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Women are top leaders in Hoosier public health posts

December 8, 2008
As a child, Dr. Judith Monroe watched her father regularly use tobacco. Later, as a young woman, she watched him die from complications related to his tobacco use.

"He did not live long enough to see my first child born," said the mother of three who went on to spend 22 years as a family physician who encouraged her patients to adopt healthy lifestyles.

Now as the state health commissioner, Monroe plays a key role in preparing the state for pandemics, terrorist or bioterrorism attacks, natural disasters and other threats to health. She's one of several local women who have risen to leadership positions in the health care community.

Among them are Dr. Virginia Caine, commissioner of the Marion County Department of Health, and G. Marie Swanson, director of the Indiana University School of Medicine's Department of Public Health.

At the national level, Julie Louise Gerberding has served as director of the U.S. Centers for Disease Control and Prevention in Atlanta since 2003.

Caine said she is not surprised that there are so many women in leadership roles in health care.

"Eighty percent of family health care decisions in this country are made by women; wives, mothers, sisters — they are the decisionmakers," she said.

The prominent role women play in health care is one of the reasons that Monroe, upon becoming Indiana's first female state health commissioner, led the formation of INFluence (Indiana Female Leaders Unite), a way for Hoosier women leaders in government, business, health care and other arenas to promote women's health issues.

Each year INFluence addresses an emerging women's health issue through public health forums. The first, in April 2007, was in response to the Camel No. 9 cigarette marketing campaign targeting young women. A second forum last April addressed health, social and economic impacts of substance abuse on Hoosier women.

Health care has a disproportionate number of women entering the field compared to other industries, said Lynn Shapiro Snyder, founder of Women Business Leaders of the U.S. Health Care Industry Foundation. The Washington, D.C.-based group helps senior executive women in health care improve their businesses and continue to grow professionally.

"It's not that unusual for women to be a CEO, president or other leader in the health care industry," Snyder said. "Remember, the managed health care system began in the 1970s, so it isn't that old. Women made substantial advances in that area."

Monroe, like several other women serving in health care leadership roles, said she did not set out to become a public-health leader. "I never consciously said, 'I want a career as a health commissioner,'" said Monroe, who graduated from the University of Maryland's medical school.

"After becoming a doctor, I saw patients day after day suffering a reduction in the quality of life because of lifestyle choices." Having firsthand exposure to the causes of disease helped Monroe evolve into the role, which she is using to promote healthy lifestyles.

One of the best ways to be prepared for a pandemic or a natural disaster is to be physically fit, Monroe said.

"It is in preventive health care that we can stay healthy through flu pandemics or other threats to our health, and this is where my interest led me," she added.

Like Monroe, Caine said she never imagined becoming a public health leader. She wanted to do research involving biochemistry. She earned a bachelor's degree in chemistry from Gustavus Adolphus College in Minnesota and her medical degree from the State University of New York, Upstate Medical University, in Syracuse.

"I was 'tricked' into the field," she said. "When I was in school, a college chairman got me and a girlfriend to spend the summer at the Harvard Medical School for a special session. We didn't intend to enroll, but he enrolled us and we were accepted, so we went."

Caine was on the faculty of Johns Hopkins and was recruited by the IU Medical School as an associate professor of infectious diseases. "In 1993, Mayor (Steve) Goldsmith asked the dean of the IU Medical School to recommend someone to be the director of the health department," she said. She became acting director.

"I found I enjoyed it, and in 1994 I became the director," Caine said. "Now, 15 years later, I'm still here."

She enjoys working with people in the community to make neighborhoods better. Caine works with the Coalition for Patient Safety, a collaboration of the Indiana Hospital and Health Association, Purdue Pharma, Suburban Health Organization, all Indianapolis hospitals, the Marion County Health Department, Indiana State Department of Health, Eli Lilly and Co. and Anthem Health. The program seeks to reduce medical errors and improve patient results or outcomes.

Swanson said her migration to public health came from a desire to help the less fortunate.

"I grew up in the '60s, and I wanted social justice and equality among all populations," she said. "I began with doing research on health disparities in cancer treatments and cure rates."

She earned bachelor's, master's and doctoral degrees in sociology from Wayne State University in Ohio and a master's of public health degree from Johns Hopkins University.

As an epidemiologist, Swanson's research has been focused on cancer and chronic-disease prevention and the eradication of health disparities. She is a former president of the American College of Epidemiology.

"I'm impressed with Gov. Daniels and his strong support of our health and healthy lifestyles," Swanson said. "I'm excited about President-elect Obama. His election has brought [up] the whole issue of social justice and inclusiveness for all. I haven't seen that in politics for a long time."
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