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Success in a flatter, more distributed and collaborative universe will necessitate a new coevals of leaders in public wellness with new mentalities, an appetency for invention and interdisciplinary coaction and a strong dosage of political understanding[ 1 ].

Kimberly JR

10.1. Introduction

Public wellness is a invariably germinating field, with new challenges and new forces that necessitate legerity and creativeness to protect our communities. High public presentation and flexibleness are non merely utile properties. They are day-to-day endurance demands for public wellness. Public wellness has added to its capacity to germinate rapidly and accommodate in a changing environment[ 2 ].

Recent developments in the field have highlighted that public wellness leaders should:

Demonstrate transparence, unity, and honestness in all actions,

Apply societal justness and human rights rules when turn toing community demands, and

Engage in duologue and larning from others to progress public wellness ends.

These are discussed in Sections 2 through 4.

10.2. Integrity, Honesty and Transparency

When asked, what was the most of import characteristic people sought in their leaders, unity was by far considered the most of import[ 3 ]. Followings need to swear their leaders to make what is in their best involvement. Therefore, leaders need to take with unity and honestness.

Integrity and honestness are guided by personal and organisational values. Each leader needs to specify his/ her values and organisations should specify and perpetrate to its values. There can be many possible values that one could take. So there is a demand to prioritise them and happen basic values that will find most of the other values.

Valuess need to be emphasized once more and once more in footings of conversations, actions and duologues within the organisation.

Webster ‘s dictionary defines unity as house attachment to a codification of values or the quality or province of being complete or undivided. Integrity means consistent behaviour that matches the values system a individual or organisation has. Trust is created when leaders ‘walk the talk ‘ and model the values in hard fortunes. Keeping unity and honestness guided by values by a leader will ensue in these qualities pervading within the organisation[ 4 ].

Human resources direction has a critical function to play in making a civilization of unity and honestness[ 5 ]:

Recruit new employees with concern for unity ;

Model unity in choice, assessment, publicity and other wagess within the organisation ; and

Discipline the transgressors.

Transparency is non an act ; it is a procedure. A leader or an organisation that strives for transparence non merely does non conceal anything but besides proclaims that we are proud of what we do and how we function. This is merely possible if the leaders and their organisations have unity and honestness. Transparency on the other manus besides supports unity and honestness.

Stephen Covey[ 6 ]says that — merely as trust is the key to all relationships, so besides is trust the gum to all organisations. It is the cement that holds the bricks together. Trust is the fruit of trustiness of people and their organisations. The trust comes from three beginnings: the personal, the institutional, and one individual systematically taking to give it to another – an act that leads one to experience another ‘s belief that one can add value. Trust is a verb AND a noun. When it is both a verb and a noun, it is something shared and reciprocated between people. That is the kernel of how a individual becomes the leader of their foreman. They merit trust by giving it. A trusty organisation will maintain its promises. Peoples will make what they say and they will make it systematically.

Without unity, trust is ne’er achieved. The best leaders are crystalline: they do what they say ; they “ walk the talk ” . Therefore, people believe them. Integrity comes from a strong sense of values. Acting with unity besides means being consistent with one ‘s picks and actions.

Integrity requires personal bravery to continue the values in benign every bit good as hard fortunes ( Covey, 2005 ) . Principle-centered leading is frequently accompanied by a strong sense of humbleness and bravery which has unity at its bosom. The power, wisdom and counsel for leader additions as these rules are applied.

Leaderships in the public wellness sector need to adhere to the highest degree of unity and moralss in their behaviour. Their honestness must use to their traffics with public, co-workers in their organisations, join forcesing spouses, and the media.

The key to high public presentation is for unity to be portion of a leader ‘s daily actions and thought, non merely when large determinations are needed but even little ordinary 1s that have deductions for or impact on person.

Social Justice, Health Equity and Human Rights

The three Fieldss of societal justness, wellness equity and human rights have different cardinal constructs, positions, linguistic communications and tools of action but have many points of intersection.[ 7 ]

Social gradient

In reasoning for shuting the spread in wellness disparities and life chances within a coevals ( 30 old ages ) , the Commission on Social Determinants of Health ( CSDH ) , says that in states at all degrees of income, wellness follows a societal gradient – that is, the lower the socio-economic place, the worse the wellness. Puting right these unfairnesss – the immense and remediable differences between and within the states – is a affair of societal justness[ 8 ].

