Most Princetonians would agree that Heather Howard is not your typical professor. Both a scholar and practitioner, the former Washington insider and New Jersey Commissioner of Health and Senior Services joined Princeton with a unique and distinguished background blending politics, policy, law and public health. She has dedicated her career and much of her life to civic engagement, garnering experience and expertise across all levels of government. In fact, Howard passed through the White House, Capitol Hill and Trenton before settling in Princeton, where she has served the municipality and the university.
On campus, Howard wears several hats – including Professor of the Practice for Princeton’s School of Public and International Affairs, Director of State Health and Values Strategies program, and her new role as Co-Director of Princeton’s Global Health Program. In this Spotlight, she shares milestones and mentors, challenges and opportunities, and her underlying – and unrelenting – commitment to advancing health equity throughout the United States and the world.
Q. After graduating from Duke University with a B.A. in History and Spanish, you went straight to Capitol Hill. What attracted you to politics?
A. I have always been passionate about government and service in various ways, although I never anticipated that I’d be fortunate enough to see government from so many different perspectives. My career has not been predictable, nor has it followed a straight line. It has included roles in the executive, legislative and judicial branches and at the federal, state and local levels – which has been exciting. What really animates me is the chance to effect change and implement policies that have a positive impact on people’s health and lives.
Q. Were there any people or experiences, early in your career, that contributed to your keen interest in health equities?
A. On the professional front, I was really lucky that my first job out of college was in the office of Nita Lowey, former U.S. Representative from New York (who was my congresswoman) – when there were very few women on the Hill. Notably, in 1990, I worked with her and the Congressional Women’s Caucus on the Women’s Health Equity Act. At that time, women were not included in clinical trials funded by the National Institutes of Health. Even the lab mice were male! So we developed legislation that required inclusion of women in clinical trials and really began to move women’s health to the front burner. I was fortunate to be at the table for that.
More broadly, I’ve had a number of strong women mentors who contributed to my interests in social policy. In addition to Representative Lowey, I clerked for Judge Martha Craig Daughtrey of the Sixth Circuit U.S. Court of Appeals, who was a brilliant, accomplished jurist and pioneer in Tennessee law, from being the first woman on Tennessee’s Supreme Court to the first woman from Tennessee on the Sixth Circuit, as well as Hillary Clinton, who was a tremendous role model for me as we spearheaded several initiatives focused on children’s health.
On a more personal note, my son was diagnosed with cancer when he was two years old. My family was still in Washington at the time and had access to the best health care. However, the experience helped me understand the dysfunction in our health care system and resulting inequities. I could see how hard it would be to navigate the system without the privilege and resources that we had. (My son is healthy now – and a freshman at Princeton!)
Q. After four years on Capitol Hill, you earned a J.D. from the New York University School of Law. What inspired that path, and why did you pivot back to politics?
A. After working on Capitol Hill, it was clear to me that I needed a graduate degree to engage more deeply in policy debates and advocacy. So I went back to school, earning my law degree, and after my federal clerkship I was accepted into the U.S. Department of Justice’s Honors Program, where I served on the Antitrust Division’s Health Care Task Force. I was back to working on health issues, this time as a trial attorney in an antitrust context. We focused on hospital consolidation and physician unionization, which was really interesting, but I preferred policy and politics to practicing law. I did that for about a year and a half before an opportunity to work at the White House came along.
Q. Tell me about your role at the White House. That must have been an amazing experience!
A. It was! I served as Associate Director of President Bill Clinton’s Domestic Policy Council and Senior Policy Advisor for the First Lady, working on children and family issues. I collaborated with so many smart, motivated people, and got to work with the executive agencies and Congress, seeing all of the policy levers at the federal level.
One initiative that I was involved with was the reauthorization of the Violence Against Women Act (VAWA), a comprehensive federal initiative designed to improve criminal justice responses to domestic violence and increase the availability of services for survivors. Reauthorization was languishing in 2000, so we worked with officials at the Department of Justice, survivors, and their advocates to lift up the importance of the program, successfully putting pressure on Congress both to reauthorize the law and also to expand it to address sexual violence and stalking.
