Leadership is getting results in a way that inspires trust
Commencement address for UCLA Fielding School of Public Health, Class of 2024
UCLA Fielding SPH website for 2024 Commencement is here.
Slide presentation that inspired me is linked at Appendix below.
Commencement Address
https://www.youtube.com/live/EGFm3_j-VYI?si=-w8Y3sziUHaYwZVN&t=2280
Transcript
Thank you Dean Brookmeyer!
Congratulations to the UCLA Fielding School of Public Health graduating Class of 2024!
I want to acknowledge Dr Jonathan Fielding. He was the Health Officer and Director of the Los Angeles County Department of Public Health when I was a deputy health officer of San Francisco. He was a role model to me and other health officers. He inspired us to lead with humility, evidence, and excellence.
I thank the faculty, students, and staff that contributed, and continue to contribute, to protecting and improving health and health equity for all in California, especially during our response to the COVID-19 pandemic.
We acknowledge and thank the families, friends, and loved ones that supported you on this journey!
I am TRULY HONORED to be here tonight.
Introduction
For more than 25 years, I have practiced governmental public health in multiple roles and at multiple levels. From working with communities on environmental justice to responding to the COVID-19 pandemic.
With the public health challenges we face today, YOU are needed NOW more than ever. One special challenge is the decline in trust of public health and science.
For this purpose, I start with Stephen MR Covey's quote that “Leadership is getting results in a way that inspires trust.”1
In public health, building trust is one of the most, if not the most important, leadership skill you can develop.
Tonight, I will share the framework I lean on for building trust. In the health field, trust and credibility is our primary currency—without it, we cannot be effective.
For concreteness, let's imagine we are Team Public Health and we want to rebuild trust with a diverse community.
Trust in public health
To build trust we must answer 4 questions from the community? They are asking,
1. Can I believe you?
2. Do you care about me?
3. Can you deliver?
4. Can I count on you?
Our answer is to ALWAYS be TRUSTWORTHY by fulfilling the 4 Cs of Building Trust …
1. have Character,
2. be Caring,
3. be Competent, and
4. be Consistent.
Also, we must look at the history and quality of our relationship with the community. These factors have impacted their propensity to trust us, their appraisal of our trustworthiness, and their perception of the risks and benefits to them of trusting us.2
However, before diving into the 4 Cs of Building Trust, I must outline the broader context and selected public health challenges.
Context and challenges
For context, historian Yuval Noah Harari,3 historian and author of “Sapiens: A brief history of humankind,” reminds us that as a global community we face three potential existential threats:
1. First, ecological collapse from our failure to address climate change.
2. Second, disruptive technologies, such as artificial intelligence, which are evolving at a pace and scale never seen before—and which can lead to great benefits or great harms.
3. And third, threat of expanding military conflicts, including nuclear war, from our inability to resolve conflicts and build enduring peace.
For public health challenges,
First, trauma and chronic toxic stress impacts are growing. Trauma is universal. We experience primary, secondary, or vicarious trauma. Vicarious trauma can occur by consuming news and information about traumatic events.
Second, mental and behavioral health problems are growing, especially among adolescents and young adults. Anxiety, depression, suicide, self-harm, addiction to substances, gambling, or social media.4
And third, trust in public health, government institutions, and science is declining.
Building trust in depth
To tackle any of these challenges we must rebuild trust.
Trust is a psychological and emotional state. Trust is the willingness to be vulnerable to the actions of another party.5 The decision to trust is mostly intuitive, and sometimes deliberative.6
In a 2021 study7 of 177 countries, researchers found that interpersonal trust and trust of government institutions were the key drivers of adherence to public health interventions during COVID-19 pandemic.
In the United States, in a 2023 study8 researchers found that the most trusted sources of health information are
At the TOP, doctors and nurses,
And in the BOTTOM third
Local and state health departments
State and local elected officials
Many communities have lost trust in, or distrust, public health institutions.
What can we do?
Again, to build trust with we must answer their 4 questions?
