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The Politics of Health

The New Physician March 2004
In October 2003, TNP spent
two days shadowing Dr. Eric Whitaker
to learn what life is like for a
physician in public office.



It’s 8:40 a.m. and Dr. Eric Whitaker is nowhere in sight. A helicopter, scheduled to leave 10 minutes ago, sits out-
side the Illinois Department of Transportation’s Division of Aeronautics, and the pilot peeks into the waiting room every 5 minutes to see if all of his passengers have arrived.


Minutes later, Whitaker rushes into the waiting room with his cell phone pressed against his left ear. He greets those waiting and signs in without removing the phone. With silver spectacles, graying hair and broad shoulders that have no need for the padding in his sleek, gray suit, the 38-year-old physician exudes confidence. As he strolls across the tarmac and hands his baggage to the pilot, it is impossible to tell that he is about to take his first helicopter ride.


There have been a lot of firsts for Whitaker in the previous seven months since first-term Gov. Rod Blagojevich (D) appointed the Chicago physician director of the Illinois Department of Public Health (IDPH) on March 25, 2003. Only seven days later, on April 1, Whitaker officially took over a state agency with 1,200 employees and a $330-million annual budget. “April Fools’ Day. There’s a joke in there somewhere,” Whitaker says, laughing.


It certainly seemed like a practical joke when he was first approached by Blagojevich’s gubernatorial transition team. After all, Whitaker had never met the governor-to-be and didn’t know anyone in his circle of advisers and confidants. So when he was asked for a résumé, Whitaker didn’t think much of it. “At the time, I thought I would be offered a position on some sort of body—some sort of state board, like a state board of health—because that is something I have done a great deal of…. Two weeks go by, and then someone calls and says, ‘We would like to interview you.’ I was a little bit shocked, because I wasn’t applying for a job.”


It turns out he was applying for a job; he just didn’t know it yet. An associate of the governor’s had floated Whitaker’s name as possible head of public health. A telegenic and well-spoken physician from the South Side of Chicago, Whitaker had gained a great deal of recognition—including stories by the Associated Press, PBS and local media—from his success with Project Brotherhood: A Black Men’s Clinic.


UNDERSTANDING BROTHERHOOD


Project Brotherhood was created in 1998 in the Woodlawn section of Chicago, where black men face high rates of heart disease, hypertension, diabetes, AIDS and death by homicide but have little desire to seek health care. As a result, the life expectancy for black men in Woodlawn is 58, almost 20 years less than for men in the affluent Hyde Park neighborhood only blocks away.


With the support of community organizations, Whitaker set about to address this problem the most logical way—he asked the men why. Focus groups discovered they wanted several things: a health center that showed them respect, where they can relate to the health-care provider; a center that wasn’t seemingly designed for women and children; and, most of all, a way to seek help without appearing “weak.”


For Whitaker, there was an obvious solution: the barbershop. In many black communities, the barbershop is a place of refuge for men, a place where they can speak freely and frankly. By establishing a facility with a free barbershop in the front and health care in the back—staffed entirely by black men—Whitaker started drawing between 20 and 50 men to the weekly clinic. Project Brotherhood has become such a success that it has garnered not only national media attention but also received the National Association of Public Hospital and Health Systems’ highest award in 2000.


THE GOVERNOR'S CHOICE


With these accolades, it’s easy to see why Whitaker caught Blagojevich’s attention. But, it was still difficult for him to imagine being offered such a lofty political position. After all, he was just an internal medicine attending at Cook County Hospital. He wasn’t a politician or a bureaucrat. His most significant previous political experience was the year he served as national president of the American Medical Student Association (AMSA). He was hoping that and all of his other experiences might lead to an influential public health position someday. But not yet.


“The fact of the matter is that a lot of my role models that I learned about at AMSA, they did a job like this in their lifetimes. [And] I thought I would do [something like this] eventually. I just thought it would be 10 years from now,” he says.


However, his age and lack of bureaucratic experience wasn’t particularly important to Blagojevich’s team. What they saw in Whitaker was an innovative vision of public health.
“When I walked into the interview—I am interviewing with the chief of staff for the governor—and I basically outlined for him a social-entrepreneurial vision of what public health could be at the community level—I mean I basically consider myself a social-entrepreneur, you know, taking ideas and making programs, with no money. So I laid out how you could empower communities to do similar things like we were doing with black men’s health in the community where we worked. He sat there and listened to me, and then he called some other people into the room, and he asked me to tell them what I just told him.”