I also worked with Hillary Clinton on children’s mental health issues. For example, a big study came out indicating that doctors were prescribing psychotropic medications to kids at an alarmingly high rate. The First Lady was very concerned about this, so we took a dive into what was going on and why. We looked at the safety of addressing mental health disorders with pharmaceutical interventions over other modes of treatment and considered equity issues related to who was prescribed medication and who was not.
Q. When the administration changed hands in 2001, you went to work for U.S. Senator Jon Corzine, eventually serving as his Chief of Staff and focusing on public health and health policy. Do any projects stand out in your mind?
A. Senator Corzine campaigned on universal health coverage, and one of the first bills he introduced was legislation aimed at providing equal access to care for all Americans. Although that wasn’t achieved until the Affordable Care Act (ACA) was enacted in 2010, we were successful in expanding health insurance coverage for pregnant women by increasing access to prenatal care. We also explored the nexus between the environment and health. For example, we addressed concerns about potential leaks from chemical plants and investigated whether the state’s density, industrialization and other environmental factors were impacting the health of New Jersey residents.
Additionally, we were deeply engaged in assisting families affected by 9/11. Almost 700 of the victims were from New Jersey, so we worked to ensure that survivors and victims’ families were accessing the relief funds appropriated by Congress.
Q. Four years later, when Jon Corzine was elected Governor of New Jersey, you joined his new team and moved to Princeton. What drove your decision to leave Washington for a post in state government?
A. Then-Senator Corzine convinced me that policy action is at the state level and that states are the laboratories for innovation. It’s an old trope, but he was right. It was a risky move, because I was so entrenched, personally and professionally, in Washington, but he was such a strong, progressive, empathetic leader that I wanted to follow him and was compelled by the opportunity to have a bigger impact in Trenton. In fact, I’ve since become an evangelist for state policy.
I began as the Governor’s Chief of Policy and eventually became Commissioner of the New Jersey Department of Health and Senior Services. We pursued ways of making the Family Care program more robust to cover more people and services, such as expanding access to family planning and increasing the Medicaid reimbursement rate for pediatrician visits, and ensuring that New Jersey seniors seamlessly transitioned to the new “Part D” Medicare prescription drug benefit.
Through this experience I developed an understanding and appreciation for the financial constraints that states face because they have to balance their budgets, unlike the federal government. So even when there’s a will, finding a way can be hard.
Q. You also served as a councilwoman for Princeton. Did you view this as yet another avenue for impacting the health and welfare of New Jersey residents, or were there other reasons for assuming this role?
A. After Governor Corzine lost his reelection, I wanted to continue to be engaged in civic life. I was living in Princeton, and serving as a councilwoman gave me the chance to impact policy at the local level while also modeling civic engagement for my son. This was my first elected position, and it taught me how a town can make things happen when states fail to do so. I’ll give you an example. After Governor Christie vetoed several anti-smoking bills, we enacted comparable measures locally. Princeton became one of the first municipalities to ban smoking in outside public areas and also was among the first towns to raise the legal smoking age to 21.
I think the through line for my career has been federalism – the delicate dance between levels of authority. Where are the levers of power? There is always tension between different levels of government. We’re seeing it right now during the pandemic in states like Florida and Texas. Who gets to decide mask or immunization mandates – the federal government, the states, or towns?
Q. What led you to Princeton’s School of Public and International Affairs (SPIA) and the Center for Health and Wellbeing (CHW)? Was it the State Health and Value Strategies (SHVS) program, or did that come later?
A. In 2011, I was working with the Robert Wood Johnson Foundation to create a program to help states implement the Affordable Care Act (ACA). Although it’s a federal law, its success depended on state implementation, so we created a program to provide technical assistance to support states. We decided that it should be housed at a university to establish synergies with research and the academic community, and Princeton was the perfect place because of SPIA and CHW. I came here with the plan to divide my time between directing SHVS and teaching.
