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The Boundary Spanning Leadership Framework’s Impact on Public Health Boundary Spanning Leadership's Impact on Public Health Alice Schenall, Tyrone Bethune, Alyssa Merski Explore three examples of Boundary Spanning Leadership's public health impact, from overdose to Alzheimer's to youth behavioral health. Since 2018, ASTHO has customized the Boundary Spanning Leadership (BSL) framework for the public health workforce. BSL develops leaders’ ability to create direction, alignment, and commitment (DAC) across both vertical and horizontal relationships within health departments and with community partners. The framework aims to work across differences in geography, demographics, leadership level, department, or unit. It’s designed for settings where the goal is not only to lead people but to lead across these differences, bridging agencies, sectors, levels of authority, and communities. In short, while many leadership models help individuals become more effective leaders, BSL equips public health professionals to mobilize collective leadership across systems, which is essential for addressing complex issues such as behavioral health and emergency response. Here are three examples of BSL’s impact and utility in public health, two of which are multi-state projects. Preventing and Responding to Overdose Overdose Data to Action (OD2A) leaders are faced with boundaries that can inhibit overdose surveillance and prevention activities without proper navigation. For example, partnership with community organizations to reduce overdose may not be effective without first exploring differences between the state health agency and community organization goals and working to build trust. Throughout BSL trainings, OD2A leaders have demonstrated many ways they bridge these boundaries and apply DAC in their overdose surveillance and prevention work. OD2A leaders may need to span boundaries… Between departments within the agencies in which they work. Between hierarchical levels within the organization. With external partners like community-based organizations. With diverse cultures, demographics, and populations with which they work like people who use drugs. Across rural/urban regions, states, or localities. Collaborating across these boundaries ensures stronger team relationships, exchange of perspectives, expertise, and experience, and alignment of vision and strategy to improve program impact. For example, BSL can help OD2A leaders secure critical health agency buy-in while meaningfully engaging people with lived experience in the planning, implementation, and evaluation of prevention programs. “This program allowed me to focus on specific skills and teach me things I had never learned before. My work will be significantly better because of this. I cannot tell you how important it has been to be able to network with the others as well.” — Participant of OD2A Reducing Risk for Alzheimer’s Disease and Related Dementias In 2025 and 2026, ASTHO and the Alzheimer’s Association hosted two BSL trainings for health departments and their partners throughout the Healthy Brain Initiative. These helped equip them with a dynamic approach to addressing Alzheimer’s disease and related dementias (ADRD) by aligning partners across public health, aging, and other sectors. Through DAC, participants engaged in dialogue that bridged boundaries to integrate brain health into chronic disease, injury prevention, and other public health initiatives. Applying BSL practices to brain health created synergies that addressed shared risk factors such as hypertension, obesity, and lack of physical activity. BSL enabled state and jurisdictional teams to adapt quickly to the latest science, engage nontraditional partners, and build the skills needed to navigate potential boundaries. These practices strengthened cross-sector collaboration and built sustainable systems of shared investment and learning, positioning brain health as a priority across the public health landscape. ASTHO selected the BSL training because leaders who effectively collaborate across boundaries