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On Aug. 3, 2022, ASTHO and the de Beaumont Foundation announced the 2021 PH WINS findings. They provide a unique snapshot of the state and local government public health workforce.

This report highlights lessons learned about how to remain resilient in the face of complex disasters and environmental events, following two listening sessions hosted by ASTHO and the Environmental Council of the States.

This playbook, originally designed for local health departments, provides resources for states and territories who would like to increase community health worker engagement.

Gain access to information, resources, and tools to develop an effective workforce planning process to create a three- to five-year workforce plan.

In recent years, states and territories have started looking at braiding and layering funding streams as a way to leverage existing resources to achieve population-level impact. Adverse childhood experiences is one area that lends itself well to braiding and layering funds, since the risk and protective factors span across multiple program areas, including maternal and child health, violence prevention, substance misuse, behavioral health, housing, chronic disease, and early childhood education.

Through the lens of the Public Health Accreditation Board's standards and measures, this report explores innovative programs and policies implemented by health departments in an effort to adopt system-wide approaches to achieving health equity.

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

State and territorial health agency health care-associated infection/antimicrobial-resistant programs play a critical role for spearheading prevention, detection, and outbreak response efforts in their communities. Support from agency leaders is critical to ensuring that new federally-supported requirements are met.

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

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

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

Congress released FY24 Labor, Health and Human Services, Education, and Related Agencies appropriations bill.

Legislative Prospectus: Public Health Workforce 2022 ASTHO Legislative Prospectus: Public Health Workforce astho, association of state and territorial health officials, association of state and territorial health officials astho, public health officials, state health officials, territorial health officials, island jurisdictions, state health, public health, leading cause of death, mental illness, 10th leading, center for disease control, united states, national suicide prevention lifeline, save lives, suicide prevention resource center, disease outbreak, disease control and prevention, national institute of mental health, preparedness plans, centers for disease control and prevention, mental health conditions, preparedness and response, attempting suicide, mental health problems, health care, evidence base, covid-19, mental health, suicide prevention, pandemics preparedness, behavioral health Years of underinvestment in public health left a fragile public health system to respond to COVID-19 in early 2020. The public health workforce overcame extraordinary conditions responding to the pandemic—working long hours, risking exposure to the disease, and withstanding threats and abuse from the public—which negatively effected the mental health of many public health workers. A Spring 2021 survey of over 26,000 public health workers found that 52.8% experienced symptoms of anxiety, post-traumatic stress disorder, or suicidal ideation. States and territories are considering several policies to support the public health workforce, including efforts to increase the number of public health workers, strengthening protections for workers privacy and safety, and ways to sustain public health funding. Download the Prospectus website

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

How Staffing and Workload Can Impact Public Health Agencies Kelsey Tillema Public health is combating burnout and high turnover by focusing on key practices to improve workforce infrastructure—learn more in this blog post. Public health agencies often face significant challenges managing workforce priorities related to staffing and workload. While these issues are not new, the COVID-19 pandemic underscored the importance of retaining the public health workforce as a critical component of emergency response. A lack of capacity to manage an agency's workload can create a toxic cycle, often negating any impact of positive organizational culture improvements. In turn, productivity diminishes, turnover increases, and the remaining workforce suffers. To combat this pattern of inadequate staffing and attrition, a robust combination of effective recruitment, timely hiring practices, equitable workload policies, pay considerations, and skilled leadership to champion changes are essential. With one in three public health employees considering leaving their organizations within the next year—citing pay, work overload and burnout, lack of opportunities for advancement, stress, and organization culture as top reasons for leaving—retaining employees in public health has never been more important. As demonstrated during the COVID-19 pandemic, a lack of solid workforce infrastructure and workload imbalance among health care professionals and public health employees can have disastrous consequences for the workforce and overall public health. According to an analysis by the de Beaumont Foundation, “state and local health departments need to hire a minimum of 80,000 more full-time equivalent positions (FTEs)—an increase of nearly 80% —to provide adequate infrastructure and a minimum package of public health services.” As challenges and uncertainties continue to arise in an ever-changing public health landscape, quickly filling open positions and retaining current public health professionals is a key strategy to ensuring a healthy workload balance among teams and programs. Timely recruitment and hiring practices, creative recruitment strategies, broader job requirements and qualifications, as well as conducting capacity and project prioritization assessments can help alleviate stress and burnout that existing employees may experience due to open roles or understaffing. Chronic understaffing and delays in filling positions can contribute to stress, burnout, and higher turnover due to employee dissatisfaction. While an agency can have meaningful organizational culture and well-being initiatives in place, understaffing and workload imbalances can quickly counteract these efforts if not addressed quickly. Policies such as providing additional pay to employees who are taking on extra duties due to unfilled positions, cross-training or cross-skilling across duties and/or programs, assessing team and individual workloads, as well as providing avenues for staff to work toward promotions when taking on work that isn’t normally part of their role can motivate employees who are asked to take on more than their job description outlines. One such framework in discussion at North Dakota Department of Health and Human Services is a creative take on a career ladder—called a “career honeycomb.” In contrast to the ladder framework that typically reflects straight upward career growth, the honeycomb is a bi-directional opportunity to look at career development from various angles. The desire is to increase employee retention and satisfaction by providing avenues for staff to receive bonuses or other incentives for taking on extra work, earn “points” toward specific career milestones or promotions, be recognized on various platforms by their colleagues and leadership team, and embed their workforce development plan and mentorship program opportunities into the various “cells” of the honeycomb. This kind of creative thinking is an innovative way to holistically address both the agency’s and individual’s needs and strengthen overall workforce development. When understanding and implementing effective hiring policies and ensuring equitable workloads across a public health agency, human resource and workforce development/well-being teams are a crucial component. An internal team that is dedicated to assessing employee capacity, hiring and promotion policies, well-being, and overall organizational culture can help mitigate burnout among staff, lower turnover rates, and ensure wise use of resources. By continuously evaluating both the staffing needs and the overall health of the organization, HR and workforce development professionals can foster an environment that attracts and retains top talent, leading to improved job satisfaction and agency performance. The relationship between staffing, capacity, and workforce culture in public health agencies is undeniable. Ensuring that there are timely and efficient recruitment and hiring practices in place, equitable workload policies, and advancement opportunities can foster a healthy and effective workforce. These efforts must be supported by a dedicated team of workforce development and human resource professionals who regularly focus on assessing and addressing workforce staffing, capacity, well-being, and organizational culture. By prioritizing these internal needs, agencies can break cycles of burnout and turnover to create a resilient and capable workforce that effectively responds to public health challenges. OE22-2203 PHIG article yes

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

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