Guest blog by Ali Abazeed, IPP ’23
Introduction
In the quiet bustle of my hometown of Dearborn, Michigan, the city that put the world on wheels, a new kind of revolution is brewing within the halls of government that brings the same locomotive force as a motor vehicle. Except this vehicle isn’t propelled by four wheels and a combustible engine. Rather, the vehicle is a lens that allows the city to incorporate health considerations into everything we do as a city government.
Dearborn Public Health (DPH) formally launched in April 2022, becoming just the 2nd city in Michigan with a health department. The department is piloting an interdisciplinary health-in-all-policies approach that integrates and articulates health considerations across government to improve the health and well-being of residents across the life course. As the founding director of public health, I found myself at the forefront of this transformative movement and brought this work to the corridors of this classroom. The Implementing Public Policy program at the Harvard Kennedy School’s Executive Education became my compass, guiding me through the uncharted waters of policy integration.
Key Learnings: The Harmony of Diverse Voices
The IPP course provided valuable insights into the complexities of governance, which came at an opportune time for us in Dearborn. We faced the challenge of innovating not only in a low-resource setting but also in a time when most people did not view public health favorably. Coming out of the throes of a once-in-a-century pandemic, the Department faced the daunting challenge of restoring the public’s trust in public health measures viewed as barriers to joy and health rather than aids. Amidst this context, I had to figure out how to develop new practices and habits in government while working with these vaunting challenges.
Almost immediately and especially after our week together in person, the course taught me that successful policy-making is akin to an orchestra—every department in our government is a unique instrument, each with its own timbre and tone. The synchrony lies not in uniformity but in a symphony; in orchestrating a symphony where differences in perspective are not dissonant but enriching. With humility and patience as my baton, I learned how to begin conducting this ensemble, transforming cacophony into a concert of collaboration.
Implementing a Vision: Dearborn’s Health in All Policies Approach
My immediate implementation challenge was certainly daunting: building a health department from the ground up, without any staff, budget, or immediate resources, and with the added challenge of implementing a Health in All Policies (HiAP) approach across all government operations. This meant infusing a health-conscious mindset into every department, so that public health would be a fundamental consideration in every policy decision made by the city.
As a fresh addition to the municipal ecosystem, our department was responsible for promoting health and showcasing its inherent worth in every policy discussion.
Before founding the Department of Public Health, I worked in the federal government for five years, first as a Presidential Management Fellow and then as a public health advisor at the National Institutes of Health. Quickly, I realized that building connections in other agencies and departments was crucial to my work. Crucially, I had spent time working with the Implementation Science team at the National Cancer Institute, collaborating with policy practitioners from across the country to advance health policies from discovery to delivery. In this work, I realized not only the importance of interdisciplinary collaboration but the actual value of working outside of siloes. This lens helped me when I took over in Dearborn.
Progress and Insights: Cautious Steps to Confident Strides
Throughout the IPP program, my approach to collaboration underwent a profound transformation. Each assignment, each peer discussion, and each reflective exercise—culminating in the creation of and continued iteration of visual tools like the fishbone diagram—provided a clearer picture of the intricacies involved in policy implementation. I began the course treading carefully, aware of the fragility of new relationships and the skepticism that often greets innovation. But as weeks turned to months and I spent time with my peers in the IPP program, learning from and engaging in robust exchanges, my trepidatious steps became strides. The trial and error that once seemed daunting became empowering, leading to significant breakthroughs in how I engaged with key authorizers and stakeholders in Dearborn.
During our in-person training, we participated in an exercise where we played the roles of key decision-makers in our challenge. Our task was to persuade a stakeholder, who was serving as a barrier, to join us. I remember working with a classmate who asked me important questions and provided a valuable perspective. Through a role-playing exercise, he suggested that one of the departments acting as a barrier in my challenge might be trying to support me. Still, he was undergoing its own changes that I underestimated.
The Long Approach: Reframing the Problem-Solving Paradigm
Those interactions and this journey overall redefined my conception of problem-solving. In a realm where instant gratification and results are often prized, patience emerged as the unsung hero. Recognizing the importance of acclimatizing others to our department’s vision meant recalibrating my approach to include key stakeholders from the outset. This early inclusion serves as the cornerstone of sustainable policy implementation, ensuring that when changes are introduced, they are not foreign edicts but familiar concepts that have been nurtured from the seed stage.
Application of Learning: The Intersection of Hard and Soft Skills
While hard skills form the backbone of any policy initiative, soft skills breathe life into its body. Negotiation, communication, and delegation have become the sinew and muscles that allow the Department of Public Health to move and adapt. These skills extend beyond the conference room into the very ethos of our operations. They are tools that I now wield with precision and care, ensuring that each interaction and decision is imbued with a sense of purpose and partnership.
Words of Wisdom: The Patient Artisan of Change
To my fellow practitioners of the Problem-Driven Iterative Adaptation (PDIA) approach, I offer this reflection: we are artisans of change, and our craft requires the patient layering of efforts and ideas. The temptation to seek immediate results is natural and understandable, but the architecture of lasting change is built over time. In any organization, especially in government institutions with strong muscle memory, innovation always has obstacles. To achieve the desired long-term results, involving those who oppose change from the outset can help us understand the scale of the challenge and identify the steps we need to take to achieve our objectives.
Threading and Weaving Our Way to Progress – Thank you
The tapestry of public policy is intricate and expansive. As I thread health considerations into its weave, I find the pattern becoming more apparent. This post is not just a reflection but an invitation to all who believe in the power of inclusive governance. The lessons from the IPP course have become the guiding principles for our department’s journey, and our progress is a testament to the potential of collaborative, patient, and holistic policy-making. With thanks to Matt, Salimah, Jessie, Daniel, Kriti, and Alison for facilitating a learning journey that I am incorporating every day, health in all policies is a guiding star across Dearborn.
Together, we stand at the threshold of a new era in Dearborn, where every policy decision is a step toward a healthier, more equitable community. As I share these insights, I hope they resonate with you, inspire you, and encourage you to weave your own narratives of change into an innovative new fabric of public service.
This is a blog series written by the alumni of the Implementing Public Policy Executive Education Program at the Harvard Kennedy School. 47 Participants successfully completed this 7-month hybrid program in December 2023. These are their learning journey stories.