From that interview, Whitaker learned he was one of five candidates for the director of public health post. A couple more rounds of interviews, and that number dwindled until only Whitaker remained.


TAKING OFF


That was March 2003. Now it’s late October and Whitaker sits in a state-owned helicopter with George Rudis, assistant deputy director of the IDPH’s Office of Finance and Administration and a 27-year veteran of the agency. Minutes into the flight, Rudis shouts over the roar of the rotors the name of a possible appointment to the department’s vacant head of vital records. Whitaker notes it’s one of the few empty top-level positions—not that there aren’t more to come, but he’s still in the process of evaluating the organization and has decided not to make major personnel or structural changes until he’s done. “Some people come in and sweep everyone out…. That’s not my style,” he says.


Soon, the helicopter makes a pit stop to pick up John Pitzer, who is the regional health officer (RHO) for the Edwardsville Region, an area covering counties in central southwest Illinois. Pitzer is also the acting officer for the Marion Region in the predominantly rural south and southeast counties of the state. While he has many responsibilities, his position often boils down to being a focal point of communication between local health departments and the IDPH. And at IDPH headquarters in Springfield, it is Rudis who acts as a liaison to Pitzer and six other RHOs.


With the late start, they are running behind for a 9:30 a.m. meeting. Of course, Whitaker’s delay was caused by an early morning cabinet meeting at the governor’s mansion, which means his tardiness receives automatic forgiveness. On this day, that understanding will come from health board members and staff of the Southern Seven, a coalition of the seven southernmost Illinois counties. With more than 72,000 people spread over more than 2,000 square miles, the geographic obstacles in this region alone make it difficult for local health officials to serve their communities.


Shortly before 10 a.m., the helicopter sets down on a small landing pad at Shawnee Community College in Ullin. A van takes the director and his party to the other side of campus where the Southern Seven Health Department sits and where more than 25 people wait to meet with the director.


Whitaker begins his first visit to the Southern Seven by diving into the issues concerning them most: the cost of malpractice insurance, the uninsured, state scorecards on public health, the monitoring of nursing homes, the use and distribution of data collected by the agency, the allocation of bioterrorism money and the lack of health-care personnel. He closes his speech by announcing there will be changes in the IDPH philosophy. “[The previous administration] told [the IDPH], ‘We don’t care what you do, just don’t get in trouble.’ Well, I’m trying to get in trouble,” he says.


The call for change is welcomed by Southern Seven health officials, but they remain skeptical. As is the case in many rural communities, local administrators often feel overlooked in favor of the more populated Springfield, East Saint Louis and, above all else, Chicago. With a new IDPH director from Chicago, there may be an even greater sense of apprehension, but it is unapparent today.


MAKING TROUBLE


In Whitaker’s case, the sense of change is profound. After all, his predecessor, Dr. John Lumpkin, served for 12 years under two Republican governors. So beyond changing IDPH philosophy to be more social-entrepreneurial, as Whitaker would put it, there is also a need to transform the culture. That is why Whitaker is quick to point out that Blagojevich has encouraged him to “get into trouble.” In this case, trouble means challenging accepted practices and finding new ways to get things done.


Just days before this trip to Southern Illinois, Whitaker and Blagojevich found a great deal of “trouble” when the governor’s office issued a report declaring the state should seek an exception from the U.S. Food and Drug Administration (FDA) so it could purchase prescription drugs from Canada. The report, which was based on a trip to Canada by an 11-person delegation led by Whitaker, said the state could save more than $90 million a year by establishing a program to buy prescription drugs from Canada for state workers and retirees. And contrary to the FDA’s stance, Whitaker’s delegation found that drugs from Canada pose no significant safety concerns.


The story gained national media attention and consumed much of Whitaker’s time early that week as he fielded questions about the report and provided counsel to the governor. And that media frenzy came on the heels of another big story as Illinois became the first state to receive the highest rating from the U.S. Department of Homeland Security and the Centers for Disease Control and Prevention (CDC) for its preparedness to rapidly distribute pharmaceutical and medical supplies in the case of a bioterrorism attack. Under the plan, Whitaker is the state’s designated official who, in consultation with the governor, would trigger a request for deployment of supplies.


Before that, there was another national story to deal with—the outbreak of monkeypox after an infected prairie dog was sold from a pet store outside of Chicago. However, what could have been a public health disaster—not to mention a public relations nightmare—was instead a shining moment for the IDPH.


