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Building More Equitable Communities Through Public Health Law Dawn Hunter Every week, my husband and I place a grocery order. We shop at an employee-owned supermarket chain known for its workplace culture. Sometimes we order online and pick it up, sometimes we have it delivered, and sometimes we do the shopping ourselves. In any case, we often purchase our groceries without much thinking—if we order online, we are prompted to “buy it again” and even in person we tend to buy the same staples. Prices are higher online than in store. In addition, we live in a community where plastic bags are still an option, but we used to live in a community where plastic bags are banned. Why am I sharing all of this? Nearly every aspect of our weekly grocery trip is shaped by the law. Laws impact: Food placement, packaging, expiration dates, and prices. Employee wages and benefits. Store location, hours, and accessibility. Availability of rideshare drivers for delivery orders. Whether to choose paper or plastic. Law impacts the way we experience our everyday lives by establishing the framework in which we operate. The grocery store is just one example of how law can shape our decisions and, more importantly, our choices. Because it shapes the resources and opportunities available to us, law is an important determinant of health. Exploring the Landscape of Public Health Law What we think of as “law” can take many forms. It includes statutes, regulations, case law, organizational policy, and budgets, and how they are interpreted and enforced. The law can be a set of requirements or prohibitions, establishing norms and expectations for our behavior as individuals, organizations, and systems. The law can also be the processes and procedures associated with creating laws, making decisions, and interpreting existing laws. Public health law, specifically, is important as a field because it includes the laws that are designed to protect and promote the public’s health and that define the power of the government to act on our behalf. In fact, law is behind every public health success of the 20th century. A 1999 issue of the Morbidity and Mortality Weekly Report listed vaccinations, motor vehicle safety, safer workplaces, healthier moms and babies, and recognition of tobacco as a health hazard among those successes. These achievements would not be possible without the law, including: School vaccination laws. Helmet and seatbelt laws. Speed limits. The Occupational Safety and Health Administration. Food fortification. School lunch programs. The Women, Infants, and Children (WIC) program. Newborn screening. The Tobacco Master Settlement Agreement. Clean indoor air laws. At the same time, these laws have not benefited everyone equally. In fact, they have often operated as a tool of racism and other forms of structural discrimination. The lesson here is that the law can create the conditions that lead to differences in health outcomes, but it can also create the conditions for equity. The Civil Rights Movement and Advances in Health Equity One must look only to the civil rights movement to see the potential. As just one example, today’s robust network of Community Health Centers was born from the activism of the Black Panther Party, which established free health clinics in response to continuing discrimination in the health care system, as well as the work of H. Jack Geiger and Count D. Gibson Jr., who established the first community health centers in 1965. The success of these efforts led to funding for additional community health centers through President Lyndon B. Johnson’s Office of Economic Opportunity as part of his War on Poverty. In fact, key legislation enacted during the civil rights movement led to significant, even if insufficient, improvements in health outcomes for Black Americans. For example, there is evidence that women’s suffrage, the Civil Rights Act of 1964, and the Voting Rights Act all led to improvements in premature mortality and infant mortality, among other benefits. The enactment of the Patient Protection and Affordable Care Act in 2010 and the resulting adoption of Medicaid expansion saw similar success. There is ample evidence of the Medicaid expansion impact on health outcomes and financial well-being, both at the individual and population level. Addressing the Training Gaps in Public Health Law for More Equitable Public Health Practice The fact that law shapes how we experience our lives on a day-to-day basis is perhaps the most important reason that public health professionals should understand the relationship between the law and health outcomes and how to use the law to achieve more equitable, thriving communities. However, knowledge of public health law continues to be one of the biggest training gaps in the public health workforce. The 2021 Public Health Workforce Interests and Needs Survey, conducted by the de Beaumont Foundation and ASTHO, found that strategic and systems thinking was one of the top training needs as well as an increased interest in policy engagement and topics related to justice, equity, diversity, and inclusion (visit the 2021 Dashboard). Another report in 2021, “Challenges and Opportunities for Strengthening the US Public Health Infrastructure: Findings From the Scan of the Literature” by the National Network of Public Health Institutes, found a need for increased awareness among the public health workforce of the legal basis for public health authority and identified both how to influence law and policy development and how to understand the effects of law and policy on health among the top training needs. These findings align with public health accreditation standards. Whether or not you work for an accredited health department, the Public Health Accreditation Board Standards and Measures serve as a guidepost for the practice of public health. There are two specific domains where this is relevant: domains 4 and 5, as detailed in Table 1. Padding Block - Medium(10) Table 1. Public Health Accreditation Board Guidance for Equity Domain Measure Examples Domain 4: Strengthen, support, and mobilize communities and partnerships to improve health. Measure 4.1.3 A: Engage with community members to address public health issues and promote health. Making the decision-making structure inclusive and transparent to empower community members or developing mechanisms for shared ownership in the process. Enhancing residents’ capacity to understand levers of power or influence in policy change. Domain 5: Create, champion, and implement policies, plans, and laws that impact health. Measure 5.1.2 A: Examine and contribute to improving policies and laws. Assessment of the impacts of the policy or law on equity. Input gathered from stakeholders or strategic partners. Padding Block - Large(2) Lessons Learned: Involving and Empowering Communities The inclusion of community members in assessment, decision-making, and capacity-building efforts to understand levers of power or influence reinforce key lessons learned in the past three years, spurred by COVID-19 and the racial justice movement of the summer of 2020: The first lesson is the need to recognize and rectify historical injustices. It is important that we understand the historical legal context behind current health inequities. We must know and name the problem to solve it. The second is the need to rectify current inequities by analyzing and assessing the ways in which our current system of laws is creating and reinforcing inequities. The third is the need to engage impacted people in identifying, designing, and implementing solutions. One of the lessons learned from the work of Geiger and Gibson was that there is a difference between what the health system thinks people need and what communities think they need. It seems we are still trying to learn this lesson today. Leveraging Law to Drive Equity and Make Public Health More Trustworthy Law is the only way to truly change the game for inequities. It can give a voice to historically marginalized people by creating pathways to ensure inclusion and representation in the political process. It can also change systems and institutions by changing the way they operate and the way that people within those systems operate. Additionally, it can serve as a tool to enforce conditions that will lead to more equitable outcomes and to hold people in positions of power accountable. We have often heard in the past few years about the need to rebuild trust in public health. I’d like to reframe that to think about how we make public health as a field more trustworthy. It starts by increasing our understanding of the authority of public health to promote the public’s health and to use that authority to create systems in which we all can thrive. article yes

