Leadership, Power, and Public Health Policy

Mo's Field Notes

Issue 4

Leadership, Power, and Public Health Policy

Welcome back to the fourth issue of Mo's Field Notes.

Speeches on greatness, resolve, and national destiny are often delivered on Presidents' Day. But strip away the marble statues and ceremonial language, and leadership looks far more mundane and far more consequential. I think that in public health, leadership is not only about charisma. It shows up in who is heard, how evidence is used, and whether leaders are honest about uncertainty when the stakes are high.

From Abraham Lincoln establishing the first federal public health structures during the Civil War, to Franklin D. Roosevelt expanding social safety nets that quietly reshaped population health, presidential power has always flowed through policy choices that outlast any single administration. The most influential health decisions are often invisible in the moment. They sit in budgets, regulatory language, and institutional design rather than dramatic announcements.

Public health policy reveals an uncomfortable truth about power: leaders rarely control outcomes directly. What they control are systems: data pipelines, advisory bodies, emergency authorities, and the degree of political insulation given to scientific agencies. Strong leadership does not mean overriding expertise. It entails creating conditions in which expertise can function without fear, distortion, or delay.

Trust lives or dies here. When leadership treats public health as a tool of convenience, trust erodes fast, and recovery is slow. When leadership protects institutions, accepts uncertainty, and communicates limits honestly, trust compounds over time. This is not abstract theory. It shapes vaccination rates, emergency response speed, and whether communities believe guidance when it matters most.

Presidents' Day is a useful pause to remember that public health outcomes are not accidents. They are the downstream consequences of choices made by people in power, often years earlier and often far from public view. Leadership is not what is said in a speech. It is what is quietly built and maintained when no one is applauding.

Adaptive Leadership, Systems Thinking, and Reflection

Public health leadership rarely follows a script. Crises mutate, data lags, and political pressure distorts incentives. This is where adaptive and systems leadership matter more than technical authority.

Adaptive leadership focuses on leading when the problem itself is not fully defined. It asks leaders to resist the urge to provide premature answers and instead create space for learning, tension, and shared responsibility.

In public health, this often means acknowledging uncertainty, protecting expert voices, and allowing institutions to adjust rather than perform certainty. As outlined in a 2020 Harvard Business Review essay on COVID-19 leadership, effective responses relied on anticipation, adaptation, and accountability rather than fixed plans.

Systems leadership pushes the lens wider. Health outcomes are not produced by single agencies or isolated policies, but by interconnected systems: housing, labor, education, transportation, media, and law. In public health, these conditions are often grouped under the Social Determinants of Health.

Systems frameworks help leaders see leverage points, unintended consequences, and feedback loops that shape population health over time. In this view, power is not command or control, but the capacity to align institutions that were not designed to work together or move in sync.

Reflection is a powerful tool for leaders. It helps leaders slow down, question assumptions, and avoid reactive decision-making. Leaders who do not regularly interrogate their assumptions tend to confuse authority with control, and urgency with effectiveness. Reflection creates the pause that keeps policy from becoming reactive rather than thoughtful.