With last minute notice from the CDC that it was investigating the pet shop, the IDPH set into action. “Over the next 10 hours, we assembled this group who worked through the legal issues for quarantining; we set up an 800 number for people who had prairie dogs and Gambian rats so that they could call for information; we worked together with the [state’s] Department of Agriculture to reach out to veterinarians and to pet store owners to let them know this was occurring; we also informed all infectious disease doctors in the state; and we sent state police out to contact people…. We marshaled all of the forces and coordinated an interagency solution to this problem.”


All of this occurred only a month after Whitaker and the IDPH participated in TOPOFF2, a massive, five-day, $16-million terrorism drill conducted simultaneously in Seattle, Chicago and Washington, D.C. Barely a month into the job, it was a wake-up call for Whitaker on how demanding the position could be and how much he would have to learn on the fly. Regardless, the IDPH and the state received high marks for their performances.


Whitaker believes these achievements set the tone for the IDPH to have a good relationship with the governor. “You learn about people in the midst of crisis, and they learned I would work with my team to do what is right for the public: Keep them informed and stay ahead of problems. As they get confidence in your ability to manage and be a good representative to do things, you get more freedom to do things.”


ON THE ROAD


Following his speech to Southern Seven health officials and a tour of a Head Start program, Whitaker sits down with local staff members for a catered lunch. Not surprisingly, the menu is barbeque—word is out that it’s one of the director’s favorites. But before he has a moment to savor the food, he’s back in the helicopter, leaving Ullin and heading about 20 miles away to the town of Anna for a meeting with more local health officials.


The helicopter lands at Union Hospital in Anna a little after 1:30 p.m., and a van rushes Whitaker, Rudis and Pitzer to city hall where an audience awaits them. While the crowd is smaller than expected—only 25 people are in attendance, as compared to the 60 anticipated—it makes little difference to Whitaker. He jumps into the issues facing the IDPH and local health officials and appears to strike a chord with the audience, reinforcing the importance of rural health and noting that the department considers rural residency to be one of the many factors contributing to health disparities in Illinois. As he did in Ullin, he also touches on the importance of providing reinforcements for an aging health-care work force.


After taking a moment to speak one-on-one with audience members, shake hands and pose for pictures, Whitaker dashes back to the helicopter. Mercifully, the day’s meetings have come to an end. Still, there is more work to do.


NO PLACE LIKE HOME


Since the moment he accepted the position, Whitaker has been moving at this pace. The past week alone, he had press conferences about the drug importation report and the Homeland Security rating—and that was while he was at home in Chicago on paternity leave, celebrating the birth of his second child, Caitlin, with his wife, Cheryl.


Since the job requires him to be in Springfield at least three days a week—five days when the legislature is in session—he knows that he will miss many of his daughter’s early achievements, not to mention the “daddy phase” his son, Caleb, is going through. “My previous position, I had a lot of flexible time where if I needed to pick up my son from school because he was sick or other things, I was there,” he says.


When thinking about his family, Whitaker wonders how long he can keep this up. At those times he thinks he’ll merely be a one-term wonder. But at other moments—when he feels he’s making a real impact—he thinks he’ll do this as long as he can, or at least as long as Blagojevich remains on the job and wants him to continue. “I have never been more happy professionally than I am right now…. The only reason [my wife] allows me to be away from home the way I am is that she knows I can make a meaningful difference.”


Landing just before 4 p.m. at an airport in Mascoutah, about 25 miles east of St. Louis, Missouri, Whitaker is on his cell phone with Rory Slater, special assistant to the director. Slater and Quin Golden, Whitaker’s chief of staff, are deciding when they’re going to leave Springfield and head down to Fairview Heights, where Whitaker and Rudis will be spending the night. Surprised they haven’t left yet, Whitaker strongly advises them to leave soon and reminds them to bring his laptop.


By 7 p.m., Whitaker, Slater and Golden huddle around a table in the hotel restaurant with a box filled with documents occupying the extra chair and urging their attention. Whitaker refers to Slater and Golden as his right and left hands. He also says he’s not sure who’s in charge of whom sometimes, but for Slater and Golden there is little doubt. They say Whitaker is a demanding but fair boss who drives them to make the IDPH a better agency. Golden says it’s nice to work with someone so committed, noting Whitaker asks a lot of them, but expects a lot of himself too.


For tonight, however, there seems to be a respite in the work. As all three have had a long day, Whitaker declares at 8 p.m. he’s going to take advantage of a rare opportunity to watch “The West Wing.”


