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A life committed to public service

Yale Medicine Magazine, 2020 - Spring


When addressing the Yale School of Medicine’s Class of 2015, Howard Koh, MD ’77, MPH, encouraged students to frame their future as an adventure: entering the medical profession is an opportunity to dive into one’s interests and identify callings. “But as you do, please listen carefully to your inner soul,” he implored. “Doing so will help you determine what is ultimate versus what is merely important.”

Koh’s own career trajectory has been guided by this deep sense of calling and purpose. Paying close attention to the needs of his patients—and those of the broader society—enabled him to derive a sense of meaning from treating disease, curbing its preventable causes, and redefining concepts of well-being. Now the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School, Koh previously served as the commissioner of public health for the Commonwealth of Massachusetts (1997–2003), and as assistant secretary for the United States Department of Health and Human Services (2009–2014) under President Barack Obama, among other positions. He has been an architect of or major contributor to many significant health care policies in such areas as health equity, tobacco control, HIV/AIDS, and implementation of the Affordable Care Act. He has also had a remarkable career in academia, publishing prolifically on a wide variety of topics in both public health and clinical medicine.

When asked whether he had ever anticipated occupying so many different roles, Koh maintained that none of it was planned. “I feel passionately that everyone has a calling and we must work hard to discover what it is,” he said. “I am so fortunate to have discovered mine.”

Many of Koh’s long-term interests are rooted in a desire to understand how people conceive meaning in their lives and how that theme influences health. From an early age, Koh’s parents, both South Korean immigrants to the United States, instilled in their children an orientation to service rooted in this sort of introspection. “They taught us that it was critical for us kids to get the best education possible and live a life that made a difference” Koh recalled. “I heard about these themes every day.”

Initially, Koh sought to fulfill this imperative through direct patient care. He ended up achieving quadruple board certifications—in internal medicine, hematology, medical oncology, and dermatology—and spent several decades as a physician working in a hospital. During this time, Koh often reflected on the words of his friend and mentor, the Reverend William Sloane Coffin Jr., then chaplain of Yale University: “Do not view a patient as an uninteresting appendage to an interesting disease!” Koh took this guidance seriously; he viewed clinical practice as a privilege that not only allowed him to alleviate patients’ suffering but also to learn about how they incorporated meaning within their lives.

On the other hand, the years that Koh spent treating illness also revealed the extent to which factors outside medicine can dictate patients’ outcomes. “From a very early point as a doctor, I saw that too many of my cancer patients died too young. And what anguished me the most—and still does now—is how many of them succumbed to preventable causes,” Koh said.

While many young doctors grapple with this reality, Koh resolved to incorporate preventive measures into his work that went beyond conversations with individual patients. Koh’s father, Kwang Lim Koh, PhD, a former ambassador from South Korea to the United States, had always encouraged his children to “be broad like the sky,” and had through his role as a diplomat exemplified enacting change through public service. Following his father’s example, Koh found himself moving toward public health and policy making. He became involved with an early-1990s ballot initiative to raise the tobacco tax in Massachusetts—at the time, California was the only state to have instituted such a policy—that ultimately generated millions of dollars and many programs for future public health efforts intended to reduce tobacco-related deaths.

Koh continued his work in statewide health policy; pursued an MPH degree at Boston University; and then was appointed by Governor William Weld as Massachusetts Commissioner of Public Health in 1997. Poignantly, Reverend Coffin offered a prayer at Koh’s swearing-in. “He prayed that we all should ‘be concerned most with those who society counted least and put last.’ I’ve never forgotten that.” Koh said. Indeed, the prayer has profoundly influenced his public health work and remains displayed on his office wall.

Koh found that his medical training was in many ways good preparation for work in the public health arena. His scientific literacy, flexibility, and ability to balance the “aspirational with the achievable,” enabled him to contribute to sound policies—and his experience in building relationships helped him recruit partners to implement them. “Being able to communicate succinctly and connect on [the] personal level are critical skills,” he said. “They come into play whether you’re talking to a patient or a reporter or a colleague in government.”

Perhaps unexpectedly, Koh often drew from his undergraduate experience as president of the Yale Glee Club when seeking input from people in many different fields. “I love choral singing and it’s not just about the music,” Koh said. “It’s also about the joy of people working together to create something bigger than themselves. That’s what public health is all about too—many voices coming together to create something special.” Applying this philosophy to his professional life has enabled him to solicit the perspectives of stakeholders from departments like housing, environmental protection, and defense, and contributed greatly to his emphasis on the social determinants of health when crafting public health initiatives.

The transition to a public health career has also brought challenges. Although Koh had previously navigated a hospital hierarchy, the complexities of government bureaucracies often meant that the timeline of policy lagged behind the urgency of the issue at hand. “To make progress in the public health arena, you have to understand that change is mostly incremental. Sometimes taking two steps forward and one step back is just the way it is,” he said. “But if you take the long view and commit yourself to your work for a long time—actually, a lifetime—you will see that the most effective leaders are the ones who demonstrate patience and perseverance.” He also credits his physician wife (Claudia A. Arrigg, MD, MEd) and three grown children for giving him endless support.

Koh emphasizes these traits when teaching his public health leadership courses. He advises students to focus on preserving their authenticity and humanity, maintaining a commitment to their mission but remaining flexible about how to enact it. He has also extended his teaching beyond his own classroom, writing articles about opportunities for medical professionals to serve as broader advocates for population health. Whether he’s teaching or publishing, Koh tends to focus on cultivating qualities like emotional intelligence rather than imparting specific policymaking skills. “I think that’s really the heart of what education should be,” Koh said. “It’s one thing to acquire facts, but it’s more important to understand how to translate knowledge for the greater good.”

For Koh, being “broad like the sky” now means following a calling to become even more interdisciplinary in his career. During past national emergencies, he led the state public health response to the anthrax threat as Massachusetts commissioner in 2001 and contributed to the H1N1 pandemic response as Assistant Secretary for Health in 2009. With the current COVID-19 pandemic, Koh is now fully committed to addressing it through teaching, writing, public speaking, and policy efforts. Through all this, he advocates for a more expansive interpretation of health, drawing upon what is ultimate. “We must define health broadly to encompass emotional well-being, spiritual well-being, the importance of community and the role of relationships,” Koh said. “These are the things that people think about when they wake up in the morning. Trying to improve health for all allow us to find meaning in the journey. To me, that’s what it’s all about.”

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