ASTHO Announces Sixth Developing Executive Leaders in Public Health Cohort ARLINGTON, VA — Today, the Association of State and Territorial Health Officials (ASTHO) announced its sixth cohort of Developing Executive Leaders in Public Health (DELPH). This highly competitive program began in 2021 and continues to strengthen the leadership capacity of mid- to senior-level governmental public health professionals. “I am thrilled to welcome the sixth cohort of the DELPH Program,” says Avia Mason, ASTHO vice president for leadership and learning. “This group of 20 scholars brings exceptional dedication and passion to the work of public health, and we are honored to support their journey as they strengthen their leadership, expand their impact, and improve the health of their communities.” Cohort six scholars include: Faisal Adam, DC Health Department Vina Ayuyu, Commonwealth Healthcare Corporation Misty Carney, Maryland Department of Health Colette Cobb, Office of the California Surgeon General Angela Cochran, St. Mary's County Health Department Jessie Fernandes, Montana Department of Public Health and Human Services Tynisha George, Chicago Department of Public Health Ethan Greenblatt, St. Louis County Department of Public Health Gabby Hadly, Snohomish County Health Department Shebra Hall, Delaware Division of Public Health Brandon Horvath, Philadelphia Department of Public Health Halana Kaleel, Austin Public Health Markeeta Keyes, City of Minneapolis - Health - Green Career Exploration Aracely Macias, New Jersey Department of Health Chelsea Moriarty Coffield, Harris County Public Health Natasha Pickens Shumpert, Jefferson County Department of Health Dipa Shah, Los Angeles County Department of Public Health, Nutrition and Physical Activity Program Jamilia Sherls, Washington State Department of Health Iliana Siarmalis, Maryland Department of Health Tenneh Turner-Warren, Arizona Dept of Health Services ASTHO continues its commitment to developing, elevating, and modeling strong leadership for the next generation of emerging public health leaders. At a time when public health demands courageous vision, strategic action and collaborative strength, programs like DELPH are more essential than ever. Through an innovative, cohort-model, participants will deepen their leadership identity, enhance their communication, and grow their ability to positively influence their organizations. Each participant is matched with an executive coach, accountability partner and DELPH team member for personalized, transformative leadership development. “Morehouse School of Medicine is proud to continue its partnership with ASTHO in facilitating the DELPH program,” says Sandra Harris-Hooker, senior vice president for external affairs and innovation and interim director of the Satcher Health Leadership Institute (SHLI) at Morehouse School of Medicine (MSM). “This ongoing collaboration between ASTHO and MSM’s SHLI advances our institution vision of ‘Leading the creation and advancement of health equity to achieve health justice.’ Together, we are equipping and empowering individuals to step into national and global arenas where strong, equity-centered public health leadership is needed most.” With support from the CDC, the success of the DELPH program’s more than 100 alumni demonstrates how strengthened leadership translates into stronger public health systems as they take on the pressing challenges facing our communities. Cohort six scholars will kick off their programming on December 8 in Arlington, VA. ASTHO Press Release Boilerplate website yes

On January 16, 2024, ASTHO and the Satcher Health Leadership Institute (SHLI) at Morehouse School of Medicine unveiled the latest cohort of 15 mid-to-senior level governmental public health professionals selected for the Diverse Executives Leading in Public Health (DELPH) program.

ASTHO Leaders Selected for de Beaumont Foundation’s 40 Under 40 in Public Health ARLINGTON, VA—Today, the de Beaumont Foundation announced its 40 Under 40 in Public Health class of 2023, a national recognition for leaders changing the field of public health. One state health official, an ASTHO staff member, and three Diverse Executive Leading in Public Health (DELPH) scholars were selected for the list. The recognition acknowledges the achievements of exceptional public health professionals and highlights ASTHO's role in cultivating visionary leaders. ASTHO-affiliated selections include: Paula Tran, state health officer and administrator, Division of Public Health, Wisconsin Department of Health Service. ASTHO staff member Alicia Justice, senior director, Programmatic Health Initiatives and Strategy DELPH scholar Dr. James Bell III, state assistant administrator, Michigan Department of Health and Human Services. DELPH scholar Heather Pangelinan, director, Public Health Services, Commonwealth Healthcare Corporation DELPH scholar Dr. Eric Tang, public health medical officer, STD Control Branch, California Department of Public Health “I’m thrilled to see ASTHO leaders once again represented on the de Beaumont Foundation’s 40 Under 40 in Public Health list," says ASTHO CEO Michael Fraser, PhD. "This honor showcases their commitment to fostering healthier communities and driving positive change on a national scale." “The professionals chosen for the 40 Under 40 in Public Health Class of 2023 demonstrate the determination, commitment, innovation, and resilience of the public health field,” said Brian C. Castrucci, DrPH, president and CEO of the de Beaumont Foundation, which launched the program in 2019. “Their work is strengthening communities and improving lives, and I look forward to following their careers and learning from them.” The nominees represent 21 states and one territory and were selected by a distinguished panel of public health leaders and de Beaumont Foundation staff. It is the third installment of the list, which launched in 2019. The nominees come from a diverse range of backgrounds and professional roles. The 40 Under 40 list also honors nine other state health department staff members, including: Kara Buru, South Carolina Department of Health and Environmental Control Shelly Choo, Maryland Department of Health Shamaree Cromartie Jones, Virginia Department of Health Mallory Cyr, Association of Maternal Child Health Programs Jervelle Fort, South Carolina Department of Health and Environmental Control Stacey Kallem, Philadelphia Department of Public Health Carolyn Rhodebeck, New York City Department of Health and Mental Hygiene Katrina Saphrey, Virginia Department of Health, Crater Health District Julian Watkins, New York City Department of Health and Mental Hygiene Learn more about the 40 Under 40 in Public Health honorees. ASTHO Press Release Boilerplate website yes

An interview with DELPH scholars Halina Palacios and Nathifa Miller about the importance of developing a strong leadership style, advice for future public health leaders, and using the DiSC Personality Assessment.

