By Dean Ana V. Diez Roux, MD, PhD, MPH

Change is always a time of reflection, and so it is for me now, as I step down as dean of the Dornsife School of Public Health after nearly 10 years in the role. As often happens, the time I have spent in this role feels short and long at the same time. On one hand it seems like yesterday that I moved to Philadelphia in early 2014, so excited to be back in a real city, full of ideas and energized by a new place and a new job, a school of public health where I could see myself clearly because of its history and mission, because of its integrated approach to science and action, because of its connection to the city and urban issues, because of its commitment to health as a human right and social justice. On the other hand, perhaps because of everything that has happened in our world since then, because of COVID, because of political and social change, and because of my own history and the aging of my parents and growth of my nieces (little girls when I came, young independent women now…) it seems like I’ve been in the role a long, long time. As anyone who has stepped down from a leadership role will tell you, it’s not easy, and it’s tempting to continue just because you can…but I am a firm believer in term limits, in making room for new ideas and new energy, in renovation and refreshment. So, I knew it was time.

I’ve had two jobs in my life that I think moved me and changed me and caused me to learn many things about myself, some things that I was pleased to learn, and others that I was not, but that I needed to understand and sometimes change (when I could!). One was being a pediatric resident in the Hospital de Niños in the city of Buenos Aires, an experience that marked me for life because of what I saw and did (or failed to do), because of what it taught me about health care systems and about our society. The other was being dean of a school of public health in the United States during a special time and unprecedented events: the election of Trump, a global pandemic, the long overdue and reenergized movement for racial justice triggered by the murder of George Floyd, landmark decisions by SCOTUS with major implications for public health, the growing visible impacts of climate change, among so many others. 

I learned many things during my time as a dean, too many to detail here. But five I think have especially stuck with me. The first of these will not be new to anyone in public health, and was something that I anticipated but that still surprised me because of its strength and pervasiveness: we still need to make the case clearly and forcefully (and even within our universities themselves) that public health is about more than health care, more than vaccines, more than care “for the poor” (important as all these things are): it is about how health emerges from the structures and systems of our society, and thus improving health and eliminating health inequities requires broad multisectoral action. This vision of public health has implications for science, for action, and for educational programs.

A second thing I learned was about universities, about how difficult but important it is to navigate and defend the mission of universities as places of knowledge-generation and transmission, as places for reflection and for the debate of old and new ideas. This is especially challenging when universities become businesses, with the risk and sometimes unintended consequence of setting aside or deprioritizing their ultimate academic and social mission. I feel so privileged to work at a university and believe that we owe it to our society to contribute in meaningful ways to understanding reality and to making it better for all of us. The desire to be in a civically engaged university (with all that means about both civic engagement AND academic excellence) is certainly what drew many of us to our School.

A third thing I learned is that systems are hard to change (they are after all by definition “policy resistant” as Sterman said in his 2006 AJPH article). This applies to social systems of course but also to systems within our own institutions, including the way in which we organize so many things. This is why you need to be evidence-based and patient but also forceful. And above all you can’t give up…. You need to be resilient and bounce back and try again through a different route. You need to use all your knowledge and your skills to make the case again and again for what you believe is right and true and fair. You need to keep your eyes on the prize, let your vision and values (and sometimes your gut and intuition) guide you.

The fourth thing I learned is that building consensus and shared governance is hard work, sometimes a step forward and two steps back. And sharing information and communicating context and consequences of decisions and actions is critical, sharing it once and then again, and then another time. You also have to listen, and this can be challenging when you feel that you know the answer, but if you listen carefully, you will often see things that you had not seen before. This happened to me many times. And yet sometimes despite all your efforts, you are on your own, and you have to make hard decisions because it is your job and your responsibility, and you can’t hide or run (well, sometimes you can but you shouldn’t). The best you can do is explain and communicate why you do what you do and recognize that others may have valid reasons not to agree. This was hard, probably the hardest part of the job.

And the fifth thing, and probably the most important thing, is that you are nothing and can’t do anything without your team and your community, those who support you but also gently tell you when you are wrong, those who are patient and give you a pass when you are frustrated and tired, those who share the vision and the mission and do so much that is never acknowledged, those who provide so many “assists.” So many people trusted me (even when I was not sure what I was doing) and supported me, and rolled up their sleeves and joined me and believed, I can’t thank them enough.

I believe being the dean of this particular School, the Dornsife School of Public Health, was so motivating and energizing to me because the School allowed me to roll up my sleeves and be a dean while still keeping my hand in many other things. These things (continuing my work as a researcher and scholar, mentoring students and faculty, engaging in discussion around key population health challenges we face) were and are still important to me personally but were also (fortunately!) integral to my work as dean. But being at Dornsife was also special because of the terrific folks who were here when I came and the many who joined since then, because of the cohesion and mission of our School, because of our ambition to be a center of scientific excellence, yet action- oriented and civically-engaged, because of our desire to be internally fair, inclusive, diverse, and true to our values, and because although we are sometimes the underdog (although not so much anymore!), we shine. For all these reasons I would not have wanted to do this job anywhere else.

I have so many people to thank that I could not even try to list all. They include faculty, staff and students at our School who have contributed in so many ways, folks from many different places and backgrounds, with many different roles. I want to specially thank the Chairs, Associate Deans, Executive Committee of the Faculty, and Staff Council who contributed so much and accompanied me along the way. I want to thank the many staff in the dean’s office and throughout the School who support our work with their ideas, generosity, and dedication. I want to thank the students for their energy and ambition to make our School and our society better. I especially want to thank two people who I have worked with so closely sharing challenges and frustrations but also wins and celebrations, day in and day out: Diane Benckert and Mary Ellen Sarno stalwarts of the School who have given so much, and models of competence, hard work, dedication, endless patience and understanding, humanity, and a sense of humor (indispensable!). 

It will be strange to be a former dean (many former deans have told me so!), I will miss the job and the many people I worked with as dean, and I have to confess being a former dean makes me feel a little old… But I am also excited to be back at the Urban Health Collaborative full time and the many exciting opportunities that await me there. As always happens in life, change and transition refreshes and reenergizes. So it will at the Dornsife School of Public Health (and already has with the great new leadership we have in place!). And I will be watching and supporting and accompanying this next exciting phase of our special School along the way.