INTERVIEW: Public Health Officer Matt Willis, MD, MPH

Erin Farahi

Dr. Matt Willis was named Public Health Officer for Marin County last November. A Marin native, he moved to the East Coast during high school and then spent four years on the U.S. National Cycling Team before entering Brown University, where he majored in medical anthropology. He received his MD from Temple University and his MPH from Harvard School of Public Health. After completing a residency in internal medicine at Cambridge Hospital, he spent six years in the U.S. Public Health Service, first with the Indian Health Service in Arizona and then at the CDC in Atlanta, where he worked as an epidemic intelligence service officer. He moved back to Marin in 2011 and took a job as an internist with Marin Community Clinics before joining the Department of Health and Human Services. He lives in San Anselmo with his psychiatrist wife Heather, their three children and a dog.

What are your first impressions of your new job?

This is an exciting time in the health system nationally and in Marin. Health care reform is upon us, and having straddled the line between clinical medicine and public health throughout my career, I recognize opportunities for new alliances between frontline provider systems and public health advocates. I hope to be an effective bridge between these two worlds. In my first three months as Public Health Officer, a few questions have consistently arisen, and I’m honored for this opportunity to address the physicians in the Marin Medical Society and other readers of Marin Medicine.

What exactly is the role of the Public Health Officer?

One definition of public health is “the science of creating an environment in which all people can thrive,” and that broad goal underlies all of my work. Specifically, most of my responsibilities as Public Health Officer fall into three domains: control of communicable diseases; disaster preparedness; and prevention of chronic preventable conditions.

The history of the Public Health Officer connects to the turn of the last century, when the primary threats to public health were infectious diseases. Because there were no antibiotics or widespread vaccinations, the main tools of public health were isolation and quarantine of cases and promoting hygiene to control disease spread. My early predecessors in Marin County were located at the quarantine station for immigrants on Angel Island.

Fortunately the role of the Public Health Officer has evolved significantly as social and medical science have advanced. While I carry the responsibility and authority to control the spread of communicable diseases in our population, this is only part of my job. The Public Health Officer also plays an integral role in preparedness for either natural or man-made disasters.

Today, however, the primary threats to public health are chronic diseases. The leading preventable causes of death are cardiovascular disease and cancer, both nationally and in Marin. Cardiovascular risk is especially tied to everyday decisions about nutrition and activity. So as Public Health Officer, it’s also my role to help promote an environment in which every person has the opportunity to make healthy choices every day.

How do you set public health priorities, and what have emerged as top priorities?

As clinicians know, clinical decision making is based on a combination of diagnostic data and evidence, as well as individual patient goals. Public health decision making is similar. It is largely data-driven, while remaining responsive to community priorities.

An analysis of basic diagnostic data for Marin’s health has helped clarify my goals as Public Health Officer. Marin is consistently ranked at the top in the state for county-wide health indicators. Marin’s men have the longest life expectancy of any county in the nation. Marin is a wonderful place to understand the power of healthy eating and active living. We are known nationally for supporting small farms and locally grown produce, for protecting green space, and for valuing exercise and outdoor activity. We have among the lowest smoking rates in the nation.

That culture and those opportunities are some of the reasons my wife and I chose to move our family here last year. It is a public health priority to protect and spread those elements of our shared community that have such clear health benefits. However, Marin is also a good place to understand health disparities. Taking the data to the next level, and comparing areas within Marin, we find the average life expectancy in Marin's least healthy neighborhoods is 17 years shorter than it is in the healthiest neighborhoods. Early cardiovascular mortality is a strong driver of disparities in life expectancy in Marin.

As I consider my priorities as the Public Health Officer, this data provides another clear organizer for long-term effort. County leadership, both in the Department of Health and Human Services and the Board of Supervisors, is also aligned toward addressing these disparities. There’s general consensus that how long one lives should not be based on one’s zip code.

What is the future of the relationship between health care and public health in Marin?

I see a role for enhanced partnership between public health and clinical providers in each of the three main domains of my work outlined above. For the control of communicable diseases, vaccination is an ideal model of a clinical intervention that protects both individual and population health. However, Marin has some of the highest rates of personal belief exemptions from vaccinations nationally. Public health can support providers’ vaccination efforts through effective public education and policies. This influenza season, our public health nurses targeted skilled nursing facilities--where residents are at increased risk of influenza mortality--to enhance internal capacity for staff vaccination based on evidence that SNF employees are historically under-vaccinated.

In the arena of disaster preparedness, health care providers will be among the first responders, and health care facilities need to be prepared for surges in any large-scale emergency. Our department organizes regular trainings with providers and facilities, so that all know their role in disaster response, and to secure support for those roles. Marin is fortunate to have a robust volunteer-based Medical Reserve Corps with almost 400 members. Their readiness is an important source of reassurance for all Marin residents.

Finally, public health and health care providers must partner in the shared design of the emerging health system in this period of reform. While specific reforms are being debated, increased reliance on the public health principle of primary prevention will be necessary to any sustainable system. Ultimately, health disparities will be powerfully diminished by improved prevention among those currently underserved. The Affordable Care Act, the patient-centered medical home, and increasing pay-for-performance around screening and education reflect the expectation that primary care can serve the public health goals of population-based prevention.

The local response to health care reform is an ongoing and dynamic conversation, and groups like the Marin Medical Society play an important role in consolidating key messages on behalf of clinicians. I look forward to participating in these conversations, and I would like to invite any members of the society to contact me with questions or suggestions for how I can best support your daily work as providers of health.

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Ms. Farahi is a planner/evaluator for the Marin County Department of Health and Human Services.

Email: mwillis@marincounty.org