1. Can I believe you?
2. Do you care about me?
3. Can you deliver?
4. Can I count on you?
Let’s answer each question with more detail.
For Question 1: Can I believe you? Our answer—Have CHARACTER
I give lectures to local health officers on how to prepare for adversity as health officials, how to deploy moral and ethical reasoning under a storm of pressures.
I remind them that there are no absolute right answers, there are only trade-offs. That they need to keep an open mind and open heart—and to always be humble. But, what is humility?
One of my favorite definitions of humility if from scholar and author John Dickson:9
“Humility is the noble choice to forgo your status and to use your influence for the good of others before yourself.”
In other words, “Humility is to hold power in service of others.”
If character is a tree, humility is the roots. The deeper the roots, the stronger your character. Nurture your character tree by reading and critical self-reflection.
For the lecture I give to health officers, at the top of my recommended reading list are books by British clinical psychologist Donald Robertson who writes about Greek and Roman Stoic philosophy with vivid and engaging stories that invite self-reflection on how to improve your character.10 To my surprise, I also learned about how Stoicism inspired the pioneers who developed the modern field of Cognitive Behavioral Therapy or CBT.11
Stoicism holds that the ultimate good is living a life of virtue, which encompasses practical wisdom, courage, justice, and temperance.12
To this end, Stoicism promotes human reasoning, self-awareness, mindfulness, perspective taking, seeking accurate feedback, evidence, and agency to focus our cognitive and emotional efforts on what we can change and improve — and it always starts with us.
While you cannot control everything that happens to you, you can always control how you reason, prepare, act, learn, and improve.
For building trust, good character is THE most important. Daily challenges and doses of adversity provide the opportunity to be humble, and to test and strengthen your character.
For Question 2: Do you care about me? Our answer—Be CARING
For caring, I promote universal values.
Universal values are values that apply to everyone, everywhere, leaving no one behind, including your adversaries.
Dr. Monica Sharma, former Director of Leadership Development at the United Nations, discovered that promoting the universal values of dignity, equity, and compassion enabled field teams to tackle difficult public health problems in all corners of the world.13
Embody and promote the universal values of dignity, equity, and compassion in every conversation and in every interaction.
With universal values,
we can connect with others through our shared humanity,
we can transcend differences to find common ground, and
we can co-create to solve problems together.
Promoting universal values and cultivating humility work together to activate a mindset for authentic caring and connection.
For Question 3: Can you deliver? Our answer—Be COMPETENT
According to the 2024 US News & World Report List of the Best Schools of Public Health, UCLA ranked at number 9 in the country and number 1 in California.14
WOW!!! Congratulations!!! This recognition is well deserved and reflects the very highly competent students, faculty, staff, and alumni.
HOWEVER, please remember to stay intellectually humble!
Intellectual humility is recognizing and owning your intellectual limitations in service of pursuing deeper knowledge, truth, and understanding through curiosity and inquiry.15
Intellectual humility generates and amplifies the growth mindset.
Some of you have become, or will become, among the best in your field.
Remember your long, arduous journey from absolute beginner to extreme expert.
Intellectual humility will not only supercharge your learning, but you will have empathy and compassion for others who are early in their learning journey.
For Question 4: Can I count on you? Our answer—Be CONSISTENT
As you climb the career ladder, you become VERY, VERY busy, and this becomes a blind spot. Remember, be consistent and reliable and keep all promises and commitments.
Relationships
Along with the 4 Cs of Building Trust, we look at the history and quality of our relationship with the community.
In relationships, key considerations include closeness, power, uncertainty, and conflict.16
Amanda Ripley, journalist and author of “High Conflict—Why we get trapped and how we get out,” reminds us that any one of us can be swept up into conflicts that can spiral into self-perpetuating, all-consuming states of distrust, polarization, dehumanization, and harm.
In a recent podcast17 she shared her mindset for interviewing people whose beliefs and values clash with hers. Recognizing the potential for high conflict, she said,
“I'm not interested in resolving it. I’m also not interested in avoiding it, ... My goal, as a journalist and as a human, is if I can do one of three things: Can I, myself, understand the other person, the problem, or myself a little better through this encounter?”
