Bringing a Local Public Health Perspective to Federal Policy Making: Milwaukee Health Commissioner Kirsten Johnson Reflects on Her RWJF Fellowship

For nearly 50 years, the Robert Wood Johnson Foundation Health Policy Fellows Program has sought to build a strong, diverse network of leaders and maintain a workforce skilled in health policy. By connecting health professionals with the first-hand opportunity to participate in the federal policy process, this nonpartisan program aims to improve health equity, health care, and health policy. To learn more about the fellowship experience, we hear from Kirsten Johnson, MPH, a fellow from the class of 2018 to 2019. Kirsten, currently serving as the Commissioner of Health at the City of Milwaukee Health Department, reflects in the Q&A below on the importance of bringing a local perspective to federal policymaking, as well as the challenges of being a public health leader during the COVID-19 pandemic.

Kirsten Johnson, MPH, discovered a passion for public health while serving in the Peace Corps in West Africa focusing on family planning and vaccine distribution. After receiving her master’s degree in public health and working in a variety of health settings, she felt a pull toward government health and a strong desire to better understand the “nuts and bolts” of the policy world. She gained hands-on experience in health policy as an RWJF Health Policy Fellow working in the office of Congressman Ron Kind (D-WI), where she lent her deep public health knowledge to the Ways and Means Subcommittee on Health. She shares more about her experience below.

How did you become so deeply involved with public health in the state of Wisconsin?

Kirsten Johnson: I used to run the Healthy Wisconsin Leadership Institute, where I used public health skills to teach local organizations and local public health departments what I call “Public Health 3.0” – a model which focuses on community partnership-building and using data and evidence to inform interventions. After that, I went to work in governmental public health as a health officer in Washington Ozaukee County. When I started, Washington Ozaukee was doing old-school public health, like immunizations, blood pressure checks, and some water quality testing, but while I was there, the county branched out into the Public Health 3.0 model. It was great because I've always been interested in health policy through the perspective of the social determinants, but realized I didn't have experience advocating for policy change. So, I decided to apply for and was accepted for the RWJF Health Policy Fellows opportunity.

After the fellowship, I returned to my old role at Washington Ozaukee for a year, during which time the pandemic started, then came to my current role as City of Milwaukee Commissioner of Health in March 2021, where I’ve been leading the pandemic effort and issuing health orders in the largest urban area in Wisconsin.

What was it like, after the fellowship, planning to return to your former job as you knew it, but getting thrown the curveball of the pandemic? That must have been challenging.

"The fellowship helped me prepare to think critically during the pandemic about the impact of whatever decision I’d be making, and not just the immediate decision."

Kirsten Johnson: Yes, but the fellowship helped me prepare to think critically during the pandemic about the impact of whatever decision I’d be making, and not just the immediate decision. So, for example, the first health order I wrote during the pandemic was to require all first responders to wear personal protective equipment (PPE). I had to think about what all the impacts were going to be, like the availability of the PPE – because it was hard to come by early in the pandemic – and how to partner with emergency management to do this.?

Effective communication is so important in public health. Did the fellowship sharpen your skills engaging with constituents?

Kirsten Johnson: I learned how to message important information in a succinct way that is compelling and persuasive. We have seen errors with this across the country in our public health messaging about the pandemic. At times, there’s been way too much information and it's confusing.

I’m on the Public Affairs Committee for Wisconsin Public Health Association, and we have people who are really upset about the policies that are moving forward. In these situations, my fellowship experience taught me to be objective and not make it personal or emotional.

What do you think the public health field in general has learned from the pandemic?

"I hope that coming out of the pandemic, those of us in positions of power take what we've learned and apply it to policy to make real, lasting change."

Moving forward, I think public health needs to address the social determinants and the root causes of health. For example, we need to make care accessible, and recognize that the individuals who were the most impacted, who got the most ill, and who died, are the people who have the least number of resources. These people have unstable housing and are working multiple jobs. They couldn’t stay home because they needed to feed their families. They weren't making a living wage. I hope that coming out of the pandemic, those of us in positions of power take what we've learned and apply it to policy to make real, lasting change.

What did you set out to achieve through the RWJF Health Policy Fellows Program?

Kirsten Johnson: I wanted the fellowship so I could understand how policy is made, who influences it, how it's written, how it gets moved to the policymakers, what they’re thinking about, and how they get their information.

Having worked in a local government agency, I also wanted to understand how decisions are made when money comes in without any understanding of how it's going to be used at the local level. What I learned is that those decisions are made in isolation. There are many well-intentioned people at the federal level, but the vast majority do not have local experience.

I deliberately chose to be in a congressional office that was based in Wisconsin, in rural health, because I wanted to learn more about rural health. I really connected with the Member that I chose to work with, Ron Kind, and his staff.

I helped with constituent meetings and speeches related to health, sat in on committee hearings and planning meetings, and shared my perspective on congressional testimonies. I think I had an impact on the 15 staffers in Ron’s office, as well as the Ways and Means Subcommittee on Health, and I like to think I helped them recognize that they needed to take local-level impact into consideration.

What types of experiences do legislators or folks in positions of power need to consider, given that they are making decisions that impact peoples’ lives so greatly?

"We need to be very intentional about listening to what they have to say and then doing something."

Kirsten Johnson: I think people need to consider that in the “flyover states”—middle and rural America—there are a lot of voters with different lived experience than those of us who are making decisions. That experience and those values are just as important as ours, and deserve to be heard, understood, and considered. They don't feel heard because we haven't listened. Similarly, in our cities, there are large swaths of communities that feel like they have no voice and haven't historically had a voice. We need to be very intentional about listening to what they have to say and then doing something.

Could you speak about the community of fellows in the program and the broader network of individuals that you were able to engage with? How do you make use of it?

Kirsten Johnson: I probably make use of it daily. In my fellowship cohort, we were all close. I have called on all of them in some way, shape, or form over the past few years for data, for ideas about billing, the pandemic, the Peace Corps – all of it. They're an amazing group of people.

The network has turned out to be really valuable to me since I very deliberately chose to be part of the Wisconsin delegation. During the pandemic, I had easy access to Representative Gwen Moore, to Senator Tammy Baldwin, and obviously to Ron Kind’s staff. I was able to have influence about how health care dollars were allocated. Both Baldwin and Kind’s staff ran appropriations around COVID response, and I’d give them some ideas.

Are there any misconceptions about the fellowship program that you'd like to address?

Kirsten Johnson: I think there's a misconception that you need a PhD to be successful in the program. I don’t have one, and was intimidated at first, but I realized I was just as qualified to be there as everyone else. I brought different skills that others hadn’t necessarily thought about.

What advice would you have for other individuals considering the program?

Kirsten Johnson: Do it! If you have a true passion for policy and it's where you see your career going, or you already have some real policy experience, this fellowship will help you be more objective and understand policy in a better and more meaningful way.

I have three kids and we moved them to DC for a year. I know other fellows have commuted, but I personally think it's worthwhile to uproot everyone and move them to have the full experience. I can't imagine what it would be like to fly back and forth because you just don't have that same level of engagement, not only in DC, but with your cohort. There were parties on the weekends that I attended related to the Hill or held by people we met. If you're going to do it, my advice is that you need to jump in with both feet and be open to whatever may come of it.

Learn more about RWJF Health Policy Fellows by following our LinkedIn Showcase Page, here ! For more information about the fall 2022 call for applications, click here. We appreciate your support in building a strong and diverse network of leaders and maintaining a workforce skilled in health policy—Email [email protected] for questions about program opportunities.