New state health commissioner: Not more with less, but ‘differently’ with less

People who work with Dr. Jewel Mullen at the Massachusetts Department of Public Health remember her first day on the job in 2008 as one that brought more than a new boss.

“The day Jewel started, we always joke that as she drove up from Connecticut or wherever she was, she arrived on the day of major budget cuts,” said Cheryl Bartlett, director of the department’s Division of Prevention and Wellness, one of the sections Mullen oversees as director of the Bureau of Community Health and Prevention. “She had to jump right in.”

Dr. Jewel Mullen

It’s an experience that could prove useful for Mullen, Gov.-elect Dan Malloy’s pick to lead the Connecticut Department of Public Health.

Malloy has not signaled any intention to cut the health department’s budget, and has spoken about the need for a more robust public health system and a desire to beef up the state’s efforts to prevent tobacco use and lead paint exposure in children. But with the state facing a massive budget deficit, knowing how to deal with dwindling resources is almost certain to be a key skill for his commissioners.

In Mullen, those who have worked with her say, Malloy tapped a thoughtful leader and skilled communicator, an advocate for making health care more focused on patients and preventing, not just managing, chronic diseases.

“You got a good hire there,” said Dr. Andrew Balder, who was part of the team that hired Mullen in 2001 to serve as medical director at the Baystate Mason Square Neighborhood Health Center in Springfield, Mass. Balder said Mullen applied for a clinician position at Baystate Medical Center, but one of the department leaders who interviewed her recommended Mullen for the more senior position she eventually got.

An internist with degrees in public health and public administration from Yale and Harvard, Mullen takes a broad view of patient care, emphasizing the need to treat the “whole” patient, not just a disease or body part.

In Springfield, she participated in early efforts to make the city more suitable for walking and other physical activity, Balder said. She also worked to revamp the health center’s medical practice to make it more patient-centered and efficient, and managed to gain acceptance from residents of the community.

At the Massachusetts Department of Public Health, Mullen championed the importance of prevention, constantly urging staff working on programs for managing chronic diseases to consider ways to prevent the conditions too, Bartlett said.

“People who work in public health want to do everything a lot of the time,” Mullen said. “They want to do everything for everybody. And we joke and say, ‘that’s because we’re public health.'”

That view can make budget cuts even more daunting. But Mullen said the budget situation in Massachusetts also presented a chance to rethink the department’s efforts.

“It was actually an interesting and almost affirming time to be starting this at the time of the economic downturn, because one of the other things we were hearing nationally was that government had to be efficient,” she said. “What I had to say to my staff was when you hear cuts, you automatically think do more with less, but it was also important for me to reiterate that it might just be that we had to do differently with less.”

That meant determining what the department could live without for a year, like certain staff trainings; figuring out which services people could get from other sources, like television ads about specific diseases; and how to help community organizations cope with cuts to their state funding. It also meant preserving programs that provided direct services to people who would go without if the department didn’t provide them.

“One of her quotes I remember during this is, ‘We’re cutting to build,'” Bartlett said. “While we’re cutting, we also need to be thinking about what next, and so to be cutting thoughtfully, so that we could continue to build when opportunities to build either come back or new opportunities occur.”

Mullen traces her interest in health, and the broad range of factors that affect it, to her childhood in New Rochelle, N.Y. She remembers learning about the public health system from going to the public health department to get vaccines.

Mullen’s mother wanted to be a nurse, and although she never became one, she served as a resource for the community. People would come by and ask questions if someone was sick. Her grandparents cared for foster children while Mullen was growing up, which she said made her aware of the different needs families had.

She also remembers that not everyone in their community had access to medical care or healthy food. It gave her an awareness that deepened during her medical training, when she saw the effects of the newly identified HIV virus.

“You start to see early on that different population groups are disproportionately affected by certain conditions,” she said. “And if you don’t work on those conditions and risk factors, people can’t be healthy.”

Mullen, who has taught at Yale, Tufts, the University of Virginia and New York University, said she cautioned students to consider outside factors when counseling patients. It is simple to tell an overweight patient to eat less, she said, but the doctor should consider whether the patient has enough access to healthy food to be able to eat properly.

“One of our responsibilities is to counsel our patients about what they can do for themselves to help themselves to be healthier, but we need to do that with an understanding of how easy it is for patients to take our advice,” she said.

As commissioner, Mullen wants to make sure Connecticut’s relatively strong overall showing in health indicators does not obscure deeper needs in some parts of the state.

The state has among the lowest rates of obesity in the country and a lower rate of diabetes than the nation overall. But obesity rates are significantly higher in cities and among minorities. And diabetes rates are far higher among black and Hispanic residents than whites.

“It’s really important for me to look at the health of Connecticut not just with the broad brushstrokes of data that we get, but to also drill down and say where should we be doing better to make sure that the general statistics that look good are reflected across a lot of different groups and communities,” said Mullen, whose family has lived in Connecticut since 1992. She has an apartment in Boston where she has stayed during the week while working at the Massachusetts health department.

Mullen declined to comment on her impressions of the Connecticut health department or what she hopes to change, saying it is too soon to say before she meets with department staff and learns more about their work.

“I walk into my position with a real belief that under the leadership of the governor-elect, we can do a good job to adjust in the ways that we need to to continue to serve the people of Connecticut and grow as a department of public health,” she said.