The Oneida Daily Dispatch (Oneida, NY)
HEALTH DISCUSSION
‘What’s possible:’ DOH Commissioner Mcdonald speaks at Siena College
Siena College students got to chat with Department of Health Commissioner Dr. James Mcdonald Tuesday afternoon where he gave a talk about leadership, inequality, and public health.
“It’s really a privilege to talk to people who are still deciding where they want to go in life, to be helpful to them,” he said. “Part of why it’s important to talk at colleges, universities is to talk about what’s possible, ‘cause you only get one life, one career. But you could do many different things within your career, and it’s really just figuring out what’s possible.”
His alma mater for his master’s degree, Siena College invited the commissioner who gave a ranging lecture about the Department of Health’s and New York State’s work in public health and what kind of questions and inequalities Mcdonald and his staff have to consider. For students looking at entering the field, like some of those present in the Maloney Great Room Tuesday, he said it’s important to have an open, diversified approach.
For example, Mcdonald said he has three main questions he asks himself when making decisions in his office: who is helped?; who is paid?; and is the person gaining something doing so at someone else’s expense? This especially applies to the health equity part of his role, especially as systemic racism, disenfranchisement, and different social determinants greatly change health outcomes.
The legislature defined many of these terms in 2022’s Public Health Law and Mcdonald took the time to show and read the definitions which are long and have so many factors that affect health outcomes for New Yorkers. Several of the social determinants listed were things like healthful foods, transportation, good housing and education which are other departments and issues that need funding just like the Department of Health does.
Mcdonald said he is currently reviewing their budget — which is $119 million — and he knows that every dollar that goes towards them takes a dollar away from those departments that would help health equity. But a large portion of their budget goes toward Medicaid which needs to have that money, and the budgeting issues speak more towards the healthcare marketplace — not healthcare system, he said — that the US operates with.
Having been in the Navy and worked on an Indigenous American reservation, he said those are healthcare systems: someone within the covered network needs assistance and it’s given to meet the health needs of that person. A health care marketplace, he said, is what everyone else typically has; get health insurance and then go procure services individually.
What that means for health care as a whole, he said, is that funding goes towards fixing an issue rather than preventing one. The vast majority of the department’s large budget goes to direct patient care.
“We are very good at funding all the king’s horses and all the king’s men, and we are very happy to put Humpty Dumpty back together again,” he said. “If Humpty, this egg-shaped monarch and this egg contained monarch, had a public health professional next to him they’d have said, ‘Humpty, you shouldn’t be sitting on a wall; you’re fragile.’
“But if Humpty said, ‘I must sit on a wall, my subjects insist I sit on a wall,’ then the public health professional would say, ‘Then I’ll build you a harness, I’ll put padding below you (for) if you fall,’” he continued. “The thing about public health professionals, we know what the future will look like. We can see it so we’re very interested in prevention.”
They are happy to fund all the king’s horses and men, he said, and with how the system is set up, that’s how the funding has to be. Prevention funding, he said, tends to get left by the wayside even though it would lead to better, less expensive outcomes.
It’s important to keep all these factors in mind when being a leader in the public health
“We are very good at funding all the king’s horses and all the king’s men, and we are very happy to put Humpty Dumpty back together again.” — Department of Health Commissioner Dr. James Mcdonald