With the Foundation’s continued support, the program has grown and widened its focus to help states develop and implement reforms that make their health care systems more affordable and equitable. Building upon my experience in health policy, SHVS offers seminars, publications and technical assistance to empower states to navigate the pressures of financial and political constraints, leadership turnover and other hurdles.
As an added benefit, this work feeds my teaching at Princeton, so when I talk about the ACA or other policies I am connected to the states’ challenges and opportunities in real time.
Q. Has the SHVS program become increasingly important during the pandemic?
A. Absolutely. Just like states were on the front lines of the ACA implementation, they are also on the front lines of the Covid response. When the pandemic struck, our program pivoted to supporting states as they respond to the crisis. We have tried to be a resource center that allows states to share information while providing insight and guidance for complying with federal policies and developing state-led initiatives. One of our most recent offerings, for example, was a webinar on strategies for equitable vaccine outreach.
Q. What are you teaching during the 2021-2022 academic year?
A. I am leading an undergraduate SPIA Junior Task Force focused on health care for vulnerable populations, as well as co-teaching a Policy Workshop for graduate students on the Affordable Care Act. In the junior task force, we’ll be talking about state health policy as it unfolds, exploring new developments in the pandemic, the natural experiments afforded by varying state policy responses, and how federalism has frustrated the response. At the end of the semester, students will present their research findings and policy recommendations to state officials in Trenton.
The graduate policy workshop, which I’ve been teaching for the past 10 years, is unique because I’m able to leverage my relationships at the state level to provide a meaningful experience for students working on a timely policy issue. Partnering with a different state each fall, we typically visit the state’s capital for field work and meet with government officials, stakeholders and legislators. Participants engage deeply and perform high level work for the “client,” state health officials. In fact, a few years ago, a group of my students proposed recommendations that were enacted by Washington state.
I really enjoy mentoring students and exposing them to opportunities in the field. I encourage them to think broadly about the rich variety of ways in which they can contribute to public health and health policy, whether they choose to work at the state or federal levels, internationally, or back in their own communities. And I’m always so thrilled when students go into these fields – former students are now working in health policy roles at the federal, state and local levels.
Q. This fall, you’ve stepped into a new role as Co-Director of the Global Health Program (GHP). Would you like to share any thoughts about this endeavor?
A. I am excited to assume this role. It’s such a dynamic program, and I love its interdisciplinary approach. We have students from all different majors, including the natural sciences, social sciences, humanities and engineering. I’m already thinking about how we can continue to bring them together and support their interests through academics, internships and independent research. There is nothing more exciting than watching a student build upon a summer internship or junior task force project… seeing how those experiences inspire a senior thesis, post-graduate work, and/or a lifelong commitment to global health issues.
Q. Will students continue to examine the pandemic as part of the GHP curriculum – this semester and beyond? In fact, would you say that it is a compelling illustration of the nature of global health, showing how the health of one nation affects the health of all nations?
A. We'd be remiss if we weren’t seeing it that way. Covid has brought home the critical importance of global health. We’ll be studying this for years, exploring the pandemic’s implications and far-reaching effects through our courses and enrichments. In fact, this year’s GHP colloquium series will focus on vaccines, addressing not only the development and effectiveness of vaccines, but also how we talk about vaccines and ensure equitable distribution. Indeed, we’ve learned that the work doesn’t just end with the development of a vaccine; a vaccine’s success depends on things like the public’s trust in our health care institutions.
Also, the pandemic has magnified (and preyed upon) health inequities, taking a disproportionate toll on communities of color. We have much more work to do to understand and lift up those inequities, and research to identify policies that can advance health equity. I know students are interested in these topics and the GHP curriculum can help them explore and contribute to evolving efforts to address the social determinants of health.
Q. What do you view as the most vital challenges ahead within the realm of global health?
A. Domestically and worldwide, we have put many pressing health issues on the back burner because of Covid. Mental health, the opioid crisis and preventive care are all of grave concern. In the United States, we’ve seen a decrease in health care utilization as a result of the pandemic. For example, people have skipped cancer screenings, and childhood immunizations are down. We have to address these unmet needs and get back to improving all aspects of public health and wellbeing, here in the U.S. and around the world.