The 50,000-member organization, founded in 1872, represents a community of healthcare professionals who tend to be forgotten by policymakers — until a bioterrorist attack or deadly infectious disease outbreak reminds them that public-health workers are their first line of defense.
In between, Benjamin and his colleagues are healthcare Cassandras, clamoring for federal, state and local funding to shore up those defenses and promoting abstract concepts such as preventive health. “We really view ourselves as really trying to be the advocate for the public’s health,” said the 52-year old Chicago native who has lived in Gaithersburg, Md., for almost 20 years.
In an era of Republican control and fiscal austerity in Washington, APHA’s voice strains even harder. Complicating matters is that, while the group is officially nonpartisan, it is “often not viewed that way,” Benjamin conceded, because its natural allies tend to be Democrats.
APHA’s top priorities parallel some of the Democratic Party’s: universal access to healthcare, the elimination of racial and ethnic health disparities and a large federal investment in the nationwide public-health infrastructure.
Benjamin himself is a self-identified Democrat who served under then-Maryland Gov. Parris Glendening (D) from 1995-2002, including a three-year stint overseeing a $5 billion budget as health secretary.
Despite APHA’s focus on obtaining federal money, Benjamin contends its mission makes it different from other groups that lobby for a piece of the pie.
“To some degree, we’re a trade association because the members we have are people that practice public health,” he said, “but we don’t have any ‘pocketbook’ issues, really, so we behave more like a consumer organization.”
The public-health community faces an uphill struggle in the current fiscal climate. Significant strides on public health were made in recent years as the Bush administration, Congress and the states focused their attention on preparing for bioterrorism, but the money train has slowed down.
The investments in public health in recent years either could represent a “sentinel moment” or a “blip,” Benjamin said.
“The administration had — and I hope they still do — the opportunity to once and for all fix the public health system in America,” added Benjamin.
“One of my fears is that if we don’t do sustained, long-term funding in public health that we will miss the moment.”
These challenges — political and medical — do not appear to daunt Benjamin, an Army-trained physician who was chief of emergency medicine at the Walter Reed Army Medical Center for four years. “I was a captain in what was, in effect, a colonel’s slot,” he said.
Benjamin attended college and medical school in Illinois. He received an Army scholarship for med school and then trained at the Brooke Army Medical Center, Fort Sam Houston, San Antonio, under James Peake and Ronald Blanck, each of whom would become surgeon general of the Army. Later, he held staff positions at the Madigan Army Medical Center, Fort Lewis, in Tacoma, Wash.
His approach to his widely varied roles as a military emergency physician, urban emergency-room administrator and state Cabinet official has a defining characteristic, according to Benjamin. “Every time I do something … I kind of go back to my ER roots,” he said.
“I view myself as a troubleshooter,” Benjamin said. “I like things that change a lot.” He added, “All of those jobs have a pretty robust political element to them.”
Benjamin had to employ his administrative triage skills adroitly during stints as head of D.C. General Hospital’s emergency room, the District’s ambulance service and the city’s public-health department during the cash-strapped and troubled period in the late 1980s and early 1990s.
His tenure at D.C. General’s ER — the largest in Washington at the time — was “right in the middle of the cocaine wars,” he said. Patients, many victims of violent crime and drugs, faced long wait times and serious injuries and illnesses.
After leaving D.C. General, Benjamin entered the District government at the end of the Sharon Pratt Kelly administration and stayed on during the comeback term of Mayor Marion Barry.
“The D.C. government was an administrative challenge,” Benjamin said. “We were, literally, every week, reprioritizing money.”
Benjamin partly blamed the city’s limited home rule for its fiscal problems: “We were always making decisions between ambulances and firetrucks, and no city ought to be in that situation.”
But he reflected on his experience positively. “I saw very hard-working people … struggling against enormous challenges,” he said.
In particular, Benjamin described the ambulance service in the District as a “disaster.” He took some credit for improving waiting times and other measures. “You don’t see those stories anymore” about extraordinary wait times, he said.
While the District was unable to solves all of its public health woes, “You’ve got to know what a win is, and you’ve got to be comfortable with [that] win,” Benjamin said.
In Maryland, the contrast was striking: “We had money,” Benjamin said. “Of course, Democrats were in the White House, so we had support at the federal level as well,” he added.
“Maryland has always been very, very cutting-edge and progressive on healthcare,” he said.
The results, Benjamin said, spoke for themselves. “Almost every health statistic that should go down has gone down, [and] everything that should go up has gone up,” he remarked.
Benjamin credited Glendening for being a strong supporter of his initiatives, which included anti-tobacco campaigns and a bioterrorism planning effort that began in the late 1990s.
Glendening said Benjamin is “one of my favorite people.” The former governor described him as “an extraordinarily capable individual” who “understands the big picture of health.”
Martin Wasserman, a GlaxoSmithKline executive who was state health secretary when Benjamin joined the department as a deputy secretary, called him “one the top leaders in public health.” Robert Bass, a former District health official who heads the Maryland Institute for Emergency Medical Services Systems, said Benjamin is “superknowledgeable.”
Former D.C. health commissioner and current UnitedHealth Group executive Reed Tuckson said Benjamin possesses an uncommon understanding of the health consequences that result from the inadequate coordination of medicine and public health.
Tuckson said that Benjamin is skillful enough to surmount obstacles to the APHA agenda, adding that he is “able to attract support from others to work with him to achieve his goals.”