By Jennifer Eder
What does Walmart have to do with public health?
In reality, a lot, said John O. Agwunobi, Walmart U.S. senior vice president and president for health and wellness, during an address last week at the Marvin Center for students in GW’s School of Public Health and Health Services.
About 140 million people walk through Walmart’s doors every single week in the U.S. That huge number means good business for Walmart, but it also means an opportunity to influence the health of large segments of the population.
“Access to that number, that kind of volume, every week…the ability with small interventions to make amazingly large differences is why I work at Walmart,” said Dr. Agwunobi, former assistant secretary of health at the U.S. Department of Health and Human Services and an admiral in the U.S. Public Health Service Commissioned Corps. “Walmart is where the people are. The opportunity to touch and change lives is quite dramatic.”
A pediatrician by trade, Dr. Agwunobi never imagined he would work in corporate America. He grew up surrounded by clinicians. His father was a surgeon. His grandfather was a family practitioner, and his mother was a nurse. But after completing his pediatric residency at Howard University, he became the vice president of a pediatric rehabilitation hospital and a medical director for an affiliated managed care plan in the District – two experiences that introduced him to the concept of population health.
“I started to realize that it’s not enough to just touch individuals,” said Dr. Agwunobi. “Public health changed my life. It broadened my view of health care and the causes of illness.”
From Washington, he moved to Florida in 2001 to serve as the secretary of health while simultaneously pursuing a master’s degree from Johns Hopkins Bloomberg School of Public Health, where he was a student of Lynn Goldman, now dean of GW’s School of Public Health and Health Services. As secretary of health, he responded to the nation’s first-ever anthrax attack.
“Florida was the first target in the anthrax mail attacks, and this was a really frightening and difficult public health crisis,” said Dr. Goldman while introducing Dr. Agwunobi. “He handled it so masterfully that the president of the United States decided he could handle bigger problems and brought him on board as the assistant secretary of health. He’s continued to be a hero of mine.”
While serving as U.S. secretary of health from 2005 to 2007, Dr. Agwunobi was responsible for disease prevention, health promotion, women and minority health efforts, the reduction of health disparities, the fight against HIV/AIDS, pandemic influenza planning and vaccine preventable disease initiatives.
In 2007, Walmart, the world’s largest company and employer of two million people, began trying to recruit Dr. Agwunobi as its president for health and wellness. The first three tries, Dr. Agwunobi declined the offer. But on the fourth try, Dr. Agwunobi began to see the intersection between public health and the corporate world and considered the unique opportunity he would have to influence millions of people across the U.S.
“Being a good company is one thing, doing good as a company is something else,” said Pierre Vigilance, B.S. ’91, a SPHHS visiting professor in the Department of Health Policy and former director of the D.C. Department of Health. “Helping companies see how to benefit their customers and the communities in which they live is an important public health function.”
As a senior vice president, Dr. Agwunobi leads Walmart’s health and wellness business unit, which includes pharmacies, vision centers and health care centers. Among the initiatives he oversees are the $4 Prescription Program and the retailer’s partnership with First Lady Michelle Obama’s Let’s Move Campaign to offer more healthy foods at affordable prices and build more stores in underserved areas.
“I still get to work with populations, and I still get to work principally on health care,” said Dr. Agwunobi. “Ultimately, I look for strategies and tactics that touch the most people in the broadest way and make them healthy.”
Dr. Agwunobi said the notion of corporate responsibility is no longer an option for companies anymore. Instead, it’s an obligation.
“Because if you’re not part of the solution, then you’re part of the problem,” he said.
Over the past 10 years, Walmart has become a leader in corporate sustainability. The retailer worked with its suppliers to get hazardous waste out of its products and committed to reducing its carbon footprint.
Now, the company is looking at how to meet its customers’ demand for health care services, said Dr. Agwunobi.
“People want an easier and better way to get services. They’re seeking convenience,” he said.
Dr. Agwunobi envisions retail clinics offering preventative screenings, health education and nurse practitioners monitoring people’s health between visits with their primary care doctor. Dr. Agwunobi calls this the consumerization of health care and believes it’s the next frontier in public health.
“We have to think of people less as patients and more as customers,” he said.
Part of this shift involves looking at health care decisions and understanding the factors that promote or discourage people from seeking care. For example, when Dr. Agwunobi was Florida’s secretary of health, he conducted a study on the use of mammography among the state’s Medicaid beneficiaries. Of the women who knew they had access to a free mammogram, only 4 percent took advantage of the benefit. The reason for the low participation? Other barriers, like the cost of the cab ride to the clinic where the mammogram would be performed.
“The impact of the economy on public health is understated,” said Dr. Agwunobi. “Folks sometimes think the solution is to give everyone coverage, but there are many economic factors to consider.”
Instead of viewing corporate America as the “dark side,” Dr. Agwunobi encouraged SPHHS students to inspire businesses to find ways to practice public health within their individual business models.
“I hope I can get one of you to see corporate America as an opportunity,” he said. “It’s tough sometimes because on the one hand corporate America causes problems that result in poor public health, but we can’t stand to overlook how to leverage them. So I urge you to think of corporate America as a target that you try to inspire, that you try to engage and that you try to leverage in the fight for public health.”