Why I’m Grateful for NASTAD: Reflections from Outgoing Washington State AIDS Director and Former NASTAD Chair

By Maria Courogen November 24, 2015

As I transition out of my role as AIDS Director for Washington State, and as we enter the season of counting our blessings, I thought I would reflect on the opportunities that NASTAD has given me over the years. In my new role as the Special Assistant to the Secretary on Health Systems Transformation and Innovation, I will certainly be using and building upon the things I’ve learned as a member of NASTAD. Here are some of the things I’m grateful for:

The assistance NASTAD provided as the Affordable Care Act catalyzed broad health system transformation

People working in HIV have known for a long time about how important whole person health is, taking into account physical health, behavioral health, and oral health. We’ve also known for a long time that care received within the clinic walls is often not enough for people to be able to manage a chronic disease. Through public health efforts, we were able to develop a strong system of support for people with HIV, both medical and social. Those things are what the evolving health system aspires to, and we have the opportunity to serve as the model to influence broader system changes. It is both exciting and uncomfortable - new providers and payers, new roles for public health, new cultures and languages to learn. We want the broader health care system to serve the needs of our clients as well or better than we’ve been able to do in the parallel system we created by necessity; but, that’s going to take some time. I’ve learned so much from NASTAD in this time of transition and am very enthusiastic about how the organization is building its team to work on Health Systems Integration. Many of the people doing the work that I’m doing now have chronic disease backgrounds, and are often surprised that I’m coming from the infectious disease world - until I explain to them that people in HIV have been doing this work for a long time. You can be sure that I’ll be coming back to NASTAD for resources and with questions.

My opportunities to work with the Global Program

While I’ve been the AIDS Director since 2010, I’ve been involved with NASTAD for many years, most significantly with the Global Program, which I joined in 2003. Having worked in India, Haiti, Zambia, and Trinidad, I’ve really appreciated and learned from the multisectoral approach taken to health in other countries. Seeing the education, transportation, and economic development sectors work together to combat a health issue was inspirational; and I’m getting to see that play out in Washington in our newly forming regional Accountable Communities of Health. Multisectoral partners are getting around community tables to look at health data, prioritize actions, and make investments to solve health problems in a way that they have never done before. In my global work, I also learned lessons about operating effectively with partners who are doing similar work. In international settings, there always seemed to be multiple entities working on HIV: universities, foundations, and governmental organizations. I had the opportunity to be in conversations where the partners would talk about their specific scopes of work in an effort to make sure we collectively addressed gaps and avoided duplication of efforts. I’m having identical types of conversations in my new job related to provider practice transformation in Washington. It is well-recognized that in order to change how health care is delivered, we need to transform how providers function, so there is a lot of investment being put into this activity. My team is working to convene the conversations with partners so we can effectively work together.

How NASTAD helps state health department leadership stay focused on the important issues

Working on issues like stigma and health equity is the reason that many of us got into this work in the first place - we saw people who were not being treated fairly or humanely because of their sexual orientation, HIV status, issues with chemical dependency, or the color of their skin, and we wanted to fix it. We know how important the “bar before the bars” on the HIV care continuum is. With its ability to use population-level data to shine a light on differences in health outcomes, influence policy, and build coalitions, governmental public health can be a leader in addressing stigma and inequity. But the reality is, we often get caught up in the minutia of working in government bureaucracy, and we work for organizations that don’t have the experience or diversity to effectively do this work alone. That is why it is imperative that governmental public health programs engage and build leadership in impacted communities. I have found this to be one of the most difficult things to do, and I’m grateful that NASTAD continues to provide such strong leadership in this regard, challenging members to do more and providing tools and resources. Even in my new role, I’ll be turning to the organization to be inspired.

Most of all, I’m grateful for the leadership development opportunities I’ve had and the friendships I’ve developed over the years I’ve been involved with NASTAD. One of the first things I did in my new job is start to connect with my peers doing similar health systems transformation work in other states, knowing how important this type of support has been for me. I’m happy that public health seems to be such a small world - I’m excited to see what direction NASTAD goes in the future and am looking forward to crossing paths again with staff and members.