are better positioned to address complex public health challenges such as ADRD, which requires interagency and multisector action. Public health leaders need solutions, and there is evidence to support and measure the usefulness of BSL concepts. Participants successfully met the expectations and objectives of the workshop: Breakthrough Innovations: Drove creative solutions that integrated culturally responsive care and brain health promotion across settings. Cross-Functional Learning: Built shared understanding between public health, aging services, and community stakeholders to address complex problems (e.g., ageism, risk reduction, caregiver burnout, access to care). Partnership Development: Leveraged cross-sector collaborations to expand age-friendly environments and relationships. The BSL training left a lasting impact on those who completed the workshop, with participants reporting increased knowledge of major boundary types and mechanisms needed to boost ADRD strategies. Participants shared their excitement to immediately implement BSL elements into their public health practice. As BSL gains momentum and attention across the field, we urge organizations to leverage the framework as a conduit to build the capacity needed to accelerate brain health strategies and beyond. “My participation in this BSL training will have a lasting impact by strengthening both my individual capacity and our team's ability to approach strategic planning, stakeholder engagement, and the development of sustainable. For my team, this will translate into stronger collaboration, clearer direction, and more cohesive implementation of our ADRD strategies.” — Participant of the Healthy Brain Initiative Building Bridges for Youth Behavioral Health in New Mexico In April 2026, leaders from New Mexico’s Departments of Health and Education came together — not just to coordinate but to truly collaborate. Partnering with ASTHO, they convened an in-person BSL training designed to move beyond siloed work and toward a shared vision for adolescent behavioral health in schools across the state. A total of 18 participants joined the training, representing a cross-sector mix of state agencies and community-based organizations. While the group brought diverse perspectives, they shared a common purpose: improving outcomes for young people across the state. The BSL framework offered them a structured way to navigate differences, build trust, and define collective direction. Throughout the workshop, participants deepened their understanding of the boundaries that often limit collaboration, whether structural, relational, or based on differences in processes and priorities. More importantly, they built the skills to identify and bridge those divides. For many, the experience shifted how they think about partnership — not as coordination across systems, but as intentional, interdependent, and relationship-driven leadership. The impact was immediate. Participants reported increased confidence in their ability to break down barriers and apply BSL strategies to advance adolescent behavioral health. Just as critical, they described forming authentic connections with colleagues across sectors, which laid the groundwork for more cohesive, aligned work ahead. Perhaps most telling: Every participant committed to using BSL strategies in the next 30 days to six months. This wasn’t a one-time training, it was the start of a new way of working. The group plans to continue meeting monthly to apply these tools, strengthening direction, alignment, and commitment in their shared efforts. “Addressing boundaries is a great practical step in all of the projects we will have going forward.” — Participant of New Mexico School-Based Health Program For public health professionals, the takeaway is clear. Complex challenges like youth behavioral health don’t sit neatly within one sector and they can’t be solved there either. Boundary spanning leadership offers a practical, human-centered approach to building the partnerships needed to create lasting change. Explore more of ASTHO's work in Boundary Spanning Leadership. article yes