A Q&A with DELPH participants James Bell III and Sandy Noel about their experiences in the program and why it is so important to develop your own brand as a leader.

To learn more about how the DELPH program has influenced our scholars’ leadership journey so far, ASTHO spoke with three leaders in the current cohort: Andrea Lowe, director of legislative services at the Nebraska Department of Health and Human Services; Tiffany Wilson, data analytics branch manager at the Alabama Department of Public Health; and Harold Gil, data science support unit supervisor at the Washington State Department of Health.

An issue that public health wrestles with is how to combat racism as we would any other public health emergency. ASTHO’s board of directors has declared structural racism a public health emergency. And health equity is the number one priority in ASTHO’s strategic plan, which means our staff will prioritize equity work as we support all aspects of our members’ technical assistance and capacity building needs.

Learn more about DELPH Cohort 3 participants.

Learn more about DELPH Cohort 5 participants.

Developing Executives Leading in Public Health (DELPH) is a leadership development program that increases and strengthens participants’ visibility and exposure in public health systems, access to key networks, and leadership development opportunities.

Learn more about DELPH Cohort 4 participants.

The Key Role of Cross-Sector Partnerships in Navigating Barriers Keon Lewis Community partnerships are critical to public health's mission to promote optimal health for all — learn more. Public health departments’ mission and vision statements often share certain values and goals aimed at improving the public’s well-being. Rather than just reactively responding to immediate health threats as they come, public health departments aim to take a more proactive approach through strategies that prevent the future spread of diseases, injury, or other incidences of harm. These actions support their visions of creating communities where all residents can thrive and achieve their full health potential. Strong community partnerships are critical to public health departments’ ability to fulfill their goals. Recognizing this, the Robert Wood Johnson Foundation introduced the Culture of Health Framework in 2015. As a leading national philanthropic organization focused on dismantling barriers to optimal health for all, the framework’s foundation is built upon the following action areas: Making Health a Shared Value. Creating Health. More Equitable Communities. Strengthening Integration of Health Systems and Services. Fostering Cross-Sector Collaboration. The COVID-19 pandemic and its aftermath underscored the factors that created challenges to health outcomes for underserved communities; it also demonstrated the importance of sustaining strong cross-sector partnerships. Public health’s ability to align its goals with the community it serves is vital to efforts to save lives. This alignment allows public health departments to leverage the diverse resources and lived experiences that community partners bring. Recognizing the unique concomitant relationship that it has with government funding, public health departments are now going to have to pivot their strategies to achieve their missions. As public health departments experience budget and personnel cuts, its ability to promote optimal health for all and mitigate the social determinants of health is now even more reliant upon the strength of collaborative partnerships. The Public Health Paradox Public health has always been a component of our nation’s health care system, which primarily reflects specific health issues that have impacted our communities. Rather than focusing on the foundational issues that exacerbate these long-term gaps in underserved communities, government systems often allocate funding based on specific diseases or chronic health issues impacting community health. Although diseases and chronic health issues are significant public health elements that need to be addressed, there are significant nonmedical factors that play just as vital a role in influencing community health outcomes. Identified by the World Health Organization (WHO) and adopted by CDC as the social determinants of health, these variables — which include elements such as social and community construct, economic stability, and education access — have become the central driving force of public health. “The Public Health Funding Paradox,” an article from Sage Journals, offers a great perspective on how an intriguing paradox has been created due to this relationship between public health and government systems. The article underscores the complexity of governmental funding that helps to advance public health strategies while there still exist harmful policies that create barriers for certain communities. The Flint water crisis in Michigan demonstrated this paradox. Flint citizens experienced lead poisoning and death from Legionnaires’ Disease, underscoring how a community’s ability to thrive can be quickly impacted by economic difficulty and leadership decisions made by the accompanying government. The Power of Partnership Public health has long had to combat a barrage of stigmas and policy hurdles. Even at the height of the COVID-19 pandemic, public health departments were not only in contention against the virus but also against the influence of viral misinformation that questioned their practices, strategies, and purposes. Despite these barriers, the nation witnessed the power of true cross-sector partnerships. Health care and grassroot organizations quickly found common ground to help address the needs of underserved populations. From addressing food insecurity to mental health and transportation barriers, communities successfully pivoted toward hope and found ways to save lives. Nonprofit organizations also created innovative and impactful peer-to-peer funding models that enabled them to fulfill their missions in spite of budget cuts. During this time, community health workers became a vital public health resource. As conduits between departments and local communities, community health workers became a necessary element to re-reestablishing trust in systems and care. Although the work of frontline workers and support staff served a critical role in mitigating the future spread of COVID-19, advocates and allies at the grassroots level also played an invaluable role in promoting health for all. As “The Public Health Funding Paradox” demonstrated, public health departments are only as effective as their accompanying government systems. If the leadership within these respective systems fails to align and empathize with their public health counterparts, then as a community we inevitably repeat a vicious cycle that results in poor health outcomes. Identifying Alternative Routes Cross-sector partnerships serve a vital role in enabling public health systems to better serve their communities. Budget cuts and stricter policies have created barriers for local and statewide agencies, academic institutions, and nonprofit organizations. The ability to develop essential personnel, continue pertinent research, and utilize mitigating practices have been inhibited by these barriers. It has become increasingly evident that, rather than focusing on reactive strategies, public health must go upstream and address the social needs of our communities. With cuts to funding, public health systems have to do more with less, making it more difficult to address diseases and chronic health problems. Working upstream to address root causes of health outcomes is one way to better leverage thinner resources. As our public health systems continue to work diligently to monitor, support, and mitigate community health barriers, there is still more research needed to explore the most effective cross-sector partnership frameworks. Public health’s efforts must remain intentional in developing comprehensive health advisory coalitions, leadership development cohorts, civic and community engagement projects, and paradigm shifts in academic curricula. The leaders and changemakers of tomorrow require growth in their competencies today. Cross-sector partnerships must continue to build their foundations upon systems of trust and transparency. Public and private health systems, the social sector, and other community stakeholders can partner to improve the population’s overall well-being while simultaneously achieving a mutually beneficial “social return on investment.” Public health’s ability to align with the achievement of optimal health for all requires more than just serving on the front line when a crisis occurs — it is critical that these departments must continuing enhancing their collaborative partnerships and community engagement. article yes

Learn how public health leaders can lead through crisis and support their teams in this blog post.

