Robert B. Hackey is a professor of health policy and management at Providence College and an adjunct lecturer in international and public affairs at Brown University. 

Gov. Daniel McKee faces one of the most consequential decisions of his tenure. The governor must choose a successor to Dr. Nicole Alexander-Scott, who resigned as the state’s health director in January.

The Rhode Island General Laws require the director to be a physician with “a minimum of one year of university graduate instruction in public health administration as evidenced by a certificate of graduation or a degree in public health, or board certification in a medical specialty and a minimum of five (5) years full time experience in health administration.” The statute, however, offers little guidance about which qualities the governor should look for in appointing a new director.

The director of health oversees a department with broad powers. In addition to regulating clinicians, the department monitors environmental health, ensures food safety, and licenses health providers, from acupuncturists to X-ray facilities. The director oversees the state’s medical examiner and reviews proposed mergers, acquisitions and planned expansions of health care facilities.

Over the past two years, the significance of this post became evident to all Rhode Islanders, as the director of health led statewide conversation about Rhode Island’s response to the COVID-19 pandemic.

Over the past two decades, Rhode Island tapped physicians with local ties to lead the Department of Health. Our most recent directors — Dr. David Gifford, Dr. Michael Fine and Dr. Nicole Alexander-Scott — each had close ties to Brown University’s School of Public Health and area hospitals. This is a key asset in a small state with a closely knit medical community.
As the McKee administration considers potential candidates for this important post, officials should prioritize four essential qualities.

• The director of health must have strong leadership skills and a steady hand to respond to unexpected public health challenges. In addition to leading Rhode Island’s response to the COVID-19 pandemic, Dr. Alexander-Scott also crafted policies to address the state’s opioid epidemic and the proposed merger of the state’s two largest hospital systems.

Her predecessors also faced unexpected tests from meningitis outbreaks at area colleges to concerns about nursing home safety.

• The director needs the political acumen to lobby effectively for the resources to address a wide range of public health challenges and to weigh difficult regulatory challenges. Federal COVID funds afford Rhode Island a once-in-a-generation opportunity to invest more in public health prevention, but doing so requires strong leadership, a clear vision and ongoing advocacy.

• The director must communicate effectively with policymakers and the public. Dr. Alexander-Scott became a regular presence on television news, radio and social media during the pandemic. While COVID-19 cases are declining, the threat from emerging infectious diseases and chronic conditions remains. In this context, the ability to educate the public and build trust is a vital skill for any new director.

• Finally, COVID-19 brought health disparities to the forefront. Black, Hispanic and Native communities experienced higher rates of infection, hospitalization and death during the pandemic in Rhode Island and across the nation. These communities face a growing burden from long COVID and remain at higher risk for other chronic and preventable diseases. The next director must forge a long-term strategy to reduce health disparities in Rhode Island.
Governor McKee’s choice of a new director of health will impact — directly or indirectly — the lives of all Rhode Islanders for the next five years. To lay the foundation for a healthier Rhode Island, we need a leader who can help build consensus among diverse stakeholders to create a more accessible and equitable health care system.


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