His confirmation may be in jeopardy, but Health Commissioner Ed Ehlinger won’t back down

It’s not every agency commissioner who can claim to have borrowed his public presentation style — which often includes singing — from the folk icon Pete Seeger. But then not every physician has an undergraduate degree in English. And not every single-payer health care advocate has the support of the mainstream health care industry.
But Ed Ehlinger is an unusual guy.

Cheerful, bow-tied and gentlemanly, Ehlinger, 65, was Gov. Mark Dayton’s choice as commissioner of the Minnesota Department of Health. Whether he will get to keep that job is something of an open question. More on that later.

For now, Ehlinger is Minnesota’s leading public health official. To explain what that means he quotes the Institute of Medicine: “Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy.”

For Ehlinger, public health means having clean air, clean water, and bikeable and walkable cities. Even the placement of three light rail stops along University Avenue, created after community organizers agitated for them, are to Ehlinger a public health asset.

“If communities can get organized and use their power to do the things that will enhance their communities, we will have a healthier society,” Ehlinger says.

That communitarian mentality — Ehlinger prefers to call it progressivism — is near the surface of everything he advocates as health commissioner, a job he regards as a “bully pulpit” in the cause of improving public health.
Todd Monson, area director in the Hennepin County Human Service and Public Health Department, says that Ehlinger’s all-encompassing approach is at the leading edge of the current public health philosophy. Public health, Monson says, no longer is just about infectious disease surveillance and making sure citizens get immunized.

“I think that Ed is going along that line which says that where you live matters, and (so does) where you spend your time at work and whether you have active living,” Monson says. “He’s kind of going along with what I call the new fundamentals.”

In a way, the new fundamentals represent a return to a health care model that Ehlinger says disappeared a century ago. After the publication of the Flexner Report in 1910, physician training was transformed, which in turn transformed — or, as Ehlinger says, divided — medicine and public health.

Out went the idea of physicians serving as a community resource like the police and firefighters. In came the idea that doctors should be trained and paid like scientists whose primary interest is evidence-based research and treatment, not community-encouraged health maintenance.

“We can’t get out of our current unhealthy dilemma by doing more by medical care,” Ehlinger says. “It would be incredibly expensive, and it’s not meeting the actual problems that are there.” Those problems include income inequality, health care disparities, bad neighborhoods, unwalkable cities and poor food, he says.
“We’re starting to say we need to bring medicine and public health back together again so that they actually function in tandem,” Ehlinger says.

An accomplished brood

Ehlinger grew up in Green Bay, Wis., one of 10 children. His father was a skilled machinist, his mother a teacher. Both parents emphasized the value of education, and apparently the lesson took. Two of his brothers are attorneys, another is a dentist, a fourth is an environmental scientist. One sister is an obstetrician, another a biochemist. The “slackers” in the family, he says, settled on advanced degrees in engineering and music.
Thanksgiving gatherings aren’t given over to boasting about each other’s latest triumphs, however. “We keep each other honest,” he says. “You can’t get a big head. Not in our family.”

Early in Ehlinger’s career, he worked as a doctor in a rural Montana health clinic. From 1980 to 1995, he was director of Personal Health Services for the Minneapolis Health Department. He also taught epidemiology and community health at the University of Minnesota. Before taking on his current job, he worked as director and chief health officer for the university’s Boynton Health Service.

Dave Golden, Boynton’s director of public health and communications, worked with Ehlinger for 16 years. At the university, Golden says, Ehlinger become a much-loved presence, as much for his good-natured warmth as for his professional prowess.

Each year, Golden says, Ehlinger managed to write new lyrics to a popular song — Bobby Bare’s “Drop Kick Me Jesus Through the Goal Posts of Life” is a favorite target for revision. The songs, which Ehlinger would perform during employee awards ceremonies, always squeezed in funny references to every employee receiving an award. “Often times it was like 30 names,” Golden says.

Ehlinger also has skills as a communicator. He may be the only agency head ever to have celebrated the 500th episode as host of a television show. His program on Minneapolis Metro Cable Network Channel 6, “A Public Health Journal,” began airing in 1985. As Health Department commission, he continues hosting the weekly interview series.