Understanding Digital Accessibility Before the ADA Title II Deadline Emily Lapayowker, Adrianna Evans With the ADA Title II deadline looming, learn how to prioritize and improve digital accessibility on your agency’s website. Digital accessibility ensures the digital world is usable for everyone. And while it is an increasingly prominent topic in public health, there is still much to learn. This resource can help public health agencies understand digital accessibility basics and promote accessible communications for the disability community, which is typically underserved in public messaging. Government Laws and Requirements ADA The Americans with Disabilities Act is a federal civil rights law that prohibits discrimination against and requires equitable access for people with disabilities. ADA’s connection to digital accessibility may not be immediately apparent, but digital accessibility is covered under the large umbrella of equal access to public areas that ADA guarantees. In fact, Title II of ADA enforces digital accessibility compliance by requiring state and local government websites and digital tools be accessible to people with disabilities — the Department of Justice has announced a compliance deadline of April 24, 2026, for jurisdictions of 50,000+ people and April 26, 2027, for smaller entities. Sections 504 and 508 Section 504 of the 1973 (Vocational) Rehabilitation Act requires any entity that gets federal funding to provide equal access to electronic information technologies for people with disabilities. Section 508 requires the federal government to meet those same standards. These sections were initially written in 1998 and then updated in 2018 to include requirements for mobile technology. WCAG Is the Industry Standard The Web Content Accessibility Guidelines, or WCAG, is published by the World Wide Web Consortium (W3C), an international organization that establishes open web standards. WCAG is currently in its second version. When evaluating compliance, there are three different WCAG conformance levels: A (lowest), AA (middle), and AAA (greatest). Interestingly, W3C recommends that all web-based information aim to hit AA because it is not possible for some types of content to reach AAA compliance. WCAG 3.0 is currently in development and expected to be a major paradigm shift. POUR Principles WCAG standards are principle-based, which means that rather than requiring all web browsers to meet a specific technical standard, WCAG requires that digital content adheres to the POUR principles. All four principles focus on the user’s experience: Perceivable: All information must be presented in a way that ensures users can perceive it using at least one of their senses. Operable: A website is considered operable if all users can effectively navigate it, even those who employ assistive technology, such as screen readers. Understandable: This is a two-pronged principle — users must be able to understand how to use a site and understand its content. Robust: Content must be robust enough that multiple technologies, including assistive devices like screen readers, can interpret it. These laws and guidelines are minimally prescriptive to promote longevity. Remaining principle-based rather than tech-based means these standards will not become obsolete as technology advances. Where and How to Make the Biggest Impact Health agencies can make small changes to digital content in a few key places that will make a world of difference for users with visual, hearing, physical, and cognitive disabilities. Some examples include emails, PDFs, website and social media content, and staff resources. Link Smart and Sparingly Screen reader technology allows low-vision users to navigate webpages and other digital content in a variety of ways. One is by jumping from link to link without referencing the content around that link. So, make your linked text descriptive enough to stand on its own. Also, avoid typing out URLs whenever you can — screen readers will read aloud the URL as phonetically as possible, which is not a great user experience. Additionally, when a screen reader reaches a link in the content, the software will announce it. Use links sparingly to avoid major disruption to the reading experience, as over-linking can make it hard to keep track of the content. Use the Built-In Text Styles Document hierarchy is another essential part of accessibility remediation. The built-in font styles, such as headers and lists, are for more than just aesthetic — screen readers use these styles to navigate Word documents, PDFs, and webpages. Use headers in order (i.e., never skip a heading level), and deploy ordered and unordered lists thoughtfully. For example, if you list specific steps in a process, use an ordered list. If you list symptoms of a viral infection, an unordered list is a better fit. Use Color and Contrast Correctly Do not rely on color alone to convey important information, because users with low vision or colorblindness may have trouble differentiating between different colors or shades. Best practice is to use additional visual markers to signal the presence of important information and ensure there is at least a 3:1 contrast ratio for graphics. Follow Alt Text Best Practices Screen readers read alternative text (or alt text) to allow users with visual or specific cognitive disabilities to understand the content and purpose of an image, table, or informational graphic. Some alt text best practices: Be succinct. The ideal length is between a few words and a couple of short sentences (use the average length of a post on X as a guide, about 250 characters). The goal is to be brief but still convey the image’s vital information. Avoid phrases like “image of” because screen readers will identify all images as such, which makes this redundant. The context around the image is just as crucial as the alt text. If there is already a detailed description of a virion’s shape in the document's body, repeating all that information in the alt text is unnecessary. Not all images convey information. In those cases, it’s important to use null alt text, which will let assistive technology know that the image is decorative. To do this, either add “decorative” in the alt text field, or mark it as decorative in the platform, if that option is available. When creating complex images such as charts or graphs, communicate what the graph is telling users rather than just what it looks like. Learn More There is a whole world to learn about within digital accessibility, but there are resources and experts to help. You can connect with internal experts on your IT team or external disability and accessibility organizations for support. You can also learn more about digital accessibility at the following resources: Introduction to the Americans with Disabilities Act by U.S. Department of Justice. Civil Rights Division Section 508 (Federal Electronic and Information Technology) by U.S. Access Board What Is Plain Language? by Plain Language Action and Information Network Constructing a POUR Website by WebAIM WCAG 101: Understanding the Web Content Accessibility Guidelines by Level Access Glossary of Disability-Related Terms by University of Washington Accessibility Online by Great Lakes ADA Center Related Content-Blog - DELPH Magazine 4 article yes

