'There Is So Much to Do'
Health Chief Seeks Aid in Promoting Wellness

Tuesday, September 2, 2008

Four months into his tenure as the District's health director , the Health section asked Pierre Vigilance about his plans to tackle the city's major health problems. In keeping with his emphasis on wellness, Vigilance arranged to have the interview conducted on foot, but the traffic noise of downtown drove him and staff writer Brittney Johnson indoors.

Excerpts follow:

You have said that your top three priorities are health and wellness, HIV and public health system enhancement. How did you go about choosing these, and exactly what does "wellness" mean?

The three primary tenets of public health are promotion of health, prevention of disease and protection from health threats, be they emerging health threats like infections or folks who potentially put you in harm's way by virtue of not being properly trained. Wellness promotion is sort of a natural follow-on from that. It is something we all want, and there is something inherently good about talking to people about what they want as opposed to what they don't want.

Many people may think of HIV as the number one health problem in D.C., where one in 20 residents is HIV-positive. Why is it number two on your list?

When I talk about three priorities, I've never said they have an order to them. They are the three things under which our activity rotates. There will be a time when HIV can be a part of wellness promotion, but not until the disease is less stigmatized, less prevalent and treated in the way that we treat other conditions. We want to move HIV testing more into the mainstream of primary medical care, for example, and have people tested the same as [for] other conditions.

How do you plan on reducing the stigma?

It will come about with us trying to promote more routine testing at emergency departments and more primary care physician offices so that people are not looking at this as something that they had to go through a bunch of hoops to have happen.

We also have to change the conversation. More people have hypertension, more people have cardiovascular disease, more people have diabetes, more people have cancer than HIV. We don't talk about those things in the same way that we talk about HIV. When the homosexual rates [of HIV] are high, we say it's them; when the African American rates are high, we say it's them; when the rates among people 13 to19 are extraordinarily high, we'll say it's kids. In D.C., it's all of those things.

Your third priority is public health system enhancement. You were known for bringing agencies together in Baltimore County ; how receptive do you feel D.C. agencies have been to this?

We can't, unfortunately, click fingers and have these things change in a day, but we all want to be well, we all want improved outcomes. No one is going to say we don't want that; it's just whether or not they have been engaged in doing it.

There are interagency meetings that were set up by the mayor that are essentially models for collaboration. We get around the table on a particular issue -- on the Children's Health Action Plan, for example -- and we've all got a particular piece. Our piece is ensuring the kids are healthy and able to learn, then the police and [the school system] have their particular pieces. Now the challenge is, how do we take that type of interagency collaboration and make it work on a more regular basis for health and wellness?

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.