Public Health in Big Cities

Abstract

I had an auspicious start in public health: As a high school student in Westchester County, New York, I won a contest to be county public health commissioner for a day. At that time, my vague notions of public health were only that somehow it helped prevent diseases. As I prepare to retire from the position of Director of Public Health and Health Officer for our nation's most populous county, I reflect on the time that has passed between that day and now. After my brief foray into public health for a day, I pursued a traditional medical education, receiving my MD degree from Harvard in 1969. However, as I completed my residency in pediatrics, it became clear to me that to solve the problems of the patients I saw day after day, medicine must be complemented by broader approaches to supporting health at individual, family, and community levels. I became convinced that I could make a greater difference in the health of patients and their families by working at the population level, although it meant giving up the gratification that comes from helping patients one at a time.