“ The hapless wellness of the hapless, the societal gradient in wellness within states, and the pronounced wellness unfairnesss between states are caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, seeable fortunes of people ‘s lives – their entree to wellness attention, schools, and instruction, their conditions of work and leisure, their places, communities, towns, or metropoliss – and their opportunities of taking a booming life. This unequal distribution of health-damaging experiences is non in any sense a ‘natural ‘ phenomenon but is the consequence of a toxic combination of hapless societal policies and programmes, unjust economic agreements, and bad political relations. Together, the structural determiners and conditions of day-to-day life constitute the societal determiners of wellness and are responsible for a major portion of wellness unfairnesss between and within states. ”

Commission on Social Determinants of Health ( CSDH ) , Closing the spread in a coevals: Health equity through action on the societal determiners of wellness: Concluding study of the Commission on Social Determinants of Health. ( Geneva, Switzerland: World Health Organization,

2008 ) . Available at hypertext transfer protocol: //


Health equity is determined non merely by the societal determiners of wellness – conditions of day-to-day life and unjust distribution of power, money and resources, gender, poorness and societal exclusion – – but besides other determiners of wellness such as safe H2O, equal sanitation, adequate alimentary nutrient and lodging, healthy occupational and environmental conditions, and entree to health-related instruction and information. The public wellness leaders need to understand the comparative function of assorted determiners of wellness in the context – topographic point and clip – where they are working.

While societal gradient is said to take to wellness gradient, the contrary relationship has non been investigated in every bit much deepness as the former. The issue at manus is – how much the impact of societal unfairness can be mitigated by policies in the Fieldss such as H2O and sanitation, nutrient security, targeted nutrition intercessions and primary wellness attention. Often it is argued that even when such policies and plans are in topographic point, better-off people tend to profit more than those who are needier. However, it could be argued that wellness equity indexs can be a step of societal unfairnesss in a society.

Rights-based attack

On the human rights side, Article 12.2 ( B ) of the International Covenant on Economic, Social and Cultural Rights[ 9 ]enumerated the following four stairss to be taken by the State parties to accomplish the full realisation of the “ highest come-at-able criterion of physical and mental wellness ” :

The proviso for the decrease of the still-birth rate and of infant mortality, and for the healthy development of the kid ;

The betterment of all facets of environmental and industrial hygiene ;

The bar, intervention and control of epidemic, endemic, occupational and other diseases ; and

The creative activity of conditions which would guarantee to all medical service and medical attending in the event of illness.

A rights-based attack including intervention of underlying determiners of wellness in the attack, tends to place the province ‘s duties and assesses the extent to which they are fulfilled. In this attack people are non donees but ‘claim-holders ‘ and service suppliers are ‘duty-bearers ‘ .

The attack to the underlying determiners by members of the human rights community tend to be narrower both in construct and accent from the function that societal determiners play in the CSDH study. While wellness system is an of import factor in human rights considerations, the CSDH study treats it as one of the societal determiners.

There is a difference in wellness inequalities versus wellness unfairnesss. Inequality in wellness can non distinguish wellness results independent of any appraisal of cause or equity. On the other manus, CSDH says[ 10 ], “ Where systematic differences in wellness are judged to be evitable by sensible action globally and within society they are, rather merely, unfair. It is this that we label wellness unfairness. ”

By and large wellness equity can be considered from the four dimensions[ 11 ]:

Universal entree to wellness attention.

Many states do non hold fiscal resources to pay for effectual wellness systems presenting comprehensive wellness services including preventative services to all its citizens. In add-on, other barriers – informational, societal and physical — besides operate to take away from cosmopolitan entree.

Non-communicable disease.

While cosmopolitan entree to wellness attention and preventative public wellness services including H2O and sanitation can turn to many catching diseases and there is some success on that forepart, NCDs have emerged as a major menace. It is estimated that by 2020, NCDs will be responsible for 60 % of sickness worldwide and seven deceases in every 10. Most will be in developing universe. By and large the hazard factors are the consequences of rich diets, deficiency of physical activity, intoxicant and baccy usage although hapless may besides endure as a consequence of infection, unequal nutrient, pollution and deficiency of basic wellness attention.

Role of community.

Strong protagonism is needed in the communities if wellness is to be prioritized. Among populations most vulnerable to illness, capacity for effectual grassroots action rests on attacks that build local capacity non merely to entree wellness attention and other services but besides to turn to other determiners of wellness.

Settings of natural catastrophes and exigencies.

Rights -based models can offer considerable advantage to guarantee wellness services in such state of affairss.

