Editor’s Note: Manoj Jain, MD, is an infectious disease specialist who is running for Shelby County Commissioner for District 13. He has contributed articles to various publications including the Memphis Commercial Appeal and the Washington Post. Professionally, Jain serves as medical director of quality at QSource, Tennessee's Quality Improvement Organization and is an adjunct faculty member at Rollins School of Public Health.

While the Memphis Medical News does not endorse candidates running for public office, the newspaper does include thoughtful commentary. The newspaper feels Jain’s commentary is timely and of special interest to its readers.

“I think you need to get a CT scan of your head,” a colleague recently responded to me as we stood in the doctor’s lounge after I told him my intention to run for public office. “Why would you ever do anything like that?” he added, a bit astonished at what I had just told him.

The answer is complicated. I began by telling him about a morbidly obese patient who comes from an underserved neighborhood and is now hospitalized with cellulites and is going into kidney and respiratory failure. Then I mentioned a truck driver who is diabetic and lacks health literacy and now has an ulcer which may result in amputation of his right foot.

“Each day, I feel like I am pulling people out of a river to prevent them from drowning, while upstream there is bridge with a hole where people are falling,” I say.

The problems are upstream – the underlying problems are not with the hospitals or clinics, but in the community, and we as health providers need to address them and be involved in the political process.

Today the Shelby County Commission has 13 members and none has a healthcare background, and yet they sign off on the budget and determine policies for the Shelby County Health Department and Regional One Health, formerly called The MED.

More importantly the Commission sets the vision for economic growth and educational progress – all of which impacts our community’s health. But today as we look at Memphis and Shelby County we see no vision for the growth and educational progress which has occurred in other cities such as Atlanta and Nashville. Often we see commissioners mired in petty bickering or angry outbursts, all of which lacks civility, credibility and respect. And all of this takes precious time away from the necessary growth and development our county needs.

There is much a doctor can add to the commission. Over the past decade the healthcare industry has transformed and is using the principles of total quality improvement, something which Toyota and FedEx have been successfully using for decades to improve quality and efficiency. “Why can’t government use the same principles of Plan, Do, Study, Act?” I ask my colleague. In fact my research shows local governments in Florida and Minnesota are doing this very thing and showing success.

Also, as doctors we understand the importance of accountability for our actions better than anyone else. Citizens need to hold their political leaders accountable. This can be tricky with so many unpredictable circumstances. It may not be possible to hold leaders accountable to “outcome measures” such as the job growth over the past six years (less than one percent in Memphis compared to almost 10 percent in Nashville). Yet the public can hold the leaders accountable to individual “process measures” – for example, how many new businesses did the commissioner meet with each month to foster economic and job growth? A focus on accountability can help reshape our thinking of politics and politicians, especially as the electorate becomes more Internet savvy and data driven.

As doctors we can address important issues of personal responsibility and encourage patients to take responsibility for their health. Similarly, we can encourage the general public to be more responsible. Parents need to take the initiative to make sure their children do their homework and unemployed workers must make an effort to retrain themselves for the changing workforce.

Few would disagree with the ideas of efficiency in government, accountability for leaders and responsibility of citizens. But how do we translate these goals to real-world actions and help people such as the obese patient and ailing truck driver?

Here’s how. On a recent quiet Saturday afternoon on the hospital floor, a nursing assistant told me about her broken family – two half-brothers in and out of jail, a cousin on drugs, and another in a gang. She relates how her mother was able to take her out of the projects and help her not only finish high school, but get into vocational school. Now a decade later, this nursing assistant is making sure her kids get an education. All of which will help fight poverty, illiteracy, and health problems such as obesity and diabetes which run in her family. We need to help the majority of our county residents “upstream” with better education and job opportunities in order to better their health. All are interrelated.

Doctors’ work is changing. Healthcare is moving out of the hospital and clinics and into the communities. Hospital admissions are decreasing, and preventive health is being prioritized with emphasis on diet and exercise. Local government can help by promoting walkable paths, more availability of healthy fruits and vegetables, and advancement of antismoking policies, which all contribute to an environment of better health.

“The future of healthcare is in the communities and we need healthcare professionals to have a voice,” I tell my colleague. He smiles and cancels my would-be CT scan.