Title: Challenges Facing MCH Leadership: Martha May Eliot Award Commentary, 2003
Author:
Section/SPIG: Maternal and Child Health
Issue Date:
by Bernard Guyer, MD, MPH
Receiving the Martha May Eliot Award from the American Public Health Association is meaningful because the award is named for one of the founding mothers of the field of maternal and child health (1) ; because it signifies the recognition and esteem of one’s colleagues; and because the previous recipients are the giants of the field and include some of my personal mentors. This is great company to be in. The only doubt attached to this award is that, as a career-achievement award, it may imply that one’s career is at its end! I console myself with the thought that this is still better than having peaked in high school!
I’ve organized these comments into three areas, each intended for a different MCH audience: the challenges facing academia, the challenges for public health practice, and the challenges of leadership.
First, for my academic colleagues, some thoughts about careers: Like Martha May Eliot, I’ve had the good fortune in my career to be a clinician, policymaker, researcher, and teacher. I teach students that careers are longitudinal, meaning that one can play all the important roles over time, but not necessarily all at once.
Ernest Boyer’s well-known book Scholarship Reconsidered provides a framework for thinking about career roles by identifying four kinds of scholarly pursuits: the scholarships of discovery, integration,application, and teaching (2).
By “scholarship of discovery,” Boyer meant the kind of research and scholarly writing that is expected of successful academics. In MCH such scholarship dates back to the founding of the Children’s Bureau, which was an investigative agency of government, publishing an immense number of influential research reports. Ironically, the amount of research carried out in MCH agencies declined over the course of the twentieth century. It is up to the academic community to be the strong constituency for excellence in research. Martha May Eliot would have been supportive of such an agenda. The “scholarship of integration” refers to the work of multidisciplinary teams on the important and difficult public health problems faced by women and children. This strong tradition goes back to the women of Hull House who founded the field of social work and worked in multidisciplinary teams. The “scholarship of application” is about using knowledge to make a difference! The history of MCH is one of activism on behalf of women and children. Recall that Martha May Eliot and her colleagues in the Children’s Bureau were instrumental in the implementation of both the Sheppard Towner Act and Title V of the Social Security Act. Finally, Boyer describes the “scholarship of teaching.” Dr. Eliot closed her career as the chair of MCH at the Harvard School of Public Health. The great strength of MCH as an academic field is that we encompass all of these forms of scholarship and must strive to achieve excellence in all of them.
Second for my colleagues practicing MCH in public health agencies some thoughts about directions for change: All fields, including MCH, change over time, despite resistance, struggle, and angst. Martha May Eliot participated in the evolution of the Children’s Bureau through the first half of the twentieth century. Where will MCH practice go in the twenty-first century?
This is the kind of question I pose to my students in the “Lifespan” course I teach at the Johns Hopkins Bloomberg School of Public Health. I begin the course with the following real phone call that I received in the late 1990s: "Dr. Guyer, I’m a graduate of Hopkins working on my first job. Our company has a contract with the Los Angeles County Health Department to prepare a report on the “forces” that will shape child health in L.A. County in the 21st century. I never took your course, but can you help me!"
In the ensuing classroom discussion the students themselves identify a long list of such “forces” that shape child health, including demographic, economic, environmental, biological, developmental, behavior, education, health systems, technology, discrimination, politics, and war, among others.
What are the implications of this broad set of forces for MCH practice? Traditionally, MCH agencies have focused their efforts on the delivery of a fairly narrow set of services to high-need populations of mothers and children. The analysis of the “forces” shows, however, that we can’t improve the health of populations unless we’re engaged with these broad issues. We are now witnessing the emergence of a body of thinking and research about multiple determinants of health and development across the lifespan. This is occurring in sociology, epidemiology, human development, and health care. MCH needs to embrace this evolution and build a new agenda for the importance of the early part of the life to the health of populations across the entire lifespan. I believe such an evolution will bring MCH practitioners into the society-wide discussions about health care for all that will take place in the next decade.
I believe Martha May Eliot would have supported this recommendation. She wrote in her final report for the Children’s Bureau (3): "Each new generation of children brings its own problems -— problems which require new approaches, new inventiveness, new counter measures -— and above all new knowledge and greater skill on the part of adults. All these things are of the future -— the children are the future."
Finally, some comments on leadership (and politics): Martha May Eliot was not an armchair spectator of the game of politics. She actively engaged in all the policy debates of her era. We are now challenged by a new era of threats to effective government, to independent scientific research, and to critical thinking in education. We can’t allow the public policy agenda to be undermined or academic enquiry to be stifled. Above all, we can’t allow the internal divisions in our own field to sidetrack us from the big picture. Like Martha May Eliot, we must be engaged and outspoken in our advocacy on behalf of all women and children. MCH is one area in which we have ample evidence for the effectiveness of excellent governmental programs to improve the health of the American population. Let’s make the case!!
I conclude with a quote about leadership from Yitzhak Rabin, made at his acceptance of the Nobel Prize (4) : "A child is born in an utterly undemocratic way. He cannot choose his father and mother. He cannot pick his sex or color, his religion, nationality or homeland. Whether he is born in a manor or manger . . .his fate to a large extent is decided by his nation’s leaders. It is they who decide whether he lives in comfort or despair, in security or in fear. His fate is given to us to resolve."
I hope we can all live up to this standard of leadership. Again, my deep thanks for this award.
Guyer can be reached at the Department of Population and Family Health Sciences, John Hopkins Bloomberg School of Public Health, Room E4146, 615 N.Wolfe Street, Baltimore, Maryland 21205, (443) 287-0088; e-mail: bguyer@jhsph.edu.
This article first appeared in the Maternal and Child Health Journal, the first exclusive forum to advance the scientific and professional knowledge base of the maternal and child health (MCH) field. You may visit the journal's homepage at: www.springeronline.com. For subscriptions and general inquiries in the US please contact the customer service department via e-mail at service-ny@springer-sbm.com or call toll free: 1-800-SPRINGER.
REFERENCES
1. Schmidt WM. Martha May Eliot: Social pediatrician, Children’s Bureau Chief. Address at the Harvard University Memorial Church, Cambridge, MA, 1977. (http://www.harvardsquarelibrary.org/unitarians/eliot m.html)
2. Boyer EL. Scholarship reconsidered: Priorities of the professoriate. Princeton, NJ: The Carnegie Foundation for the Advancement of Teaching, 1990.
3. Furman B. Dr. Eliot leaves US Child Bureau. New York Times, November 9, 1956.
4. Rabin Y. Remarks by Prime Minister Yitzhak Rabin on receiving the Nobel Prize for Peace. Oslo, December 10, 1994. (http://almaz.com/nobel/peace/1994c.html)