CBE’s public health expert, Dr. Vassilis Karokis-Mavrikos, recently contributed to the WHO Public Health Leadership Course in Athens, Greece – a collaborative initiative between the WHO Regional Office for Europe and the University of West Attica, with the support of the Greek Ministry of Health and the Stelios Philanthropic Foundation. In this CBE Blog, he shares his reflections on the need for public health leadership across levels today, and on what it will take for public health systems to meet that need.
The title of this blog post pays tribute to Michael Mintrom’s seminal piece on policy entrepreneurship, which Paul Cairney and Claire Toomey recently adapted to systems leadership.
So you want to be a…? It is the kind of question that arises when need, demand, and knowledge all conjoin in an area, field, or practice, setting the stage for transformative breakthroughs. And that is exactly how it felt in the Stelios Foundation Conference Hall in forever-sunny Athens, Greece, during the second week of November, when the latest iteration of the WHO Public Health Leadership Course took place.
The WHO Public Health Leadership Course is a young but already well-travelled programme, having taken place in Rome, Italy (2022), Bordeaux, France (2023), Lisbon, Portugal (2024), Astana, Kazakhstan (2024), Kyiv, Ukraine (2024), and now Athens, Greece (2025). It spans multiple weeks and is delivered in a hybrid format, in collaboration with international experts and local public health schools. The course features a star-studded roster of contributors, including Professor Sir Michael Marmot, Professor Martin McKee, and former CDC Director Tom Frieden.
The most recent instalment was led by the WHO Athens Quality of Care and Patient Safety Office (João Breda, Thanos Myloneros), with the support of the Greek Ministry of Health and the Greek National School of Public Health (University of West Attica). The nearly fifty participants were professionals at different career stages working in public health across municipalities, regional health authorities, ministries, hospitals, international organisations, universities, and the media. They attended lectures, activities, and workshops delivered by national and international experts, engaged with political representatives from the Ministry of Health, and worked collaboratively on Problem-Based Learning (PBL) case studies coordinated by Professor Janet Hart.
Having had the honour of being invited as a contributor to the course and as a facilitator for the PBL component across the two weeks, I returned from Athens with reflections on the need for public health leadership across levels today, and on what it will take to meet that need.
Public Health Systems Need Empowered Public Health Professionals
Greece’s successful containment of COVID-19 spread during the first wave of the pandemic (maintaining fewer than 100 daily cases until August 2020) caught many by surprise. Having developed one of the first accounts explaining the Greek pandemic response, our research highlights[1] that this success, as in past crises and emergencies, is largely attributed to the country’s alarm reflexes. While the Greek policy style is very much one of centralisation, and while capacity – in financial, human-resource, and procedural-infrastructure terms – has historically been lacklustre, public health professionals on the ground have time and time again outperformed expectations.
More importantly, the Greek case is much more the rule than the exception. The recent place-based governance shift here in the UK is likewise motivated by the observation – and increasingly the admission – that empowering local specialists is imperative for managing the multiple and compound needs facing societies today. As one participant remarked to a representative of the Ministry of Health during the course’s concluding session, “I want you to listen to us.”
But for successful public health system governance and performance, empowerment means more than listening. It requires:
Delegating planning and executive responsibilities to local and regional authorities, public service organisations, and specialist bodies during both periods of normalcy and crisis.
Developing process infrastructure that regularly monitors local needs and feeds insights into policy venues committed to long-term planning.
Investing in the continuous upskilling of human resources, from decision-makers to practitioners – with initiatives such as the WHO Public Health Leadership programme offering a strong blueprint.
Public Health Systems Need Ideational Alignment Among Participating Stakeholders
Embedding the multidimensionality of public health into governance paradigms remains one of the greatest outstanding challenges for societies across the globe. Over a century ago, Winslow described public health as a science and art oriented toward preventing disease, prolonging life, and promoting physical and mental health and well-being. As we are reminded daily, this science and art is, at its core, the exercise of public policy.