The accent in human rights is on equality of self-respect, legal standing and legal position, and non equability in societal or economic place. The former may non needfully take to the later and perchance even frailty versa. Non-discrimination as human rights can be an of import step for wellness equity.

The countries of convergence and complimentarily between societal justness, wellness equity and human rights are significant although their nature of concerns, attacks and accent vary.

The public wellness leaders concerned with wellness equity need to pay closer attending to societal determiners of wellness and underlying societal unfairnesss and be prepared to utilize legal human rights enshrined in human rights model to act upon them ( Figure 1 ) .

Social justness

Determinants of Health

Health equity

Human rights

Figure 1 Social justness, human rights and wellness equity

Dialogue and Learning

The leader of the yesteryear was a individual who knew what to state. The leaders of the hereafter will be a individual who knows how to inquire.

Peter Drucker wellness leaders need to maintain up with the quickly changing and increasing complexness of the public wellness field. Therefore, they need to go on to larn. They would necessitate to have feedback and to beg new thoughts from a diverseness of stakeholders. The critical beginnings of information would include people and community leaders, leaders of other wellness establishments, professionals working in other related sectors, research workers and politicians. They can seek the feedback in a assortment of ways- though direct and indirect contacts, societal networking, studies and interpersonal duologues.

The public wellness bureaus need to go learning organisations[ 12 ]. The learning organisation will necessitate leaders who will continuously larn. Peter Drucker said that persons have different manners of larning – through hearing, reading, and through observation, experience and contemplation[ 13 ]. They need to place mix of their manners and so form their acquisition.

However, there is a possibility of information overload. Therefore, leaders need to prioritise. On their personal leading journey, they can place a few ( one to three ) key countries that they seek to better, fix an action program, implement, and follow-up with colleagues to see if betterments have taken topographic point.

In decision, public wellness leaders of the hereafter will hold to larn, alteration and turn on the occupation. They will necessitate to make out to multiple stakeholders, ask for inputs, respond in a positive mode and implement action programs. Through this iterative procedure, they will go more effectual.

Effective Dialogue as a Means of Learning

Dialogue is a spoken conversation or written exchange between two or more people. For effectual duologue, there has to be common regard and willingness to actively listen to other participants. It requires the followers:

Engagement from both sides. Dialogue recognizes that people have different positions, point of views, cognition and skill sets. These demand to be respected.

Freedom. Dialogues are non to be conducted under coercion or menace.

Valued part. Each participant should value the benefit they will deduce through the duologue.

A public wellness leader would necessitate to hold ability to dialogue with community, stakeholders in wellness sector, and other sectors that have significant bearing on their work and mission.

When effectual duologue takes topographic point, both parties experience alteration and can take part in adaptative work of alteration through coaction discussed in Chapter 12. Dialogue creates trust, apprehension and empathy for others ‘ places.

Stephen Covey ( 2005 ) says that ‘you should understand foremost and so seek to be understood ‘ . He recommends that you should joint places and positions of other party and seek verification that you have right understood them. The other participant could reiterate the same procedure. Therefore, increased apprehension will non merely take beginnings of misinterpretation and struggle therefore but besides result in better ways to turn to issues.

Therefore, duologue will

be utile to increase trust, cut down struggles and heighten common apprehension ;

lead to making shared involvements and willingness to turn to common jobs ; and

bring forth originative ways to turn to jobs through corporate action.

Effective Listening

For a leader, it is of import to listen good to ( and presenting appropriate inquiries to ) his/her followings, subsidiaries and equals, non merely to acquire information but besides to set up or beef up interpersonal relationships. For the talker, it is a positive feeling when he or she gets a sense of non merely been heard but besides understood. The power of effectual hearing is in the custodies of the leader.

What is effectual listening? Effective listening comes from a combination of active hearing and good inquiring. Active hearing and good inquiring act to promote unfastened communicating of thoughts and feelings between two parties – the hearer and the talker.

Here are some utile tips:



Your tools



Your Eyess

Expression at the individual who is talking

This shows you are interested in what he or she is stating, and besides that you understand

Your organic structure

Be cognizant of what your organic structure is stating the other individual

The organic structure has a non-verbal linguistic communication all of its ain and it can convey messages from openness and friendliness to ill will and distance. How does your organic structure act when you are listening to person? As a leader, you want your organic structure linguistic communication to demo that you are unfastened and welcoming of the talker ‘s message.

Emotional vibraphones

Non-verbal communicating

It is non hard to acquire a sense of the emotional vibraphone the talker is directing you. Is what he or she is stating being said in a composure, smooth mode or in an aroused, agitated mode?