Rethinking “Soft” Leadership Skills in Public Health Rethinking “Soft” Leadership Skills in Public Health Angela Cochran, Jamilia J. Sherls Learn how public health leaders can leverage interpersonal skills to better navigate cross-sector partnerships in this blog post. Budget reductions, staff lay-offs, conflicting federal guidance, limited funding opportunities, being asked to do more with less — these are just some of the challenges public health professionals navigate. Public health’s goal to promote health, safety, and wellness across the nation is difficult to achieve while negotiating these challenges, often leading to stress and burnout. According to the 2024 Public Health Workforce Interests and Needs Survey, approximately 71% of state and local government public health workers are experiencing at least one symptom of burnout and about 20% are experiencing near-constant symptoms. When stress creeps into collaborative spaces, it can lead to frustration, misalignment, poor decisions, strained relationships, and weakened outcomes. As leaders work with internal teams and external partners to achieve public health goals, they must remain vigilant for signs of stress impacting the work. Stress often presents as irritability, conflict, errors, and stagnation. When stress gets in the way, it is critical for leaders to tap into their “soft” skills to alleviate pressures and create a clear path forward. Across sectors, communication, empathy, adaptability, and critical thinking are often grouped under the label “soft” leadership skills. Soft skills are considered foundational, interpersonal qualities or skills that help individuals interact with peers and navigate complex work environments. They may also increase resiliency, which is important in today’s ever-changing world. The term “soft skills” may sound neutral, but it carries an implicit assumption that these skills are easier, less rigorous, or secondary to technical expertise. These are, in fact, the skills that most define the quality of a leader. In practice, they are the very competencies that determine whether collaborative efforts succeed or stall. While there are many “soft” skills or leadership practices that can be helpful in stressful partnership situations and reducing conflict, there are three leadership habits especially critical to sustaining collaboration: Practice Intellectual Humility. Intentionally Build Psychological Safety. Anchor Communication in Values, Not Reaction. Each of these habits is learnable and, when applied with intention, can shift the entire energy of a room. Practice Intellectual Humility Collaborative leadership requires the ability to rethink assumptions without abandoning core values. In cross-sector work, leaders frequently navigate different perspectives, competing priorities, and incomplete information. Approaching these situations with a fixed mindset or rigid assumptions can limit progress, while intellectual humility creates space for better solutions. Practicing intellectual humility does not mean being easily persuaded or lacking confidence. It means remaining open to new information, asking thoughtful questions, and recognizing that no single perspective fully captures the complexity of the issue. Leaders who model this behavior create environments where others feel more comfortable contributing ideas, raising concerns, and engaging in meaningful dialogue. This becomes especially important when partnerships, both internal and external, are under strain. As expectations shift or challenges emerge, the ability to pause, reflect, and reconsider can prevent unnecessary conflict and support more productive problem-solving. For example, in cross-program initiatives where teams bring different priorities or funding requirements, taking time to understand competing perspectives before moving forward can prevent misalignment and strengthen long-term collaboration. Intentionally Build Psychological Safety Effective collaboration depends on trust, but trust does not develop passively. It must be built intentionally through leadership behaviors that create psychological safety. In practice, this includes clearly defining roles, maintaining open communication, and creating space for respectful disagreement. Proactive relationship management, such as regular check-ins and early disclosure of challenges, is essential to maintaining alignment and preventing breakdowns in collaboration. Without these efforts, stress can quickly erode trust and lead to disengagement. At the local level, building psychological safety often requires visible leadership behaviors that demonstrate support rather than control. This can include showing up alongside teams during outreach efforts when additional support is needed, not to direct the work but to reinforce shared ownership and trust. It also involves intentionally creating space for team members to share perspectives and acknowledging when or how those perspectives shift your own thinking. For example, when team members raise concerns or offer alternative approaches, responding with openness, such as acknowledging a perspective that had not been previously considered, can reinforce that you value their input. Over time, these behaviors help establish an environment where staff feel more comfortable speaking up early, allowing leaders and teams to address challenges before they escalate. Leaders play a critical role in shaping this environment by normalizing open dialogue and demonstrating that they value differing perspectives. Anchor Communication in Values, Not Reaction In fast-paced and often high-pressure environments, it can be easy for communication to become reactive. However, reactive leadership can create confusion, erode trust, and shift focus away from shared goals. Anchoring communication in shared values provides consistency and clarity, particularly when navigating uncertainty or competing demands. This means responding thoughtfully, aligning messaging with the broader mission, and maintaining transparency even when challenges arise. For example, during executive leadership discussions involving shared funding opportunities or cross-agency initiatives, leaders may face competing priorities and uncertainty around ownership of the work, responsibilities, or decision-making authority. In one discussion regarding a collaborative grant opportunity, a leadership team navigated tensions by grounding the conversation in organizational values that had been intentionally developed through prior team building, reflection, and difficult conversations around how the group wanted to lead and work together. Because there was already a shared understanding around values such as honesty, respect, integrity, trust, and clarity, team members felt comfortable asking difficult questions openly and respectfully. Rather than reacting defensively or avoiding tension, the leadership team was able to clarify expectations, define roles, and move forward with greater alignment and confidence. Listening to partners and stakeholders remains essential, but listening does not require immediate agreement or action. Leaders must balance openness with discernment, ensuring that decisions remain aligned with both evidence and organizational values. This approach reinforces stability within partnerships and helps to sustain collaboration over time, even when external pressures are high. Applying these three leadership habits the next time you feel the room get tense will significantly improve group dynamics, allowing the team to focus on the tasks at hand. It is important that leaders understand these practices require intention, consistency, and reflection. After an event, leaders should take time to think and reflect on how they used these practices, what the immediate outcomes were, and if there is anything different they would do the next time. These leadership habits do take practice, so leaders should be patient with themselves as they get more comfortable applying them in the heat of the moment. As the great philosopher Epictetus said, “It’s not what happens to you, but how you react to it that matters.” Public health is truly in unprecedented times, bringing with them unpredictable, challenging, and nuanced situations. Leadership calls for not only “technical” expertise, but for “soft” expertise as well to manage stress and complexity, provide clarity, and achieve the best possible outcomes in collaborative spaces. Resources PH WINS 2024 Findings by de Beamount Soft Skills Matter Now More Than Ever, According to New Research by Harvard Business Review Intellectual Humility by Character Lab Values-Based Communication (PDF) by TCC Group What Is Psychological Safety at Work? Here’s How to Start Creating It by APA Reviewed by - Mason, Prather article yes

ASTHO invited five DELPH scholars to provide examples of how community and diversity shape their leadership within their local health department and share recommendations for a more inclusive workplace.

