Johns Hopkins’ Sharfstein shares his health care ‘toolbox’

Joshua Sharfstein

If anybody has come close to having “done it all” in health policy, it’s Joshua Sharfstein, M.D.

The vice dean for public health practice and community engagement and a health policy professor at Johns Hopkins Bloomberg School of Public Health, Sharfstein has worked in city, state and federal government, in the legislative and executive branches. He’s worked on drug policy, health coverage, infant mortality, payment and delivery reform, substance abuse, tobacco, public health – not to mention a global health stint in Central America.

When he’s not making policy, he’s teaching or writing (or sometimes tweeting) about it.

That wide-ranging background has given him an unusually broad perspective of both problems and solutions.

“I’m able to see problems from different angles, and I can see different kind of tools,” he said in a recent phone conversation, citing investigations, policy proposals, inspector general reports, and public outreach as among the ways of shedding light and spurring change. “I built a toolbox of different ways to create policy.”

From March 2009 to January 2011, Sharfstein served as principal deputy commissioner of the U.S. Food and Drug Administration where he oversaw the agency’s successful performance management and transparency initiatives under the Obama administration. Before that, from December 2005 to March 2009, he was commissioner of health for Baltimore city, where he was ahead of the curve in addressing both overdose fatalities and infant mortality.  For four years before that, he was a health policy adviser for Rep. Henry  Waxman – who shaped health policy in countless ways, including tobacco and HIV/AIDS.

He’ll be on an Health Journalism 2019 panel in Baltimore discussing patient access to generics and biosimilars – but drug policy is only one of his many interests.

He isn’t just a wonk – he’s also a pediatrician and until a few years ago, he was able to combine policy work with some ongoing patient care. Talking about, say, NIH research on adolescent sexuality on the Hill in the morning – and then seeing a pregnant teenager in the emergency department at night “was an interesting juxtaposition,” he recalled.

“I love the sense of being in the room with parent or grandparent and knowing that nothing else matters more than the health of the child,” he said.

Sharfstein graduated from Harvard in 1991, and then worked on public health in Guatemala and Costa Rica. After Harvard Medical School, he completed the Boston Combined Residency Program in Pediatrics at Boston Medical Center and Children’s Hospital in 1999; and had a fellowship in general academic pediatrics at the Boston University School of Medicine in 2001.

His latest book, The Opioid Epidemic: What Everyone Needs to Know, comes out in June. He co-wrote it with his wife, Dr. Yngvild Olsen, a prominent expert in addiction medicine.

Opioids, including heroin addiction, has been a public health concern of his for quite some time. As Baltimore health commissioner, he was immersed in addressing addiction and overdose fatalities long before the rest of the country got drawn in.

“It was very much seen as an urban phenomenon – it really didn’t penetrate the national discussion of drugs, which was very dominated by an enforcement approach.” Sharfstein knew a public health problem when he saw one, and Baltimore expanded treatment. Deaths went down. He took a similar proactive approach to infant mortality, coming up with programs that have served as models in other cities – some as simple as having voices from within a community teaching other parents about safe sleep for infants.

“We tried all these tactics that did not work,” he remembered, before trying the simple and effective approach of having “mothers and fathers looking into the camera” and explaining sleep safety.

As someone who has been ahead of the curve on many health challenges, he thinks about what our public policymakers are missing. One concern is that we’re not paying enough attention to adolescents. “Challenges that can emerge in adolescence are the roots of public health problems,” including violence, substance abuse, unplanned pregnancies ‘There’s a set of challenges we should think about” at the population level.

His biggest frustration – that for all the energy the country spends fighting about the health care system, there isn’t enough talk about health itself. The question that should be paramount in evaluating policies, he said, is “would this make the country healthier.”

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