Health chief's outlook is global

If chickens die in Thailand, King County spends millions of dollars preparing for a possible pandemic flu. When drug-resistant tuberculosis spreads in Africa, health officials here monitor the potential ramifications to the Puget Sound region.

Nowadays, disease knows no borders, King County Executive Ron Sims said Monday, explaining why he nominated David Fleming, currently the director of global health strategies for the Bill & Melinda Gates Foundation, to take over as director of Public Health — Seattle & King County.

"He knows best practices worldwide," Sims said. "He can start with, 'This is what works in Malaysia [and] this is what works in the United Kingdom,' so we can begin to have not only the best components in the U.S., but the best components in the world."

Since joining the Gates Foundation in 2003, Fleming has overseen programs to combat diseases affecting poor populations around the world. Before that he worked at the national level as deputy director of the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga. Before moving to Atlanta, he was Oregon's state epidemiologist.

But Fleming, 52, said Monday that working on local health issues was something he had always wanted to do.

"It's been great working at the Gates Foundation," he said. "One of the things we do is we give resources to other people to get the job done, but I find that I miss actually doing the work of getting the job done."

Fleming's appointment is subject to the approval of both the Metropolitan King County Council and the Seattle City Council before he could take over the job in February. The agency employs about 1,400 people and has an annual budget of about $267 million.

If confirmed, he would become the highest-paid county employee, earning $243,160 a year. By comparison, Sims makes about $170,000.

The salary would match Fleming's Gates Foundation pay and is comparable to what similar public-health leaders elsewhere make, Sims said.

Dorothy Teeter, chief of health operations, has served as interim director of Public Health since 2005, when director Alonzo Plough left for a job at a private California foundation after about 10 years at the helm. She will return to her previous job.

Fleming earned a bachelor's degree from the State University of New York (SUNY), Albany, and a medical degree from SUNY's Upstate Medical University. He was the Oregon state epidemiologist in the 1990s. Then he went to the CDC from 2000 to 2003 to guide the scientific integrity of the centers' programs during a time when it was heavily scrutinized over issues including the outbreak of West Nile disease in New York, an anthrax scare and handling of monkey pox and SARS, or severe acute respiratory syndrome.

At the Gates Foundation, Fleming worked on a $1.5 billion initiative to vaccinate children in developing countries. He also teaches at the University of Washington School of Public Health.

In a telephone interview from Berlin on Monday, Fleming said he is looking forward to a job that won't require spending 40 percent of his time far away from Bainbridge Island, where he lives with his wife and two teenage daughters.

If confirmed, Fleming would take over an agency that has been deep in preparation for the possibility of a pandemic bird flu. It also has faced criticism recently over proposals to close two public-health clinics, in Bothell and Seattle's Northgate neighborhood.

But Fleming said the two main health challenges facing the county are the rising cost of health care and what he called issues involving "lifestyle choices," such as smoking and obesity.

"We need to be thinking again about creative ways to assure quality health care is being provided at costs that are affordable, particularly looking at ways of preventing illness before it occurs," he said.

Mary Selecky, the state secretary of health, said she worked with Fleming when he was a point person at the CDC on the SARS outbreak.

"I think it's a great match," Selecky said of his nomination for the new job.

"You've got a very diverse community that includes rural and urban; it includes many different ethnicities; and you've got challenges around disparities in health because there are disparities in income."

Sharon Pian Chan: 206-464-2958 or schan@seattletimes.com