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

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

Learn about the importance of equity, diversity, and inclusion in public health—three pillars that are crucial to building healthier societies.

Colorado's New Online Mentorship Initiative Supports Local Public Health Agencies Elise Moore Learn how CDPHE developed an online mentorship program to enhance local public health leadership, with tips for other health departments. The Colorado Department of Public Health and Environment (CDPHE) launched their Athena Success Partnering program, an online staff mentorship initiative for local public health agencies. CDPHE's Office of Public Health Practice, Planning, and Local Partnerships (OPHP) developed the program as part of its Executive Director Learning Pathways project, which supports those leading local health agencies in Colorado—especially after many of those leaders faced intense scrutiny during the pandemic. CDPHE used Public Health Infrastructure Grant (PHIG) funds to procure the software to support its online mentorship programs. Several different entities in CDPHE are now using the software for mentoring initiatives, including programs for new hires, human-centered leadership, and peer support. In addition to the Athena Program, OPHP uses the software for a peer connection program for Colorado Chief Medical Officers. Development and Launch of the Mentorship Program An Executive Director Advisory Group helped guide OPHP’s thinking around the options and elements to include in its online mentorship program for local health agencies. The Athena Program provides new and experienced executive directors and emerging leaders the opportunity to form supportive peer relationships for skill development, confidence building, networking, effective agency leadership, and supporting retention efforts. OPHP started by focusing on local public health agency executive directors and has recently opened the program to all Colorado local public health agency staff. The program offers a series of steps or prompts to guide mentors and mentees, with content to last for a year of regular meetings. Some of the automated prompts include ice breakers and questions about communication, goal setting, and leadership. Additionally, the platform has a learning section where users can find articles and resources related to professional development. Participants use the platform for traditional mentoring, and to connect with colleagues with expertise in specific areas. Users can ask questions or request mentorship for specific time-sensitive problems or learning needs. They can also join role-specific groups, such as planners and emergency preparedness and response and resiliency staff. OPHP notes that it took time for staff to develop new habits for using the platform for questions and resource sharing and that some executive directors did not feel qualified enough to become mentors to other executive directors. To address some of these challenges, OPHP created resources and opportunities for users to understand the program's benefits, including a monthly newsletter. In one edition, OPHP outlined reasons to become a mentor—addressing the benefits, time investment, preparation guidance, and qualifications to be a mentor. Program Receives Positive Response Both mentors and mentees in the Athena Program have expressed positive outcomes and benefited from their relationships. Broomfield County Executive Director Jason Vahling shared that he benefitted from the mentor experience. “Initially, I was signing up to be a mentor, but I feel like, at times, we switch back and forth between being the mentor and mentee and learn from each other. It has been great to have a partner outside the metro area to get insights and learn from." Mentorship Platform Evaluation Plans As the program continues, OPHP is using quantitative and qualitative data (e.g., participation counts, user surveys, and key informant interviews) to assess participant engagement. Program administrators are also assessing supports and barriers to participation and whether participation in the mentorship program is helping build essential knowledge and skills in implementing best practices for core public health services and foundational capabilities, management and leadership, and staff support and retention. OPHP’s Advice on Planning an Online Mentorship Program For health departments seeking to build their mentorship platform, OPHP shared a few tips: An advisory group was valuable for program planning. Talk to potential participants about their needs, as these may vary. Be patient and take the long view. Demonstrate how the program benefits both mentors and mentees. Provide various options for engaging with mentoring, peer support, and group interaction opportunities. Future Plans for Strengthening Staff Expertise CDPHE plans to continue leveraging PHIG funding, as well as their academic health department partnership with the Colorado School of Public Health, to offer a program to prepare participants to successfully take the Certified in Public Health (CPH) exam and earn certification with a pilot beginning in January 2025. PHIG recipients interested in learning more about Colorado’s experience can reach out to the team at ophp@state.co.us. Special Thanks-Blog - Colorado's New Online Mentorship Initiative Supports Local Public Health Agencies OE22-2203 PHIG website yes

