John Lumpkin (right) looks on as Governor Jim Edgar signs a World AIDS Day poster pledging increased support
for AIDS education and services.

As the director of the Illinois Department of Public Health, John Lumpkin has 11.7 million patients. Those individuals, the total of Illinois residents, rely on Lumpkin and his staff for numerous public health services, yet the vast majority donít realize it.

"The latest Harris poll showed that most people think public health is health care for the poor," says Lumpkin. "But when you ask them about the things we do, you find an approval rating of greater than 80 percent for most of the programs in public health. Apparently, the public just doesnít know that we are responsible for these programs."

Twelve years ago, Lumpkin was still an emergency medicine specialist, but around that time he came to a realization that changed his career path. Frustration, as it turned out, helped him choose public health. "After a period of time working in an emergency department, there was a level of dissatisfaction in trying to treat problems one person at a time," he says. "Now, Iím able to serve 11.7 million at one time. I wanted to have a broader impact, to move into meaningful prevention, and reach a broader group of people."

Lumpkin says that has come to pass. Not only does his department develop policy that affects every Illinois resident, but it serves people in diverse settings, from counties that number 7,000 in total population to Chicago, with three million people in the city proper and another four million in the suburbs.

To augment his public health skills once he changed directions, Lumpkin pursued an MPH at the UIC School of Public Health. It wasnít so much the degree he needed, Lumpkin says, but the expertise he gained in epidemiology, biostatistics, and health systems management, all of which have been essential in his job as the stateís health guardian. "If youíre going to practice public health on a practical level, you must have those skills," Lumpkin says. "Training in epidemiology allowed me to think in a more systemic fashion than one case at a time, to look at implications in a broader sense - of not only treating somebody with a major injury, for instance, but of considering what can be done to prevent that injury in the first place.

"Until I came to the School of Public Health, I didnít fully appreciate the difference between an injury and an accident. Accidents, according to the dictionary, are events that are unpredictable and unexpected. But you realize that if you put a teenager with a six-pack under his belt into 3,000 pounds of steel, run him down the highway at night, and he crashes into a viaduct, thatís not an accident. That is something you can prevent."

Being responsible for the health of nearly twelve million residents requires Lumpkin to take the broadest view of public health possible. While a laypersonís idea of public health may only include safe drinking water, fluoridation, immunizations, and clinics to help the indigent, IDPH has helped fund research projects conducted at UIC that look at public health concerns from new and innovative perspectives. These have included an analysis of health problems in the aftermath of the huge Midwest floods in 1993, the health repercussions for workers at a now-shuttered plant that manufactured PCBs, and a measure of the safety of Lake Michigan fish for people who catch and eat them frequently.

Lumpkin sees public health evolving away from the provision of direct primary health care services, a responsibility it began to assume in the 1960s, and back into a more traditional role that will actually serve more people. "We got involved in primary health care in a major way because of what the Institute of Medicine called our assurance function," Lumpkin says. "We provided services to people who couldnít get them anywhere else, but as time goes on other providers will find that population attractive because of changes in insurance coverage, and public health will transition. We do have a unique role, and that is to deliver population-based health services. That has been and will continue to be the foundation of what we do in public health."

As a state-level advocate for public health, Lumpkin has a key concern about funding its practice in a realistic way. "Public health is underfunded, yet we are expected to be there when a crisis occurs. One of these days, weíre going to be confronted with a crisis or an epidemic, and we may not have the resources to deal with it."

Under Lumpkin, however, Illinois does have a public health planning process called the Illinois Project Local Assessment of Need, or IPLAN, which is unique in the fifty states. Through this process, the state has significantly strengthened its partnerships with local departments of public health. As part of this initiative, ninety-two local public health departments are now conducting community-based needs assessments every five years and have developed new coalitions within their communities that better address their particular health problems.

"Overall, my mission is to create conditions in which local health departments and local public health efforts can be successful," Lumpkin says. "Thatís really the point of action. If we can give them the framework, the resources, and the tools to do their programs, then the health of the people of the state will be improved."

Contributed by Rick Asa

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