In 2022, together with Maria Mavrikou and John Yfantopoulos[2], we proposed that evaluating public health systems should focus on the alignment between the system’s mission and the ideational orientations of its stakeholders. Put simply, without a shared understanding of the true nature of public health – as a social process aimed at prevention, promotion, and protection – no comprehensive implementation of public health policy can be achieved. Greece offers a prime example: It introduced a modern and comprehensive approach to public health in its inaugural public health bill in 2003[3], yet failed to challenge entrenched medicine-centric tendencies, thereby undermining the ambition of its mission[4].
The case studies on which course participants worked showed that the scope of public health is widening more rapidly than ever, covering everything from the public-health risks of rising temperatures, to the link between diabetes and depression, to AI-supported decision-making, to domestic-violence prevention. The successful public health systems of the future will be those that consistently reinvest in embedding public-health principles across an ever-expanding web of policy sectors and across all levels of government.
Public Health Systems Need Integrated and Interoperable Data Infrastructure
We may be living through the greatest technological revolution to date, but the idea of an integrated public health data infrastructure is at least two centuries old (…see Florence Nightingale’s work during the Crimean War). Although long acknowledged as essential for successful public health governance, it has remained a persistent challenge for most health systems – largely due to the significant resources required to build and maintain effective data-collection and data-sharing capacity.
What the current digital revolution has enabled, however, is the possibility of building this capacity at far lower cost and at far greater pace. Greece exemplifies this new reality. Since the COVID-19 pandemic, the country has used the crisis as a window of opportunity[5] to roll out an unprecedented volume of state-of-the-art digital governance systems. Moreover, after establishing a comprehensive, nationwide COVID-19 patient registry for the first time, it has used this as a blueprint for integrated digital patient files that are expected to launch in early 2026.
But launching systems is only part of the task. Systems also need to be integrated and interoperable. This means:
- Linking health data with other administrative data to incorporate social, economic, and demographic determinants that are essential for effective evaluation.
- Developing in-house government expertise to set up and maintain systems in ways that ensure long-term compatibility.
- Establishing horizontal channels of communication (between agencies, authorities, and departments) and vertical channels (across levels of government) so that systems receive consistent input, structured throughput, and widely relevant output.
- Investing in educating and engaging users – policy professionals and the public – to ensure equitable access and effective use.
Otherwise, setting up new data infrastructure risks resembling a “jump-started Lamborghini”.
So you want to be a Public Health Leader? The good news is that demand has never been higher, as public health finds new ways to challenge us every day. But as we keep learning from these challenges, like with all wicked problems, doing things well becomes increasingly complex. The public health systems of tomorrow will need leaders across all levels of governance (including, crucially, public health professionals), consistent investment in embedding public health principles across all facets of public policy, and integrated and interoperable data infrastructure. Transformative windows are many and arriving fast – and initiatives such as the WHO Public Health Leadership Course offer one-of-a-kind opportunities for the leaders of today and tomorrow to seize them
[1] Nikolaos Zahariadis and Vassilis Karokis-Mavrikos. (2022). “Centralization and Lockdown: The Greek Response”, In: Policy Styles and Trust in the Age of Pandemics: Global Threat National Responses, edited by Nikolaos Zahariadis, Evangelia Petridou, Theofanis Exadaktylos and Jorgen Sparf. Routledge.
[2] Vassilis Karokis-Mavrikos, Maria Mavrikou and John Yfantopoulos. (2022). “Stakeholder Perceptions and Public Health System Performance Evaluation: Evidence from Greece during the Covid-19 pandemic”, Frontiers in Political Science.
[3] Maria Mavrikou, Nikolaos Zahariadis and Vassilis Karokis-Mavrikos. (2023). “The strategy of venue creation: Explaining health policy change in Greece”, International Review of Public Policy, Vol 4(3).
[4] Vassilis Karokis-Mavrikos and Maria Mavrikou. (2023). “Shifting Ideational Paradigms in Public Health: the case of Greece”, In: The Modern Guide to the Multiple Streams Framework, edited by Nikolaos Zahariadis, Nikole Herweg, Reimut Zohlnhöfer and Evangelia Petridou. Edward Elgar.
[5] Vassilis Karokis-Mavrikos. (2024). “What Can Drive a Digital Governance Transformation? Greece, the Covid-19 crisis and “a jump-started Lamborghini”. Policy and Internet.