Public Health Leader Profile: Joy Borjes on Leading Teams Through Change ASTHO Staff, Center for Health Care Strategies Staff ASTHO | Joy Borjes of Texas HHS shares perspectives on leading teams through change. Introduction As a child, Joy Borjes witnessed firsthand the power of state programs to improve the lives of those they serve: Joy’s parents received government support related to their disabilities, which inspired her to become a civil servant. “I grew up seeing that government services can make a difference, and I wanted to be a part of that,” she reflected. Now as part of the Texas Health and Human Services Commission (HHSC), Joy supports programs that impact the lives of more than 7.5 million Texans every month. In 2022, after working in state government for more than 10 years, Joy was promoted to a new position as the associate commissioner for family health strategy in HHSC's family health services division and began leading a team working on women’s and children’s health initiatives. In this role, she oversees the coordination of programs within the women’s health portfolio, which includes family planning services and breast and cervical cancer services. Across the country, health care policy at the state level is often complicated by evolving dynamics, changing demographics, and emerging needs; state public health leaders must navigate the confluence of relationships, policy, and change. With help from Joy’s leadership, the family health services division has celebrated several recent successes, including the impending release of a redesigned long-acting reversible contraceptive (LARC) toolkit, strengthened partnerships with external groups, and a 65% increase in funding through the Texas Legislature for the state family planning program in 2024. To support some of these achievements, Joy and her HHSC colleagues joined the Contraception Access Learning Community (CALC), led by ASTHO in partnership with the Center for Health Care Strategies. The learning community offered an opportunity for dedicated staff time and external support to work on improving women’s health outcomes in the state. This leadership profile highlights lessons from Joy’s nearly 12-year career working for the state, with a focus on her successes in advancing women’s health access through strategic oversight of the learning community workgroup. Rich Text Block-Blog - Joy Borjes on Leadership - CALC Leadership Lessons Investing in Relationships The learning community workgroup Joy pulled together included staff from the family health services division and Texas Medicaid, along with external advocates from the Texas Women’s Healthcare Coalition (TWHC), academic researchers, and others. For the workgroup to succeed, Joy knew the importance of cultivating relationships and fostering trust, especially with people she had not worked with before. “As we were coming together with our external partners, we had frank conversations with them about what our roles were, what our goals would be, and what capacity we had,” Joy shared. The workgroup decided their first goal would be to redesign a 2018 provider toolkit that focused on increasing knowledge and effectively using LARCs. Redesigning the toolkit had long been a desire of the family health strategy team, but competing priorities prevented them from doing so without extra support. Because Joy had invested in building relationships with her workgroup members, she knew their expertise, passions, and priorities. Joy was able to explain the importance of redesigning the toolkit to the workgroup’s external members and increase their investment in this work. Through collaboration and with momentum and support from the learning community, the workgroup is nearing completion of the redesigned toolkit. Rich Text Block-Blog - Joy Borjes on Leadership - Key 1 Motivating a Team Through Change At the start of the learning community, HHSC underwent a reorganization of the commission’s client services programs, including Joy’s family health strategy team and the women’s health programs with which her team works. Simultaneously, Joy’s external partners restructured. This concurrent period of transition disrupted the work of the learning community