Shirley Fleming speaks at a Chicago neighborhood
health center.

For Shirley Fleming, now the deputy commissioner for public health services in Chicago, the road to her chosen field began with her younger brother.

"He was born with a very low birthweight in 1948 as a result of poor prenatal care," Fleming says. "He had several disabilities and was severely retarded, and it just didn’t have to be that way. It’s really prevention at the front end of life that matters. It’s exciting to me to try and make sure people get the care they need throughout life but especially at the beginning. It was this realization that led me to pursue a career in nurse midwifery."

In her four years as deputy commissioner, Fleming has seen the Chicago Department of Public Health’s emphasis shift from providing primary medical care to a return to the more historic functions of public health. "The focus on medical service is no longer primary. Public health has been moving back into its role of monitoring and assurance. We have more time to work on advocacy, policy, and legislation. These are essential elements of public health because they help build the infrastructure."

Fleming began her public health career as a certified nurse midwife in the Chicago Department of Public Health, working in the Chicago Public Schools and the city’s health clinics, and later served as a consultant for maternal and child health. She subsequently decided to return to school to work toward her DrPH, completed in 1994, with a specialization in this field. She says the expertise she gained in the collection and analysis of epidemiologic data has been particularly valuable in her job with the city. Such data are the basis for scientifically sound program planning, and they are shared with community-based organizations that have formed partnerships with the city health department in order to respond to the health problems and needs in their own neighborhoods. Using epidemiological data, Fleming says, gives the community groups an advantage in their planning and allows them to direct and apply their programming more effectively.

Fleming adds that her advanced degree was necessary "to give me the kind of vision I need. To improve the public health system, you need to understand what it should consist of and how to make that happen. Public health is the only area of health care that is truly holistic, and the only way you can have an impact is to deal with medical, social, and environmental problems together. I feel at home in my profession because it gives me the resources of a range of disciplines to improve the health of the community.

"In public health, we can move from prevention all the way to intervention, but our primary focus as public health professionals is on prevention. When I came here, we were struggling with doing for people rather than doing with people, and I think we’ve made strides toward creating partnerships with the people we serve. People in the community have a lot to bring to the table about their own issues and their own solutions. When you go out into the community and take that approach, you get such richness back."

That approach, in turn, has further stretched the traditional boundaries of public health practice in the city, Fleming notes. As one example, the Chicago Department of Public Health has initiated training programs that prepare community members to work with other residents, helping them to understand basic public health concepts that can improve the quality of life for themselves and their children. Program topics include door-to-door education on nutrition, safety, and child care. The training can serve as a stepping stone for residents whose work in areas such as the Robert Taylor Homes sometimes leads them to further training and a career in public health in their own communities. "It provides them with a first entry into a supportive environment and encourages them to provide needed services in their own neighborhoods," Fleming says. "We’ve convinced some people that practicing public health is a good thing to do. Some have come to work for our department, and others have gone on elsewhere to bigger and better things. It’s amazing what people can accomplish when they just get some support and know someone cares."

The Chicago Department of Public Health is now also doing outreach in partnership with other city units. To serve minority elderly women better, for example, it is working with the Department on Aging to increase mammographies and reduce the high mortality rate due to breast cancer. Fleming also furthers public health outreach by acting as a consultant and advisor on committees serving the Chicago Public Schools’ Head Start program and the American Cancer Society.

"When I look back to what motivated me to work in public health, I recognize that it was its focus on prevention," Fleming says. "My patients in the hospital just kept going in circles. You’d see them come back when you knew you had sent them home with good instruction and thought they would make it at home. I became frustrated with my inability to sustain health and decided I had to get to the other end of the spectrum of care. Public health is that end."

Contributed by Rick Asa

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