Infusing Diversity, Equity, and Inclusion Into State Public Health Agencies: Perspectives from Connecticut, New York, and Tennessee Association of State and Territorial Health Officials, diversity equity inclusion, public health, public health agencies, connecticut and new York, tennessee and new York, public health workforce, equitable access to care, health equity, access to care, share resources, diverse executives, delph scholars, leadership development, implement dei, health agencies, office of multicultural health equity, advisory council, racial equity, human rights, health and mental hygiene, board of health, anti racism, department of health, addressing dei, health disparities, political landscape Samia Hussein, Erika Kirtz, Jannae Parrott ASTHO | DELPH Scholars share insights on creating an inclusive and equitable workplace in public health agencies from Connecticut, New York, and Tennessee perspectives. A diverse public health workforce is essential for organizations to offer equitable access to care and address the many social and political factors affecting health. Public health agencies are most robust when they mirror the diversity of the communities they serve, as this enables them to access and share resources with the community and other stakeholders more easily through established connections. Therefore, infusing Diversity, Equity, and inclusion (DEI) into multiple levels of state and local public health agencies is vital. In a LinkedIn Study, 76% of employees indicated that diversity is essential when considering a job, and 80% of survey respondents indicated they want to work for a company that values diversity. With the recent resignation wave hitting many state and local public health agencies, the need for authentic attraction of new employees who share our DEI values is more urgent than ever. It is time for public health practitioners to transform the systems to be more inclusive and structured to provide the necessary resources and interventions to all individuals, especially the most vulnerable. As Diverse Executives Leading in Public Health (DELPH) Scholars, we value this DEI conversation centered around equity within the workplace. Our leadership development program has allowed us to connect with others working on this same effort nationwide. Together, we have learned valuable lessons as we implement DEI at our health agencies and are eager to share them with you. This collective effort and shared purpose drive us in our DEI journey. State Perspectives on Addressing DEI Connecticut: Samia Hussein The Office of Multicultural Health Equity (OMHE) was established in 1996 as an appointed office by the then Commissioner to create health equity programs and initiatives that address our staff and client needs, including establishing our Statewide Multicultural Advisory Council (MCAC). Recently, in Connecticut, the Commission on Human Rights and Opportunities and the Commission on Racial Equity in Public Health co-hosted a statewide symposium titled “Cementing Equity in State Government” that launched the results of two fundamental equity studies across the state. The studies are a result of legislation passed declaring racism a public health crisis. The first step in our DEI journey was to ensure a foundation of definitions, terms, and a safe space for dialogue around shared experiences, which can lead to culture change. This was accomplished through buy-in from leadership by consulting with a full-service DEI agency, Kaleidoscope Group, based in Chicago. The Commissioner, Executive Leadership Team, and Union Leadership collaborated in offering this mandatory full-day DEI training to our entire agency (~3400 staff). OMHE and MCAC create a shared three-year strategic plan that is a vehicle for making a substantial DEI impact (e.g., reviewing health inequities) and provides recommendations for the Commissioner through programs/initiatives and policy changes. It is imperative to collaborate with multiple internal and external stakeholders to have a pulse on DEI issues. This existing infrastructure allowed OMHE to oversee this training mandate and continue advancing DEI programs statewide. Our preliminary data for DEI training has shown that nearly 80% of staff reported the training as a worthwhile investment, and 82.1% strongly agree that they will apply the knowledge and skills learned from the training at their workplace. We continue to look at client data points for behavioral health inequities and address DEI concerns collaboratively. New York: Jannae Parrott The New York City Department of Health and Mental Hygiene (DOHMH) has embraced a proactive and inclusive strategy to tackle DEI by prioritizing integrating health equity and anti-racism throughout the agency. This work is primarily supported and driven by the New York City Board of Health resolution declaring racism a public health crisis. At DOHMH, the first step was to launch an agency-wide initiative to empower staff with the knowledge and tools to effectively address racial health disparities and enhance health outcomes for all New Yorkers. This initiative involves educating and training staff on how racism and other oppressive systems can impact healthcare, analyzing how racism may have influenced our past work, establishing new policies to mitigate such influences, and collaborating with local communities to explore additional strategies for combating systemic injustice. DOHMH will soon launch a new data equity skills training course to engage staff at all levels in applying practical data equity skills. Its objectives include fostering awareness of the importance of data equity, providing tools and training for people who work with data to enhance equity in data practices, and offering resources for staff involved in data-informed decision-making. Additionally, DOHMH has initiated comprehensive internal reforms aimed at dismantling silos and modernizing our data systems. This transformative process enables the agency to advance the linkage of public health, healthcare, and social service data, ultimately enhancing our understanding and efforts to improve population health. Tennessee: Erika Kirtz The Tennessee Department of Health (TDH) has been strategic in its approach to addressing DEI in the state. We have shifted our language to focus on eliminating disparities, which is the central focus of our equity work. A key priority is overcoming limitations in our data and surveillance systems to detect disparities in vulnerable populations better. Offices within TDH are linking multiple datasets to gather demographics and risk factors to understand how to serve the populations best. For example, the Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) program in TDH has implemented processes to link surveillance datasets to secondary data sources (inpatient and outpatient hospital discharge data, etc.) to gather information on demographics that aid in the understanding of risk factors associated with the acquisition of certain multi-drug resistant organisms. The findings from this data linkage allow the team to pinpoint risk factors that can be overcome with targeted interventions. We have also begun breaking down silos to collaborate across offices and divisions on the various equity-related initiatives. The overall goal is to transform the current systems to operate through an equity lens, which will be standard practice throughout TDH. There is also a push to continue diversifying the workforce by actively recruiting interns and staff from local Historically Black Colleges and Universities (HBCUs) and other institutions with minority populations. The TDH’s central office is in Nashville, TN, near two prominent HBCUs: Tennessee State University and Meharry Medical College. TDH staff have attended job fairs and specifically sent notifications to faculty at these institutions to help recruit for internships, fellowships, and employment. TDH’s approach is to remove the negative stigma around the term equity, which allows our department to continue serving the people of Tennessee. Call to Action The work of DEI can be challenging, and there is no specific blueprint for addressing it. However, we want to share key takeaways and lessons from this process. It is imperative to have leadership buy-in and support early in the process. The work will not be prioritized if it does not start with the Commissioner and the Executive Leadership Team. Also, this process is not one-size-fits-all and requires a clear vision. The first step is establishing a clear baseline of health equity measures to assess progress continuously. Guidance from the Robert Wood Johnson Foundation can assist in measuring equity in your state. Review what other agencies are doing to adopt best practices that can be applied to your agency. Please note that this process is not for one person and requires a diverse and dedicated team to champion this work. This process requires financial investment through consulting, training, or hiring core staff. There will be many people who are resistant to change or critical of this work. Remember the why and the importance of these practices. Use data to support decisions and stick to the strategies or action plans that lead to success. Also, identify key partners committed to this work and use each other to overcome challenges. Understanding the political landscape and concerns these initiatives might evoke is vital. These concerns can be overcome by being proactive in communicating the benefits and importance of this work, building relationships and awareness of social inequities, and inviting all employees to play a role in advocating for the advancement of DEI. When considering diversity and inclusion, we must think beyond gender, race, and ethnicity. Consider understanding the makeup of the diverse communities served. Expand upon client and staff demographic data. Even if the Federal and State