workgroup, as members were focused on their own internal reorganization. Leading the workgroup through these changes was difficult; the workgroup struggled with high staff turnover both at HHSC and within TWHC. The remaining members had limited work capacity, with many taking on work left by their previous colleagues. Through the restructuring and staff departures, the workgroup lost key experts and the priorities of the workgroup became unclear. In reflecting on this period, Joy shared, “I wish I had been more intentional about reaching out to our external partners in the learning community to explain what we were doing, instead of making assumptions that everyone knew. We struggled because of the change and lack of clarity.” Throughout this period of uncertainty, Joy realized the power of leading with transparency and vulnerability. “There’s value in being vulnerable by acknowledging when work is difficult,” Joy reflected. “I don’t sugarcoat things, but even when things get tough, I’m still enthusiastic about the work we’re doing to serve Texans.” After a few months of reprioritization, Joy was able to reconvene and motivate the learning community workgroup to continue working toward its goals. Rich Text Block-Blog - Joy Borjes on Leadership - Key 2 Setting a Vision Through “Yes, and...” Many leaders struggle to find time to plan strategically—it is easy to get tunnel vision, focusing only on the present. After the multi-organizational restructuring, Joy met with workgroup members to discuss new roles, responsibilities, and goals for the learning community. As the workgroup thought about their goals, Joy realized the potential to leverage the time and resources of the learning community to prepare for her other large focus: the 89th Texas legislative session starting in 2025. The Texas Legislature convenes every two years to pass laws and make decisions that impact HHSC and other state agencies. For state officials, preparing for the biennial legislative session is a crucial part of their work. During the 88th legislative session in 2023, Joy partnered with HHSC’s family planning program leadership to request increased program funding. Together, they saw a 65% increase in funds allocated to the agency’s family planning programs. Knowing that planning for the 2025 session would help both the family health services team and their partners, Joy leveraged the learning community to set a vision for the legislative session. She noted, “I wanted to make sure we were prepared for the next session instead of getting stuck with focusing only on the present one. The legislative cycle moves so fast. The 89th session will be here before we know it, and it only lasts 140 days. So, a little bit of planning—making sure the agency knows what our stakeholders will be advocating for, for instance—can go a long way in helping legislators make complicated policy and funding decisions.” In developing a vision for the next legislative session, Joy encouraged the workgroup to collaborate in shaping their goals. She reflected, “In my interpersonal interactions, I’m a believer in the ‘yes, and’ approach, borrowed from improvisational theatre. Even in difficult moments, being able to say, ‘I see your point and here’s something I can do to build off of that idea,’ helped keep our team motivated and excited about the work.” Rich Text Block-Blog - Joy Borjes on Leadership - Key 3 Closing Joy’s approach to leading both the HHSC family health strategy team and the learning community workgroup highlights key lessons for public sector leaders. Under Joy’s leadership, the updated LARC toolkit will reach thousands of providers across the state, and the increase in funding the Texas Legislature provided will allow Joy and her partners to increase access to their family planning programs in 2024. The successes of Joy’s team were driven by her approach to leadership. Joy invested in relationships by making time to talk with others in her field. She set the right goals for the right time by taking advantage of available resources and support. Finally, Joy embraced authenticity by leading with self-awareness and transparency. Contraception Access Learning Community Arnold Ventures Funding website yes

