News  |  May 30, 2023

Earlier this month, the 21st Century Learning Community (21C) came together for a hybrid convening to share transformation strategies and challenges, connect with professionals doing similar work, and brainstorm how to move their ideas into action.

Our first session was called “This or That.” This activity modeled the realities of choices health departments must make – some choices are not easy, you may stand alone in some, and some choices have more than one great option forward. With this framing, participants from 21C states chose which priorities to focus on during our time together. Building on previous conversations, topics included:

  • Implementing and operationalizing the Foundational Public Health Services (FPHS).
  • Public health workforce issues like recruitment, retention, training/professional development, and trauma informed practice.
  • Effective communication, messaging, and advocacy methods like considering language used (or avoided), engaging the public and policymakers to gain insights into their priorities and ideas for improvement, bringing them in as champions for sustainable funding for public health, and building the public’s understanding of governmental public health’s role.
  • Collaborating, partnering with, or building relationships with Tribal public health departments.

Underpinning each of these themes is necessary to create an equitable, transformed, and sustainable governmental public health system. Embedding equity throughout all activities requires doing things differently than before, including diverse perspectives and engaging in innovative processes to drive systems change. 21C states are testing and piloting new initiatives and strategies. They are putting actions behind the mission to shift the public health field from repeating outdated processes that yield ineffective results. 21C states are striving for real change through bold approaches, willingness to ‘fail’, and an energy to keep trying new things.

The sections below include at least one question participants tackled during their time together. Is your health department thinking about things in the same way, or do you have another idea? E-mail your thoughts to [email protected].

What is the best way to intentionally embed and advance equitable practices in your community if some words must be excluded from the conversation (e.g. equity, transformation)?
Offering Racial Equity 101, and later 102, to local boards of health and public health professionals from a judgement-free place fosters an environment of learning, questioning, and growth. It also creates an opportunity to use shared language and discuss community-specific strengths and challenges. Another strategy is to find language that resonates with your community. Through implementing the FPHS, health departments are already striving to do the work by connecting to people’s values around improved health.

Is there a roadmap for what to do after assessing capacity to implement the FPHS?
There is not a one-size-fits-all roadmap; all health departments are unique and need to use their results to determine system and sufficient resource needs. This requires thinking in new and innovative ways so needs are not underestimated. Despite differences across states, there are tools health departments can use to move their work forward, including the FPHS Planning Guide. Upon completing a FPHS Capacity and Cost Assessment, health departments are encouraged to use findings to advocate for additional resources and develop a plan for the future. Health departments should look at the gaps the data reveal and use that information to better understand their ability to implement the FPHS; from there, they can move to focus on their vision. This vision should be set from the start of transformation work and include what the health department is working towards, not what it would take to achieve the same results and operate in the same systems. Questions to consider are: what does the future governmental public health system look like in your state? What does a reimagined public health infrastructure look like to you? It is also important to consider where filling in the missing gaps gets you; is it to a baseline level or to where your health department wants to be (i.e., its vision)?

    With similar workforce challenges across the United States, how can we tackle the workforce gap together?
    We know that employees value flexibility, the option to work from home or in a hybrid environment, a supportive supervisor and/or mentor, tuition reimbursement, and the opportunity to help others. We also know that not all health departments can offer the same benefits at this time, so we must think about what is possible within existing limitations, while striving to reimagine those limitations in the longer term. For your health department, conversations with employees may prove to be the best way to innovate. For the field, realistic expectations on the timeline for improvement and sharing creative strategies can lead to the greatest change. Many health departments are focusing on the future workforce beginning with K-12 and are investing in apprenticeship programs, utilizing the Public Health AmeriCorps program, and other pipelines to ensure the interest exists. Additionally, many health departments are partnering with local universities to develop programs that benefit all involved. Examples include building and/or strengthening relationships with MSIs (Minority-serving institutions), such as historically Black colleges and universities (HBCUs) designing internships/fellowships to meet requirements for entry level roles, building or utilizing existing academic health departments, collaborating on curriculums that will prepare the future workforce to address emerging needs, and bringing health department staff on as to share their experience in the field.

      Can existing large scale communications be tailored to meet the needs of rural or frontier communities?
      Communication systems developed during the COVID-19 pandemic demonstrated the need for mass communications, training, and resources to be customizable. To have the capacity to achieve this, it is important to:

      • Establish a communication team and plan, including a social media plan and presence.
      • Evaluate if existing communications align with the Foundational Areas and Capabilities, and update as needed.

      How can public health transformation work be shared outside of the field, specifically as it relates to advocacy for increased funding?
      Communicators should think about what is meaningful to or valued by decisionmakers). Then, they can look at available data to provide evidence of how their health department has or may benefit from investment. This may look like increased capacity, a story about the outcomes of specific funding, or an example of how investing in data infrastructure can provide invaluable insights into the community served. Sell the strengths and benefits of a well-funded public health system rather than focusing on historic or current pitfalls. Research is another strategy to determine effective communication strategies and messages for your community. This may require hiring consultants for their expertise to help design talking points that effectively reach your target audience. Additionally, forming a commission with dedicated staff to move things forward has proven to be an effective strategy to develop communications to successfully advocate for transformation funding. This commission may focus on engaging the media to bring increased attention.

          Before sharing takeaways related to Tribal public health, we must acknowledge that we did not have any Tribal public health partners as participants in this convening and thus voice, perspective, and interests could not be fully represented. PHNCI at PHAB is working to intentionally bring in and build out the Tribal participant aspect of 21C, as we aim to foster an environment where all participants in governmental public health can learn and transform together. In various 21C states, there are new and ongoing partnerships between Tribal public health, local public health, and state public health working to move forward Tribal modernization efforts.

          Are Tribal health departments thinking about public health transformation in alignment with state efforts?
          Tribal nations should not be expected to engage in statewide transformation efforts that they do not opt in or contribute to. Relationships must be built, and state and local health departments need to do the work to understand the history, rebuild trust, and examine how they may be perpetuating systemic practices that have contributed to historical and current day inequities for Tribes. Participants from 21C states shared how they have, are currently, or hope to include Tribal public health departments in transformation efforts and are very interested in learning from each other, alongside Tribal partners.