A COUNTRY DOCTOR


By 6:30 a.m. the following morning, Whitaker and his right and left hands are already at work. The day does not begin pleasantly for Whitaker, who learns that the 15-minute talk he had planned for today’s St. Clair County Health Care Consortium Conference in nearby Belleville is, in fact, an hour-long presentation and participation in a town hall meeting with three other speakers. He’s not overly concerned, though; the conference is about health disparities, and Whitaker has been asked to speak about Project Brotherhood.


They arrive at the conference on schedule, and the meeting gets underway with some opening remarks. Then Whitaker, joined by a local state representative, makes a $12,500 check presentation to Southwestern Illinois College Programs and Services for Older Persons for an initiative that provides AIDS care and education to the elderly. Following some stereotypical political pictures—Whitaker and others standing behind a giant check—the first speakers step to the podium and present a variety of charts and graphs illustrating the severe health-care disparities between whites and blacks in St. Clair County.


After 35 minutes of numbers and statistics, it’s Whitaker’s turn. However, there are no charts or graphs in his presentation. That’s not his style. The Chicago physician prefers to address the large audience much as he would speak to longtime patients. He uses casual language and moves his speech along at a leisurely pace, interjecting fond personal memories and stories. For a discussion on Project Brotherhood, this is particularly easy.


Unfortunately, like time with his family, Whitaker’s clinical work has been sacrificed for the IDPH. “Hopefully as we get better control of the agency, I’ll be able to do more of that,” he says.


As the town hall meeting begins, an audience member contests the racial element in Project Brotherhood, saying that for St. Clair County it may be inappropriate and unnecessary to have a clinic staffed solely by blacks. Whitaker explains that’s not the point. He says the point is to learn what keeps people from seeking health care and then doing something about it. Next, he outlines common problems facing the disadvantaged in urban and rural areas, opening with a favorite line. “I’m a simple country doctor from the South—the South Side of Chicago, that is,” he says with a grin.


Making a connection to this and other rural areas of Illinois is an early priority for Whitaker. “The major issue for me is to get out to areas that I don’t have a lot of information about from personal experience and to hear issues that get raised.”


And with the distrust rural health officials have developed of their urban counterparts, trips like these become even more important. “There are some commonalities to issues from the urban to rural areas, problems with access to medical care, access to oral health. But there are unique issues, like the medical malpractice issue…. I can’t sit in Chicago and make decisions in a vacuum, because otherwise I would be missing the whole picture.”


After grabbing boxed lunches, the IDPH group continues its tour of Southern Illinois, traveling from Belleville to Granite City, a steel mill town along the Mississippi River. They arrive at Coordinated Youth and Human Services, a United Way-run facility. A moving van sits outside, and workers carry in furniture from the organization’s Marysville clinic, which was closing due to a reallocation of Medicare funds. The loss of funds is one of the many subjects touched on by the program coordinator during a quick tour of the facility, which is followed by a brief meeting.


The visit lasts about 30 minutes, and Whitaker and his staff are back on the road, going to Madison County Health Department, which is located in a vacated hospital in Wood River. Toni Corona, the recently hired county department administrator, greets Whitaker, saying, “We welcome your enthusiasm. I have to tell you, you get me fired up.”


After a tour, Corona leads Whitaker to the lunchroom where local officials have gathered. Immediately upon entering the room—just as they did in Belleville—Slater and Golden move to the back to work. Golden plugs in her laptop, and Slater taps feverishly on his Palm Pilot. Wherever they go, the work never seems to stop. “I’ve never seen a group so plugged in,” Rudis says.


While they attend to IDPH correspondence, Whitaker works the crowd, sitting with local health board members and asking about their experiences, both personal and professional. In this environment, he looks like a polished politician, not just some physician-turned-bureaucrat. “I love politics. I think all relationships in life are political, and this is just taking it to a much, much higher level,” he says.


As his speech begins, it takes a familiar tone to those of the day before. When he begins discussing the IDPH’s bioterrorism response effort, an audience member’s cell phone rings—oddly, it sounds like a siren. “[That’s] the last thing you want to hear when talking about bioterrorism,” Whitaker says.


He wraps up his speech by promising changes within the department and the commitment to make serious changes in the state’s public health. “I can be ambitious. I don’t know any better…. My being here is a fluke. I didn’t even know this was a career path.”


With the audience hanging on his every word, that’s difficult to believe.
Scott T. Shepherd is an associate editor with The New Physician. Direct comments and questions about this article to tnp@ amsa.org.