Dave’s work opened my eyes to many of the obstacles that stand in the way of the work we do in public health. In the quest for funding, one challenge public health faces is explaining the impact of public health programs and associating these results with the cost of services. Framing public health issues in business terms to funders and taxpayers can help make the case for the pressing need for public health programs.

I also learned a great deal from Dave’s contribution to a report he collaborated on for the Institute of Medicine (IOM) titled Investing in a Healthier Future. The IOM report calls for defining foundational capabilities that should constitute the backbone of all public health agencies and also calls for establishing uniform accounting to enable cross-agency comparisons and improvements in our understanding of the relationships between resource expenditures and program outputs and resulting health outcomes. Dave’s wisdom and experience provides the confidence to public health leaders to pursue the implementation of the IOM report recommendations.

Dave’s perspective on the IOM report helped jumpstart our own research on the needs for a uniform chart of accounts across public health agencies. With the support of the Robert Wood Johnson Foundation, PHII is developing an accounting model that any public health agency could adopt. With such a uniform database of expenses, we would gain metrics that would allow us to compare jurisdictions and translate the outcomes of public health into terms policymakers can identify with.

Without Dr. Fleming’s insight, this work would certainly not have been possible. I wish Dave the best as he moves on from the Seattle and King County public health department, and I’m confident that his forward-thinking perspectives will continue to ripple into policy, best practices and public health programs for many years to come.