Shereef M. Elnahal, M.D., M.B.A. The son of physicians who grew up in Atlantic County, Dr. Elnahal became Acting Health Commissioner in January after serving in the U.S. Department of Veterans Affairs as Assistant Deputy Under Secretary for Health for Quality, Safety, and Value. He received a dual-degree M.D. and M.B.A. with Distinction from Harvard University, and graduated summa cum laude with a B.A. in biophysics from Johns Hopkins University. He was sworn in as Health Commissioner on April 2.
How will your work in health quality and safety at the U.S. Department of Veterans Affairs inform your goals in New Jersey?
The population that I served at the VA is actually similar to the overall New Jersey population. You’re talking about almost nine million veterans with similar issues to what New Jersey at large is facing right now: A lot of veterans were addicted to opioids or at risk of becoming addicted; there were shortfalls in extending access to women’s health; and there was a high prevalence of chronic diseases that were sometimes hard to treat because of issues with access to care. The strategy I undertook at the VA, in partnership with the leadership and frontline employees, was to identify where the best practices already were in the agency. Where could we find solutions that worked really well for the stakeholders we were trying to serve — be it veterans with opioid addiction or women veterans who didn’t have services set up? And then how could we scale those initiatives to treat thousands more veterans? We want to take a similar approach here in New Jersey.
You have spoken passionately about persistent racial disparities and infant mortality in New Jersey. How do you plan to address black infant mortality, which is three times that of white infant mortality statewide? Previous efforts have failed.
Not only do I think this is a priority, but First Lady Tammy Murphy and Gov. Phil Murphy also believe these disparities are a major public health issue. I’ve chartered a team to use a broad public health approach. This approach will get to the root causes of the issue through a literature review going back decades to see what scientists have found; speaking with public health researchers and conducting focus groups; and interviewing community health workers and people who have been served by the department. We’re seeing, not surprisingly, that the disparities are mostly in metropolitan areas. We plan to micro target our interventions based on our research and geographic analysis. Finally, we need to utilize programs that directly address the identified root causes, and some of the major issues that have come up already in our analysis include access to care — not just primary care but women’s health care, family planning care. All of that will inform how we target our grant funding, and how we redirect the programs that we manage to benefit the folks that we’re serving.
You recently recognized hospitals and nursing homes with close to 100 percent flu vaccination rates. Can you tell us why that’s important, and why you visit the facilities to honor them?
As a front-line physician, and when I was in training, if I did not get a flu vaccine or if I did not agree to wear a mask during flu season then I would lose access to my electronic health record account and not be able to do my job. Public health research has proved that vaccinating health care workers has a positive effect. You protect patients from contracting the flu. You see a benefit from a public health standpoint to the general population if patients in the hospital are not getting the flu from hospital workers and other patients by extension. This is an evidence-based approach that has worked. There are already hospital systems leading the way in New Jersey in this area. And my goal is to identify where that’s already happening — and to spread that success to as many facilities as possible in the state.
At the age of 12, you were diagnosed with Type 1 Diabetes, an autoimmune disorder in which the body destroys the insulin-producing cells in the pancreas. How has living with a chronic illness influenced your thinking about changes we need in our health care system?
I think that’s a great question because more than anything, even my experience as a physician and as a policymaker, my experience as a patient with this disease informs both my passion and my approach to my job today. As I have said, I couldn’t have been luckier in the circumstances that I grew up in as a Type 1 diabetic. Both of my parents are physicians. I had access to the health care system, and access to the specialists that I needed. And still I had a difficult and challenging time.
Your daily life is inseparable from diabetes. The disease affects everything from your diet to your involvement in recreational activities and sports and even your professional and academic life. Because I understand that, I also know that the social determinants of people’s health, especially those with chronic conditions, are so important. Our focus in New Jersey is going to be much more than just improving the health care system because I know how important all the other social factors are as well.
The Quality Institute has been a strong proponent of creating an Office of Health Care Transformation to support strategic planning and budgeting for the state. What are your thoughts on that?
It was something that I supported in principle when I was on the transition team. The principle behind it is something that I know the Governor agrees with and everyone across the administration agrees with, which is that we have to improve coordination across the state government on issues surrounding health. And so already the members of the Cabinet who have a hand in public health are meeting to discuss issues like black infant mortality. We’re going to be meeting regularly with the Department of Human Services, the Department of Banking and Insurance, and other critical agencies that we absolutely need to partner with in order to meet the public health priorities that we have.
You were a co-chair of the Governor’s Health Transition Team. What were the key messages that you heard from the other members of the team on how to address health policy in New Jersey?
Well, one key message that rang loud and clear is that the Department of Health needs to be more responsive to stakeholders. And this is not to say that the employees of the department are the reason for this. I think that the department hasn’t been as supported as it should have been. There have been a lot of vacancies that we’ve already started to fill, with the Governor’s support, to make the department work better. In addition to the public health priorities I’ve outlined, we have a set of internal priorities that we’ve already started to address in terms of our functioning, making us more responsive, efficient and customer-centric. All of that is going to take place over the next year or two. The other thing that I heard, particularly from the other co-chairs, is that we need to focus on health disparities. As a general population, New Jersey actually leads, for example, in infant mortality. We have among the lowest rates in the country overall. But the disparity of those outcomes, depending on your race and geography, is striking. And so we need to change that.
It’s a sunny afternoon and you have a chunk of time off from work. Where will we find you?
You almost certainly will find me on a playground with my two-year-and-four-month old daughter. And my son just was born at the end of March, so if I am not working, you definitely will find me on a sunny day outside — and surely with my family.