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

Advancing State Maternal and Child Health Policymaking Through Boundary Spanning Leadership ASTHO, Association of State and Territorial Health Officials, state policy, maternal and child health policy, maternal and child health, maternal health, public health, health equity, access to care, boundary spanning leadership, medicaid coverage, postpartum coverage, missouri department of health, department of health, prism learning community, mch policymaking, pregnancy risk, pregnancy realated death, socioeconomic disparities, pregnant and postpartum women, multi sector action network, improve partnerships, establish direction, strengthen relationships, mental health, community based organizations, public health agencies, shared barriers, elementary and secondary education, collaboration and coordination, key legislation Maria Gabriela Ruiz, Ramya Dronamraju ASTHO | Advancing State Maternal and Child Health Policymaking Through Boundary Spanning Leadership Missouri is addressing a critical maternal health crisis characterized by rising pregnancy-related deaths, socioeconomic disparities, and limited postpartum coverage. This challenge prompted a bipartisan push for Medicaid postpartum coverage extension and the need for a cohesive, comprehensive state system involving diverse stakeholders to improve outcomes for pregnant and postpartum women. As a result, the Missouri Department of Health and Senior Services (DHSS) team joined the Promoting Innovation in State and Territorial Maternal and Child Health (MCH) Policymaking (PRISM) Learning Community in 2021: a partnership between ASTHO and the Association of Maternal and Child Health Programs. Through PRISM, Missouri worked to increase access to quality health care for pregnant and postpartum women through innovative policy solutions. The team established three overarching goals based on state priorities: Advocate for extending postpartum Medicaid coverage to 12 months. Establish a multi-sector action network to provide a multidisciplinary system of care, promoting health equity and ensuring appropriate care coordination for women and mothers with mental health and substance use disorders. Improve access to quality health care for low-income pregnant and postnatal women, including Medicaid coverage of services provided by professional midwives, doulas, and community health workers. Boundary Spanning Leadership Training Overview As part of DHSS’ engagement with PRISM, Missouri participated in a Boundary Spanning Leadership to improve partnerships, develop solutions to address the emerging needs of the MCH population, and foster trust among partners dedicated to improving maternal and infant health in Missouri. Boundary spanning leadership (BSL) is defined as the capability to establish direction, alignment, and commitment across boundaries to achieve a higher vision or goal. The main vision of Missouri’s BSL training was to build momentum on their PRISM goals and improve MCH outcomes in the state by strengthening relationships with relevant stakeholders. BSL training participants included representatives from DHSS and Departments of Social Services, Mental Health, Elementary and Secondary Education, along with other critical partners from community-based organizations, academic institutions, and local public health agencies. BSL introduced tactical skills to create psychological safety as a cross-sector team and respect for the values and unique challenges of each team/organization represented. This space provided the direction, alignment, and commitment that participants to leverage in addressing challenges among the MCH population. Lessons Learned Recognizing Shared Barriers: A central aspect of the BSL training is for participants to align on shared barriers and concerns. Participants identified funding as a challenge when developing programmatic and policy initiatives, highlighting complex state and federal funding structures, bureaucracy, and sustainability. Collaboration and Coordination: Participants discussed the disconnect between the availability and accessibility of MCH services in Missouri, which results from fragmented communication between agencies, leading to duplication of efforts and straining already limited resources as well as personnel. Throughout the BSL training, participants discovered ways to work together to amplify available resources, coordinate programmatic efforts, and reduce barriers to access for MCH populations. Public Health Workforce Capacity: The COVID-19 pandemic resulted in workforce turnover and decreased capacity, leading to further disruptions in service delivery, quality, and efficiency. BSL participants highlighted acquisition, training, and staff retention as priorities to focus on moving forward. State Successes Enacting Key Legislation In May 2023, Missouri passed SB 45, which extended Medicaid for birthing people to 12 months postpartum, including coverage for mental health and substance use disorder treatment. The extension of coverage for 12 months after delivery is estimated to cover more than 4,000 women who would otherwise become uninsured two months after the end of pregnancy. Developing a Coordinated Approach Since the in-person BSL training in April, Missouri has developed interagency connections and relationships to bolster MCH progress in the state. One example is a partnership forged between the DHSS Office of Dental Health and leadership at Uzazi Village, a community-based health organization that provides “adjacent models of care” for Black and Brown childbearing families to restore health, vitality, and joy to communities of color during the perinatal period. These organizations collaborated to bring oral health care to pregnant and postpartum people without access to dental care services. The State Dental Director and MCH Director coordinated the donation and transport of the larger dental equipment and the purchase of smaller equipment and supplies needed for the clinic; the State Dental Director also connected Uzazi with a dental provider. Missouri is poised to capitalize on the connections established during this training and further enhance collaborative efforts to improve MCH outcomes. Next Steps Missouri achieved all three of their goals through engagement in PRISM, exemplifying a proactive approach to addressing critical maternal health challenges. The team has made significant progress in advancing policy initiatives to improve access to quality health care for pregnant and postpartum women. Developing a coordinated approach to addressing MCH issues remains a priority as Missouri continues to foster collaboration among diverse stakeholders. The team will be able to leverage its new connections to address emerging issues, such as the current, which is disproportionately affecting children and families. Moving forward, Missouri is well-positioned to build upon its successes and further strengthen interagency connections to continue making impactful strides in maternal and child health. Special Thanks-Blog - Advancing MCH Policymaking Through BSL website yes