And what does that state you about the talker?


Sum uping what you have heard

It is utile to hesitate at appropriate minutes to sum up the chief points of what you have heard. This tells the talker that you have been paying attending and understood what was said.

Good Questioning



Open -ended inquiries

An illustration is: “ What was the meeting like? ” non “ Did you go to the meeting? ”

Probing inquiries

“ What do you intend by adult females non being able to utilize the clinic? ”

Clarifying inquiries

“ Do you intend that services are underused due to location of clinic or the hours of operations? ”

Ask for personal positions and feelings

“ What do you believe of the manner the new guidance service for striplings was introduced into the country? ”

Ask for ( and give ) feedback

Ask for feedback after group work or treatment to measure whether the work or treatment has been productive or completed satisfactorily.


Identify a individual who you think is a good hearer. Detect how he/she listens to other people and name down five features:






The rule of silence is of import for bettering listening accomplishments. Some actions include

Hesitate a few seconds before replying person.

Accept silence as a normal portion of conversation.

Work to equilibrate speech production and listening clip during conversation.

Break oculus contact for a minute to let the other party to experience comfy with silence.


Practice the above actions with five people you speak in the office for a hebdomad.

How make you see their reaction and response to you?

Has it improved the quality of the conversation and information you received?

How to Listen Efficaciously[ 14 ]

An involuntariness to listen is excessively common among the host of hapless leaders we have to set up with. And about 60 per centum of all direction jobs stem from defective communications.

Leaderships have to larn to touch the Black Marias of people before they can inquire for their manus. In the workplace, the director has to first cognize what ‘s in the bosom of his people, and listening to them enables this. When the director listens, he connects with those people, and learns of their joys and concerns.

i?’ Listen to your followings. Follow this piece of advice from a British Earl, Philip Stanhope: “ Many a adult male would instead you heard his narrative than granted his petition. ” Good leaders do more than behavior concern when they interact with their people – they take clip to acquire to cognize their people, a feel for each as a individual. As directors, you want to be the sort that people want to follow. If you are in the wont of listening merely to the facts and non the individual who expresses them, you are strongly advised to alter your focal point – return clip to listen to your people.

i?’ Listen to your clients. Whether you are running a concern, a service or an disposal, you have clients to cover with. These people represent your greatest chance and they should be your precedence at all times. Unhappy clients should ever be a concern. If you are caught up in your ain thoughts and neglect to listen to their concerns, ailments and suggestions, you will be in problem. The American Red Indian Tribe Cherokee have a fantastic expression, “ Listen to the susurrations and you wo n’t hold to listen to the shriek. ”

i?’ Listen to your rivals. This might look odd at first. As a leader, you do n’t desire to establish your actions on what the other cat is making, but you should still listen and larn what you can better on. Larry King, the American telecasting talk show icon, puts his ideas across plaintively when he comments, “ I remind myself every forenoon: nil I say this twenty-four hours will learn me anything. So if I am traveling to larn, I must make it by listening. ” King does non do the error of others, who see other organisations as competition and concentrate their attending on edifice and defending their ain cause, to the extent they forget to larn what the other group is making.

i?’ Listen to your wise mans. No leader is so advanced or experienced that he can distribute with a wise man. You are ever larning from detecting and listening from leaders who have more experience than yourself. If you do non hold a wise man, you should travel out and place one to be at that place for you. While you get the procedure traveling, get down by reading the success narratives of others -sports and media personalities, administrative officials and business communities, politicians and solons, scientists and philosophers.

Bettering on Your Listening.

Are you a good hearer or are you excessively busy making your ain thing? When was the last clip you truly paid attending to people and listened to what they have to state? Do more than merely catch the chief points, start listening to non merely their words but besides their feeling, significances and undertones, if any.

Change your agenda. As mentioned, pass more clip listening to your followings, clients, rivals and wise mans. Give them more attending and on a regular footing – daily, hebdomadal or monthly.

Meet people on their ain sod. A key to being a good hearer is to happen a common land with people, whether they are your employees or clients. It is good pattern to train yourself to inquire at least four to five inquiries about the person as a individual whenever you meet up – this manner, you get to cognize the individual better. And seek common land to cement your connexion with him.

Read between the lines. As you interact with people, pay attending and listen closely to both the factual and emotional content of their conversation. Sometimes by listening and reading between the lines, you begin to cognize what ‘s truly traveling on. Try listening with your bosom.

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