Guest editors share highlights of a new JPHMP supplemental issue, Transformation and Innovation in Public Health.
We are at a critical juncture in public health practice in the United States and must take the path towards transformation. Governmental public health departments seek to respond and address ongoing public health challenges despite chronic underfunding, staffing shortages, and crumbling and outdated infrastructures and systems intended to ‘hold up’ their ability to implement programs and respond to crises locally. With the COVID-19 pandemic and increased public acknowledgment of existing disparities, health departments are examining their role in advancing equity, first by acknowledging structural racism as a public health issue (some health departments acknowledged this years ago) and interrogating how the public health system has perpetuated inequity.
Opportunities for transformative change are ever-present, and a new JPHMP Supplemental Issue, Transformation and Innovation in Public Health, by the Public Health National Center for Innovations (PHNCI) at the Public Health Accreditation Board (PHAB), with funding from the Robert Wood Johnson Foundation (RWJF), highlights stories and opportunities from the field. Thank you to all the authors who contributed their time, perspective, stories, and narrative to this supplemental issue. Below are highlights from each article:
- The Foundational Public Health Services (FPHS) are an important framework for public health transformation – and can be embraced to describe what’s needed by public health everywhere to truly build equitable and just public health systems. “The FPHS reinforces the fact that no individual’s health status should be determined by where [that individual] lives.”
- A re-envisioned public health data infrastructure can only be achieved through deep community engagement, cross-sector partnerships, and an equity-informed framing of data modernization. The Robert Wood Johnson Foundation is responding to the call to revise previous norms of its philanthropic practice and focus more explicitly on eliminating the root causes of structural factors such as racism that present obstacles to achieving a national culture of health and health equity, including the need for a modern, agile public health data system that guides decisions to help communities thrive and not merely respond to the next threat.
- A Framework for Aligning Sectors (Figure) offers an innovative approach to successfully align health care, public health, social services, and other sectors to jointly tackle complex challenges that matter to community members. Early findings from the Sentinel Communities Project show that when different sectors were more aligned prior to the pandemic communities were better positioned to organize stronger, more equitable responses to the public health emergency.
- Ohio, Oregon, and Washington have defined, measured, and advocated for the Foundational Public Health Services (FPHS) delivered by the governmental public health system, conducting assessments of gaps and funding needs and highlight the importance of having a robust public health infrastructure that is well supported in the areas of Foundational Capabilities.
- Through a public health–led community health improvement planning process, a cross-sector consortium in Ohio implemented community-based system dynamics to provide a systems science lens to guide efforts to eliminate structural racism. Through group model building sessions helped to identify leverage points for actionable focus to eliminate structural racism and develop causal loop diagrams.
- In Pierce County, Washington, six Communities of Focus, with Tacoma-Pierce County Health Department are using participatory budgeting process to bring community members to the table, co-design solutions, and put the final decision-making power around investments to fund programs and services in the hands of community.
- To bring together individual efforts, and diverse perspectives, toward deeper understanding and system transformation, Black Hawk County Public Health (Iowa) adopted a participatory action approach of dynamic system mapping and systemic strategy design. Stakeholders developed a system map visualizing the patterns driving inequitable outcomes, and bright spots and resiliencies, identified and experienced across the community. Then they populated the system map with local stories and data. These offered a foundation of understanding and connectivity upon which high-impact opportunities for engagement could be identified and developed.
- Minnesota authors describe lessons learned from intentional integration of three equity teams in COVID-19 response efforts. Teams focused on reaching communities through trusted partners, elevating the voices of communities most impacted, respecting Tribal sovereignty, establishing equity leadership, and setting equity goals and metrics. They further highlighted the need for future investments that support structuring equity in the public health system and ongoing need for public health infrastructure investments.
- Of the 205 health departments self-reported PHAB Annual Report responses on innovation examined, 75 (37%) described elements of the health department’s approach to fostering innovation. The most common approaches to innovation included partnerships (59% of those health departments that described their innovation approaches) and leadership (27%).
- We learn about the distribution of power to change social and political systems that shape health, through the Power-building Partnerships for Health program. The Program pairs local health departments and community organizing groups to support relationship building and advancing equity work. Examples from Santa Barbara Power Building to protect farmworker health are described.
- Data Across Sectors for Health (DASH) and All In: Data for Community Health examine, through the All In National Inventory the nature and extent to which public health entities are sharing data across sectors in ways that are innovative and supportive of their organizational missions to promote community health, equity and well-being. Findings describe how public health plays a pivotal role in innovation to share data across sectors to serve as a community health improvement foundation and what improvements could enhance sharing efforts.
- Through an evaluation of PHNCI’s first five years, perspectives of key informants, implementation of activities, outputs, accomplishments, and opportunities were explored. Insights focus on PHNCI’s contribution towards public health innovation and transformation – including increased understanding and awareness of innovation in the public health field; the value of PHNCI grants and learning communities to support innovation; and more.
- In highlights from the interim Cross-sector Innovation Initiative evaluation, we learn about strategies to foster cross-sector partnerships through the structure of an evaluation effort. More learnings to follow in the coming months.
- The Lincoln Trail District Health Department (LTDHD) has used Public Health 3.0, the FPHS, and PHAB Standards as foundations to undergo strategy planning and build a culture of quality improvement as an organization.
Together, the articles in this issue demonstrate both the need for, and importance of, transforming governmental public health practice to keep pace with the evolving needs of communities. Through sharing these bright spots, successes, and lessons learned, we hope that others are inspired by the tremendous potential that practitioners have to improve communities and build equity. PHNCI encourages you to read the full issue here and share your story to inspire future innovators and transformers!
Reena Chudgar, MPH, is PHNCI’s Director of Innovation and brings over 15 years of public health experience in her efforts to support health departments and communities in using innovation as a tool for transformation and to create equitable and just public health systems. Her work centers around strategy and program implementation, and she is passionate about social and systems change, addressing root causes of historical and current racial and health inequities, and local and people-centered decision making. She aims to support public health by engaging in dynamic partnerships, fostering cross-sector collaboration, looking to community expertise, and advocating for public health needs. Reena received a Master of Public Health degree and a bachelor’s degree in chemistry from Emory University.
Jessica Solomon Fisher, MCP, is the Vice President for Strategic Initiatives at the Public Health Accreditation Board (PHAB) and Public Health National Center for Innovations (PHNCI). She joined the organization in December 2015, as the Chief Innovations Officer. In her current role, she oversees communications and education/technical assistance and a variety of strategic initiatives for PHAB.
Naomi Rich is a Program Specialist at PHAB, where she provides administrative and strategic communications support to the Public Health National Center for Innovations and Program, Research, and Evaluation teams. Prior to joining PHAB in 2020, Naomi applied a community organizing lens to her work in political campaigns, nonprofits, and a communications agency. She holds a Bachelor of Science in Community and Regional Development from the University of California, Davis.