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

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

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What We Learned at the Public Health TechXpo and Futures Forum ASTHO | Our staff's top takeaways from the TechXpo. astho, association of state and territorial health officials, public health techxpo and futures forum, public health leaders, u.s. public health system, public health policy, data sharing and modernization, population health, governmental health agencies, public health infastructure, workforce resilience, public health workforce, techxpo and futures forum, public health infrastructure, build workforce resilience, future of public health, health techxpo and futures, health leaders and experts, experts across the technology, health workforce, health outcomes, futures forum, health leaders, health departments, public health professionals, today and the future, public health services, public health techxpo Dylan Reynolds Marcus Plescia and Garfield Clunie present "The Future of Measuring Health Equity - A World of Evolving Data." Last month, ASTHO kicked off the Public Health TechXpo and Futures Forum in Chicago, an opportunity for some of the world’s top leaders in technology and to engage public health leaders on challenges and solutions for successfully modernizing the U.S. public health system. Over 600 participants were in attendance, with 200 more attending virtually from around the world. It was a packed three days. Our speakers demystified the world of public health policy, opened doors to new funding streams, and gave us a glimpse into the glittering future of data sharing and modernization. Heavy hitters from Amazon and Google weighed in as well, showing us how they’re working hand-in-hand with health agencies to change the way they approach population health and well-being. So as we look back on a busy week—and look ahead to our virtual follow-up event on June 15—here are some of the messages that stuck with us the most: "Standards are like toothbrushes. Everyone has one, and no one wants to use some else’s." The line from Gabriel Seidman, director of policy at the Ellison Institute for Transformative Medicine, was met with a belly laugh from a crowded room during one of the week’s most well-attended sessions, a panel conversation on the future of measuring health equity. However, Seidman’s comparison was an apt one. There is certainly much to be said for a public health data system that is engineered to meet the specific needs of its target community. However, for public health experts to do their best work, they must be able to speak a common language—at a local, state, territorial, and national level. When each level of public health is operating with different standards in place and with a different definition of success, data gets lost and people get left behind. One of the loudest calls to action from the week was for governmental health agencies to break down these data siloes and establish common standards between agencies. The "Next Pandemic" is a Priority—But It's Not the Only One There is—understandably—mounting national attention on preparing for what many public health experts believe will be the inevitable "next pandemic." The COVID-19 pandemic showed us what a lack of preparedness could mean for population health, and there is so much unknown about what the future of pandemics has in store. However, experts at the TechXpo reminded us that public health is about more than responding to a singular crisis. "I think many of the conversations we're having are so focused on COVID-like pandemics," said John Auerbach (alumni-MA) "But if we look at the things that are still killing people, for the most part it's not infectious disease." Instead, Auerbach cited challenges that have long been a part of the public health story, such as diabetes, the fentanyl overdose crisis, and climate change. Before COVID-19 entered the national spotlight, public health’s day-to-day work was largely centered on chronic disease and behavioral health. Auerbach reminded us that amid all of the unknowns of our future, there is plenty we do know—and plenty we can be doing to address it. "Modernizing data systems is more than buying a big computer." While there were many versions of this message over the course of the forum, Auerbach perhaps said it most concisely of all. In other words, it doesn’t matter if a public health agency has a chrome-plated exterior and a cloud-based data system, so long as the underlying infrastructure isn’t sustainably and thoughtfully built. Whether it’s a matter of restricted funding, antiquated processes, or siloed thinking, health agencies and their leaders must have a plan to address these challenges before assuming that “buying a big computer” will catch their data dashboards up to speed. This was one of the ironies of this future-forward event: Amid so many exciting innovations and inventions, many of the challenges boiled down to basic, equity-centered questions about the best way to get this new technology in the right people’s hands. If public health is going to take a technological leap at a national level, then it must also be able to make a leap at a community level—in communities of color, in territorial health agencies, and in our policies. Jumping lightyears ahead doesn’t count if entire populations are still being left lightyears behind. Workforce Resilience Cannot Be Taken for Granted We cannot separate the future of public health from the future of its workforce. The COVID-19 emergency response has left many public health workers feeling burned out and harboring traumatic levels of toxic stress, pushing many of them to seek out jobs outside the field. In fact, according to a recent analysis of data from the Public Health Workforce Interests and Needs Survey, 46% of state and local public health employees left their jobs between 2017 and 2021. For public health to reach its full potential in the future, we must begin investing in that workforce today. Over the course of the week, we heard often from mental health experts and senior health officials to learn about their priorities, challenges, and paths to improve workforce well-being in their health agencies. This included the unveiling of the PH-HERO Workforce Resource Center, which arms health agencies with the resources and knowledge they need to support their workforce. Whatever the future of public health holds, it begins with a workforce who is motivated to make that future a reality. More than anything, the TechXpo was a reminder that public health’s future is as multiple as it is uncertain. We are working toward a future that is more adaptable than ever before—with thought innovators and health experts who are constantly reflecting, pivoting, and adjusting to the moment. There are so many conversations yet to be had. For those who have not done so already, we invite you to register for our fully virtual TechXpo follow-up forum on June 15, and add your voice to the growing chorus. website yes

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Kim Henderson, formerly of DC Health, reflects on her experience and role leading public health communications for the nation’s capital.

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Many states have experienced considerable challenges in recruiting and retaining HAI/AR staff, in this interview, public health officials from Kansas discuss their successes and lessons.

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