provided significant resources for local, state, regional and national entities to address population-based health needs and services, and also had within them the germs of generating tools for addressing the questions that would arise. The greatest irony was that this bill passed under a Republican president – Nixon.  This leads to the second greatest change Piccagli noticed, “a vitriolic and non-substantive debate on many issues affecting public health, including health care reform debate.” Today, we don’t have policy discussions, we have political exchanges. This lack of an ability to work across political parties and really focus on important issues is a real threat to the public’s health.  Today, Piccagli says we face a public health challenge that includes a “loss of resources, loss of bipartisanship and most devastating, a loss of hope”– all of this when we are seeing an increasing set of new health challenges in the population.

So what do future leaders need to take on this new environment?  Piccagli describes three key things: cognition, determination and passion.  Cognition, he explains, is the ability to understand systems complexity, and the tools appropriate to that, and having the psychological tolerance for ambiguity – not the need to be a command and control chief.  Determination was the second quality. “It’s easier to find people with cognitive capacity than to find people who have determination to be frustrated again and again.”  His last quality is passion.  “We live in a culture that assumes technical skill is important, but passion for resolving a problem, and energy to gnaw away is really the quality leaders need.  It’s easier to teach someone to be technically proficient than it is to engender that passion.”