ADH Director Nate Smith Discusses his Leadership Style and Shares How He Plans to Lead as New ASTHO President

By George T. Roberts, Jr., MHA, FACHE, NACCHO President and Chief Executive Officer of the Northeast Texas Public Health District

Nate Smith, MD, MPH currently serves as the Director and State Health Officer for the Arkansas Department of Health (ADH) and President of the Association of State and Territorial Health Officials. As champion for science, Dr. Smith provides evidence-based leadership for the department. Under his leadership, ADH provides over 100 services through 90 local health units to 75 counties. Dr. Smith oversees several services and programs including immunizations, WIC, preparedness and emergency response, chronic disease prevention, injury and violence prevention, suicide prevention, and outbreak response.

Dr. Smith has a long history of being a leader in the field, having previously served as ADH’s branch chief for infectious diseases, state epidemiologist, and deputy director for public health programs. His experience reaches far outside of the U.S. to Kenya, where he served as a medical missionary at Kijabe Hospital. In this role, he was involved with the President’s Emergency Plan for AIDS Relief, a program that resulted in the reduction of adult HIV prevalence from over 10 percent to less than 6 percent. During his time in Kenya, Dr. Smith also served as chief of internal medicine, medical intern program director, infectious diseases consultant, country medical director for the University of Maryland School of Medicine in Kenya, and senior medical technical advisor for the AIDSRelief program in East Africa.

Below, he shares his leadership style, how he influences major players, and discusses how he plans to use his leadership experience in his role as the President of the Association of State and Territorial Health Officials (ASTHO).

As a health director, what leadership style do you use? How do you encourage the development of your employees?

I try to lead by example and build a high trust environment. I see the Arkansas Department of Health as a mission-driven organization and frequently remind myself and my colleagues that the mission of the department is to protect and improve the health and well being of all Arkansans. If we stay true to our mission, then I am confident of success.

The most valuable resources we have are our colleagues and the people we partner with. With that in mind, I encourage my employees to achieve their full potential using public health best practices supported by science-based decisions.

What would you say is the most difficult part about being a leader? How do you lead through change?

The most difficult part of being a leader for me is having to make decisions that negatively impact the lives of others. Sometimes that comes in the form of redirecting resources to higher priority areas; sometimes that means downsizing staff due to budgetary constraints or implementing disciplinary action for a staff member whose behavior or performance are no longer consistent with our mission.

Leading through change is another challenge. For example, we recently underwent a reorganization of state government which added 23 boards and commissions to the Arkansas Department of Health. The best way I know to lead through change is to remind myself and my colleagues that even though we are experiencing many transitions, our mission, purpose, and values remain the same.

As a public health leader, it’s important to be able to influence the decisions of stakeholders, policymakers, the community, and other partners. How do you get others to accept your ideas?

The prayer of peace sometimes attributed to St. Francis of Assisi implores, “O divine Master, grant that I may not so much seek…to be understood as to understand.” I think this is very good advice for us as public health professionals. We are often so eager to share our ideas and perspectives that we do not take time to listen to the priorities and perspectives of others. If we really want to influence others, I think we must be willing to be influenced ourselves.

How will your experience as a leader of the Arkansas Department of Health influence or inform your leadership as the President of ASTHO?

Arkansas is a relatively small, rural state with limited resources. For us to accomplish our mission at the Arkansas Department of Health, we have no choice but to build robust partnerships based on trust and shared priorities. At ASTHO we have important work to do—building healthy and resilient communities, helping to end the HIV epidemic, working for health equity across our states and territories. This work is too big, though, for us to do alone. As ASTHO President I will seek to strengthen our partnerships with local and federal partners and across sectors by identifying shared priorities and being a trusted partner.

To share your story of transformational leadership or to recommend a leader to be highlighted, please contact Taylarr Lopez, NACCHO Communications Specialist, at