Roots of Equity: Addressing Health Disparities and Advancing Inclusive Solutions in Michigan Ninah Sasy Addressing historical inequities and health disparities to promote health equity and well-being in Michigan. Social determinants of health (SDOH)—e.g., socioeconomic status, education, employment, housing, access to health care, and environmental factors—profoundly shape individual and population health. SDOH includes social and cultural factors such as racism, discrimination, and bias (based on race, ethnicity, gender, sexual orientation, disability, or other marginalized identities) that contribute to health inequities by creating barriers to resources, opportunities, and fair treatment. Understanding and addressing these factors is essential for promoting health equity and improving overall well-being. The Historical Landscape of Systemic Discrimination My grandparents were born in the late 1930s and early 1940s, during which a significant number of discriminatory practices and policies directly impacted their career trajectory and the stability of their family. Jim Crow laws enforced racial segregation, leading to inequities in education, housing, and employment opportunities. Like many African Americans, my grandparents relocated from the South to northern states for better opportunities (specifically Flint, MI, to join the automobile industry). When they arrived, they encountered additional discrimination, including redlining. The practice of redlining involved discriminatory lending practices by financial institutions, explicitly denying or limiting financial services, such as loans or insurance, to certain neighborhoods or communities, often based on the perceived risk of racial or ethnic minorities. Despite that, my grandparents were fortunate to live the American Dream of owning a home; I remember their beautiful green lawns and my grandmother’s flower gardens from when I was a child. Importantly, African Americans weren’t the only ones impacted by discriminatory laws and practices. My maternal grandmother, who was Native American, faced discrimination as well through forced assimilation, a direct contrast to the Indian Reorganization Act of 1934, which was intended to promote cultural preservation. Many minority populations and impoverished farmers faced unimaginable discrimination—and the repercussions are still evident today. Health Inequities and Racial Weathering Health inequities persist when comparing African Americans to their White counterparts. Most recently, during the COVID-19 pandemic, significant disparities in mortality rates became apparent. Understanding the origins of these disparities connects back to the historical landscape of our country and the antiquated policies that perpetuate these inequities. In addition to the Jim Crow laws creating an unfair advantage for some Americans to achieve generational wealth, there are day-to-day infractions that persist today. Racial weathering describes the cumulative physical and psychological toll of experiencing systemic racism and discrimination over time. This phenomenon manifests through chronic stressors such as microaggressions, unequal access to resources, and institutionalized racism, which can have profound effects on individuals' health outcomes. Research suggests that racial weathering contributes to disparities in chronic illnesses, mental health conditions, and overall well-being among marginalized communities. The cumulative physical and psychological toll of experiencing systemic racism and discrimination over time. This phenomenon manifests through chronic stressors such as microaggressions, unequal access to resources, and institutionalized racism, which can have profound effects on individuals' health outcomes. Research suggests that racial weathering contributes to disparities in chronic illnesses, mental health conditions, and overall well-being among marginalized communities. My grandparents and their neighbors took pride in their homes. However, several factors, including the closure of numerous factories, have contributed to disinvestment in the Flint, MI community. When the primary employer, the automobile industry, departed, so did a portion of the population to seek employment in other communities. Consequently, there was a lack of investment in the school systems, as they relied heavily on property taxes. This domino effect resulted in food insecurity and housing instability. Once vibrant homes with lush lawns and blooming flowers were replaced with abandoned properties and businesses. As a result, individuals must travel 20 to 30 minutes by car to reach a grocery store instead of taking a 10-minute walk for fresh produce. Transforming Public Health in Michigan Culturally Appropriate Solutions According to the Michigan State Plan on Aging, approximately 2.5 million people in Michigan (or 25.3% of the state’s population) are 60 or older. Considering the comprehensive policy and programmatic needs to support this growing population, we must better understand and create culturally appropriate solutions. It is also critical that we acknowledge and address the longstanding historical inequities intertwined in laws, policies, and social structure that have created health inequities in our aging minority populations. Addressing these inequities is crucial to support health equity and improve the overall well-being of all older adults in Michigan. We are fortunate to have the Michigan State Plan on Aging at the state level. The Plan was developed and implemented with the support of diverse voices by integrating fundamental principles such as health equity, elder justice, person-centered practices, and evidence-informed approaches across all goal areas through Michigan Department of Health and Human Services (MDHHS) leadership. Michigan Department of Health and Human Services (MDHHS) leadership. Building a Statewide SDOH Strategy As the Policy and Planning Director, I have the privilege of leading the development and implementation of our statewide SDOH strategy. This strategy aims to create a healthier and more equitable society by tackling the social and environmental factors influencing health outcomes. It is imperative to address health disparities to guarantee that everyone, regardless of their background, has an equitable chance to enjoy a healthy and satisfying life. The strategy strives for a future where innovative concepts and community-led solutions are central to dismantling health disparities and fostering the comprehensive well-being of communities. Representation Is Key Representation matters because it ensures that diverse voices and perspectives are heard and considered in decision-making. MDHHS recognizes the importance of representation and continually gathers information from community partners and residents to inform its work. Within the MDHHS SDOH policy team, I have taken proactive steps to assemble diverse leaders to provide insights and guidance for collaborative efforts. My leadership goal is to cultivate a culture where every team member feels appreciated and empowered to share their viewpoints, nurturing an atmosphere of transparency and mutual regard. Convening diverse partners is essential for fostering inclusive and practical solutions to complex societal challenges, particularly in public health. By garnering a wide range of perspectives, experiences, and expertise, these partnerships can better identify and address the root causes of health disparities and inequities. Through intentional engagement with our SDOH task forces, advisory councils, and SDOH Community Influencer Program, we strive to build trust and longstanding collaborative relationships. By prioritizing diversity and inclusion in our engagement efforts, MDHHS seeks to create policies and initiatives that genuinely reflect the needs and experiences of the communities we serve. However, there is always room for improvement. As public health leaders, we should continually assess how we engage with the community to ensure we build longstanding relationships. Healing Historical Wounds Reflecting on the Michigan initiatives makes me proud to be a public health leader. However, having lost two of my grandparents before they reached the age of 70 and remembering the challenges that they endured throughout their lives, I continue to feel disheartened. Many factors impact health care outcomes for the aging population, especially for BIPOC communities. Navigating the social and health care system is challenging. The digital divide, the deeply ingrained distrust in health care, and the rekindling of past traumas are just a few additional barriers for the aging population, which are further compounded in minority and low-income populations. As leaders in public health, it is crucial to continuously enhance our community engagement practices, ensuring that our programs and policies accurately reflect the community's needs. This involves: Cultivating solid relationships with community partners to reach our most vulnerable populations, particularly the elderly, effectively. Actively pursuing opportunities for professional growth, such as anti-bias and cultural competency training. Taking proactive steps to eliminate barriers to partnerships by reforming grant-making procedures, promoting flexibility in program design, and refining our community engagement strategies to capture the invaluable perspectives the community offers entirely. Embracing collaborative decision-making processes is essential. Advocating for policies like the Caregivers Act, which removes barriers for family members to care for their aging loved ones, aligning with culturally competent care. Prioritizing equitable solutions that address not only socioeconomic disparities but also the underlying inequalities among minority groups should be an essential aspect of policy reform discussions. Our commitment to investing in the elderly will benefit future