He is also a good writer who once penned a theatrical play. Golden points to a sensitive letter Ehlinger emailed to his Health Department employees at the time of the government shutdown, a message that became something of a viral sensation inside state agencies. It noted that Ehlinger received his own layoff notice on the anniversary of his father’s death.

Though Ehlinger knew he would be considered a “critical” employee and not be laid off, the notice reminded him of the day his dad, Jerry, came home after being fired from a job. The dismissal, Ehlinger wrote, was in retaliation for having advocated for better wages and working conditions.

“The most important man in my life was totally devastated,” Ehlinger wrote. “His self-image and self-esteem had been badly damaged. Fear was evident in his face as he wondered aloud how he would support his large and growing family. I had never seen him cry, but I could tell that tears were very close to the surface.”

The family made it through the crisis, Ehlinger wrote, and he hoped those experiences would inspire Health Department workers. “They taught me the importance of partners, family, friends and neighbors in getting through a crisis like this,” he wrote. “We will get through this together.”

“That’s really what he is like,” Golden says. “In my world, he is really respected.”

Confirmation fight?

Whether that respect extends as far as the state Capitol is an open question. Along with Dayton’s Department of Human Services Commissioner Lucinda Jesson, Ehlinger may be in the cross hairs of state Sen. David Hann, R-Eden Prairie, a Tea Party favorite who has acknowledged that he might challenge Dayton for governor in 2014.
Hann blocked $25 million in federal health care grants by requesting they undergo further legislative review before the money is spent. As a result, Dayton accused Hann of “undemocratic” and “unconscionable” behavior for blocking funds he deemed “urgent.”

The flap led to a contentious Nov. 15 hearing during which Hann dressed down Ehlinger. He said that in a previous meeting between the two, Ehlinger had not warned Hann that blocking the grants might place the health of 5,000 Minnesota children at risk, as Dayton charged. Ehlinger responded that he never got a chance, because Hann had rushed out of the meeting. However, Ehlinger told Hann, “I do not recall saying no one would be harmed.”

“All I know is that if these programs aren’t funded, the state will be worse off healthwise for that,” Ehlinger says. Hann may have an ideological reason for blocking the money, or he may have data that Ehlinger isn’t aware of for opposing them. “I don’t know about,” Ehlinger says. “I’d be glad to discuss those with him and talk with him.”
Hann has not stated whether he will move to block Ehlinger’s confirmation. However, several days before the Nov. 15 hearing, he warned he would take “a dim view” of any commissioner who was “willing to cooperate” with Dayton in circumventing legislative oversight and unilaterally expand health care programs.

Thus the stage might be set for contentious confirmation hearings in the coming legislative session.

Ehlinger acknowledges he could lose his job over the dispute but says he is not worried. He doesn’t see himself as indispensable, and at 65, the commissioner’s post is not a stepping stone to any higher position. He could retire happy with the career he has already had, he says.

“I am not going to play to the test,” he says. “I am not going to try to do stuff that needs to be done for the sake of confirmation.”

That answer does not surprise Ehlinger’s old friend Golden. “He’s tough,” Golden says. “He doesn’t back down from stuff at all.”

Monson says he hopes that Ehlinger is confirmed. For a local public health official like himself, Monson says, Ehlinger is a great ally. “He has been a great supporter of local public health,” he says. “He sees how we work in the trenches, and he knows our strengths and our limits. It is wonderful to have a partner like that.”

The Ehlinger File

Name: Ed Ehlinger

Job: Commissioner, Minnesota Department of Health

Age: 65

Grew up in: Green Bay, Wis.

Lives in: Minneapolis

Education: Premontre High School, Green Bay; B.A., English, University of Wisconsin, Madison; M.D., University of Wisconsin, Madison; M.S., public health, University of North Carolina, Chapel Hill

Family: Wife of 42 years: Sally Ehlinger, Ph. D., a retired early childhood physical activity specialist. Two adult children, Betsy Featherstone and Gretchen Ehlinger. Four grandchildren.

Hobbies: Biking, cross-country skiing, children’s music, storytelling. “I play music and I sing songs to my grandkids, and I tell them stories.”