She chooses to engage by listening and learning, not debating or persuading. People who feel heard are more likely to listen back. She creates space for dialog and building trust.
Here is my trust-building CHALLENGE to you!
First, in the coming months, reach out and get to know someone that does not share your values, or with whom you have a disagreement or misunderstanding. Of course, do this safely. You might even start with a family member.
Second, focus on listening, and learning about them, the issue, or yourself. It's not a debate.
Third, reflect and act on what you have learned.
And fourth, repeat steps 1 to 3
The path to resolving conflicts, building alliances, and solving complex problems starts with curiosity, inquiry, listening, learning, and connection.
Summary
To summarize, “Leadership is getting results in a way that inspires trust.”
We have a serious decline in trust of public health and science.
Embracing a systematic approach to building and rebuilding trust will accelerate your learning, growth, and effectiveness in your personal and professional life.
Finally, join me in building the truly diverse alliances necessary to promote healing and health equity, and to protect and improve health for all in California and beyond!
Again, congratulations to the UCLA Fielding School of Public Health graduating Class of 2024!
Thank you!!!
Appendix
The commencement address was inspired by an Excalidraw slide presentation I gave on building and extending trust to CDPH staff. A key slide summary is below.
Footnotes
Stephen MR Covey (2008). The Speed of Trust: The One Thing that Changes Everything (book). This is the best-selling book that introduces good character as a pillar of building trust.
Joseph A. Hamm, Corwin Smidt, Roger C. Mayer (2019). Understanding the psychological nature and mechanisms of political trust (article). RC Mayer’s research has contributed immensely to our understanding of organizational trust.
Yuval Noah Harari (2024). Disruption, Democracy and the Global Order – Yuval Noah Harari at the University of Cambridge (YouTube).
Jonathan Haidt (2024). The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness (book).
Charles Feltman (2021). The Thin Book of Trust: An Essential Primer For Building Trust at Work, 2ed (book). Highly recommended! Rather than character, Feltman uses “integrity” which means behaving in ways that align with your values. The limitation of this approach is that one can have high integrity but have poor character.
Robert F Hurley (2011). The Decision to Trust: How Leaders Create High-Trust Organizations (book). When we decide to trust, we are deciding to risk vulnerability to the actions of another party. Most decisions are intuitive and heavily influenced by our emotional state. In contrast, when we get on an airplane we have made a deliberative decision that the benefits of flying outweigh the risks. Understanding trust introduces one to many disciplines, in this case, decision sciences.
Gillian K SteelFisher, et al (2023). Trust In US Federal, State, And Local Public Health Agencies During COVID-19: Responses And Policy Implications (article).
John Dickson (2011). WCA Summit Sunday - John Dickson - Humilitas (YouTube). This is an inspiring talk on humility.
Donald Robertson. How to Think Like a Roman Emperor: The Stoic Philosophy of Marcus Aurelius (book)—Absolutely amazing book! Start here. Donald Robertson is a clinical psychologist and he introduces Stoicism using concepts from Cognitive Behavioral Therapy (CBT). Promoting Stoic philosophy is a non-religious way to promote character development through storytelling. Robertson focuses on introducing CBT-validated, evidence-based strategies.
Donald Robertson (2019). The Philosophy of Cognitive-Behavioural Therapy (CBT): Stoic Philosophy as Rational and Cognitive Psychotherapy, 2 ed (book).
Massimo Pigliucci. Think like a Stoic: Ancient Wisdom for Today's World (video course). Pigliucci is a biologist turned philosophy professor at the City University of New York. The video course is worth it! Subscribe to their notifications and wait for a steep discount. His books are also great.
Monica Sharma (2017). Radical Transformational Leadership: Strategic Action for Change Agents (book) and (website).
Definition adapted from Intellectual Humility (webpage).
Alexa Weiss, et al (2021). Trust in Everyday Life (article).
The Atlantic Podcast (2023), featuring Amanda Ripley. How to Have a Healthy Argument (YouTube).