Leading from the Inside: Advancing DEI at the State Level astho, association of state and territorial health officials, workplace cultures, financial performance, creates a positive, diversity equity and inclusion dei, united states, work life balance, hiring process, human resources, organizational culture, top talent, team members, employee engagement, recruiting process, long term, public health worker, socioeconomic status, races ethnicities, retain employees, company s culture, diversity equity inclusion, public service, recruitment retention development, public health workforce, work culture, organizational values, diversity matters James Bell III Three steps on how to implement DEI strategies at the organizational level. Campaigns for racial justice have grown throughout our country, and parallel conversations focusing on diversity, equity, and inclusion (DEI) have increased, especially in public service. We experience this effect through the lens of facilitating more equitable and responsive service delivery. Our programming, policies, and data must be culturally informed and relevant. But DEI must also be valued internally in how we contribute to employee recruitment, retention, and development. Today’s workplace is complex, and DEI is vital for improving outcomes for all the populations we serve. Most modern organizations have come to terms with the critical need for DEI initiatives. The evidence highlighting how these efforts can improve an organization’s productivity, creativity, retention, and financial success has been clear for some time. But, honestly, is that enough? And why haven’t we made the earth-shattering changes we all know are possible? Perhaps it could be traced back to the changes we hope to seek being assigned outside of our organization when it should be us who are leading and implementing change. Breaking down siloes for diversity requires new ways of working with fewer barriers among and across teams and their unique people. To remove these perceived barriers, I propose that a few key steps must take place. 1. Put the people first. I have been in too many meetings where employees are considered “resources” or “FTEs,” and it’s so unfortunate. As advantageous as it may be for some, the lure of DEI as a return on investment cannot be the sole purpose for pursuing such initiatives. We lose the essence of humanity and unique individuality that makes diversity so special when we limit people to a box on an organizational chart. If governments want to attract and retain the best possible talent, the actual business case to make is talent itself. Building a diverse and inclusive culture cannot only be a human resources function or a top-down effort. All people across departments should see themselves reflected in this work and be able to identify a path to make it their own. As leaders, we should work relentlessly toward understanding the needs of others while building a safe environment for the type of collaboration needed to solve complex problems better. This means constantly learning and embracing new concepts, ideas, and ways of doing things. Each of us has the power to create a more substantial, fairer workplace where everyone can contribute their strengths, talents, and ideas while being treated with dignity and respect. 2. Back your program with a budget. Organizations have shouted their pledges and promises to foster more diverse, equitable, and inclusive environments from any rooftop they could find for at least three years. Although determining which groups are walking the walk is challenging, a strong indication of one’s commitment is to look at budget line items. A lack of or limited budget is an immediate red flag that conveys that DEI is not a priority. Just like anything else, if something is important to you, you will spend the money required to implement it properly. One of the best ways to demonstrate your commitment to DEI is through sustainable, tangible financial investment. This allows our DEI initiatives to be continuous and to evolve over time based on the immediate need. We are not in a position to check the box or allow one implicit bias course to cover all the broad gaps we are experiencing. There is also the benefit of a broad supply of qualified DEI practitioners and consultants who are experienced in guiding organizations through complex DEI issues. Should we continue to face complicated and longstanding DEI issues, it isn’t up to our staff to try to resolve them. We must assign monthly, quarterly, or annual monies to address these problems. 3. Hold yourself and your organization accountable. Regardless of agency or size, DEI efforts within organizations often lack strategic follow-through and accountability. These endeavors are often reactive, episodic, or only prioritized after a public relations crisis. We can’t only respond when we are required to respond. The communities we serve—and our employees—expect that we will carry out our responsibilities and fulfill our promises. We have not consistently been diligent in creating mechanisms for feedback, and if we have, we fail to implement them. To truly embed DEI into our culture, we need meaningful metrics and the willingness and courage to use the data to hold ourselves accountable. How will we ever know if we are going in the right direction or making desired changes if we never discuss the data? And that isn’t to say results must be perfect because we know changes take time. But it communicates clear goals and allows for solid focus and discussion for alignment. This disclosure is necessary to drive change and inspire others by demonstrating that progress is possible. The future of state government must fully embrace diversity, equity, and inclusion both as an aspiration and as a responsibility. We must create a sense of belonging and environment for organizational justice, even if this means resisting the status quo that we have nurtured and become far too comfortable letting stand. We should be celebrating rather than marginalizing employees because of their individuality. We should be challenging business practices that undermine our organizational values and fail to treat employees equitably. Author card spacing 1 Related Content-Blog - DELPH Magazine 2 website yes