'There Is So Much to Do'

When people talk about healthy neighborhoods, they talk about parks and rec and stuff. But public safety is just as much a part of neighborhood wellness as open space or walkability.

Have you had any surprises or had any preconceived notions debunked within your first few months in Washington?

There was an understanding that this was not going to be a job without challenges. I think there may have been some long-standing reasons for some frustration, and that may be partly a function of the way that we had been running the machine behind the programs, across the board in Medicaid, HIV/AIDS and community health. So we are sort of looking very closely and trying to make changes in our business processes so that things can be more efficient. We've also got to do a better job in how we allocate funds and where we allocate funds and holding people accountable.

We have to hold ourselves accountable, and we have to hold other people accountable for a slightly more holistic way of doing things.

When I say a holistic [way], I'm saying, if your focus is on African American men with prostate cancer, it would great for us to see you linking those men with primary medical care, because [your] screening them for prostate cancer is great, but odds are if they're in D.C. and they're an African American man, they may be at risk for or have hypertension, diabetes or some cardiovascular disease and therefore be at risk for a stroke or heart attack. So what are you doing with this opportunity here? What are you doing to try to influence these other things that are also very important?

How does the larger scale affect how you go for your goals?

We are smaller than Baltimore County, but the size of the public health problems here outstrip that particular jurisdiction. I think that this is a unique opportunity; that's part of the reason why it's good to be here. . . . There is so much to do.

We know Washington is an urban center and is hard to compare to states, but what exactly makes it so unique and vulnerable to these problems?

I think that the breadth of the heterogeneity of the population is one piece of it, and I think there are some historical issues that have prevented some parts of the city from climbing out of some bad socioeconomic situations. So if we look at a couple wards in particular, we've got some changes happening there, but still a significant amount of disease and significant lack of access to care.

People are dealing with so many other issues right now, like violence and the economy; how do you think you can push health to the top of the city's priorities?

I don't know that we necessarily need to be trying to push ourselves out there as the main thing. I do think at some point everybody comes around to ask a question related to health, and at those points we step up and say, "This is our recommendation." In the meantime, we continue to work quietly and diligently on the work that needs to be done.