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In-depth analysis on state health policy surrounding the public health workforce. This is part of ASTHO's annual legislative prospectus series.

Insight and Inspiration: Conversations for Public Health Leaders ASTHO is honored to present Insight and Inspiration, the premier webinar series designed to motivate public health leaders as they respond to new and ongoing public health challenges. The nation’s preeminent thought leaders, authors, and strategic thinkers offer attendees strategies to further develop their leadership skills as well as ground themselves and their teams even amid crisis. This series is open to governmental public health professionals at all stages of their careers. Check out upcoming opportunities and previous session recordings below to take your leadership to the next level. website

Reprioritizing Black Maternal Health How We Can Prioritize Black Maternal Health Lawrence Young Black women face significant rates of maternal morbidity and mortality — learn how public health can better support them in this blog post. I do not have to look far to understand the urgency of the Black maternal health crisis. I have watched friends, colleagues, and loved ones from every walk of life struggle through pregnancies that should have been safe and celebrated. Some are highly educated professionals. Others are young mothers still finding their way. Many had access to quality insurance and still faced complications, long hospital stays, and minimal follow-up care. Many have shared unfortunate experiences that run the gamut from feeling unheard or perhaps unnecessarily undergoing a procedure — the care in health care was not there for them. These are not isolated incidents. They are part of a larger, structural failure that demands our attention and our action. As public health professionals, we must ask ourselves: How can we better care for and about Black mothers? And what would it look like to center them in the systems that were created to protect women in one of the most vulnerable times of their lives? Understanding the Root of the Crisis Black women in the United States are three to four times more likely to die from pregnancy-related causes than their White counterparts. In many states, including Connecticut, this difference persists even when controlling for education and income. These outcomes are not the result of individual choices or biological differences — they are the result of systems designed with historical blind spots. Education and income, often seen as protective factors, do not shield Black women from these outcomes. Research shows that pregnancy-related mortality rates are higher among Black women with a college degree than among White women with the same level of education or with less than a high school diploma. The same is true for women with respect to the risk of dying within the first year postpartum. These disparities grow with age and extend beyond mortality to include severe maternal morbidity, such as preeclampsia — a pregnancy complication related to high blood pressure — which can have lasting health impacts if untreated including death. Additionally, American Indian, Alaska Native, Black, Native Hawaiian, Pacific Islander, Asian, and Hispanic women all experience higher rates of ICU admission during delivery compared to White women. ICU admission is considered a key marker for maternal complications and system-level failure. Public Health as Partner in Progress Public health has a responsibility to do more than document issues and concerns. We must be in the business of addressing them. In Connecticut, we are working across agencies and community organizations to move from acknowledgment to action. One of the most important leaders in this work is #Day43, an initiative launched by Waterbury Bridge to Success Community Partnership. The name refers to the period between 43 days and one year postpartum, during which approximately 20% of pregnancy-related deaths occur. #Day43 exists to raise awareness of Black maternal health and transform systems to support mothers. Their work spans research, advocacy, policy, technical assistance, and storytelling grounded in lived experience. Waterbury’s maternal health data reflects this crisis. According to the #Day43 Black Maternal Health Report, 18.6% of pregnant women in Waterbury received late or no prenatal care. Those in the city face higher rates of C-sections, limited access to postpartum care, and insufficient support for mental health and breastfeeding. The community described a significant lack of maternity care resources, particularly in the North End, where many Black and Hispanic families reside. Through initiatives like this, residents are not just seen as stakeholders. They are recognized as storytellers, system builders, and agents of change. Their leadership is shaping how we define, measure, and deliver maternal care in Connecticut. This vision aligns with broader maternal health equity efforts across the state. For example, The Connecticut Health Foundation is developing a Maternal Health Equity Blueprint in partnership with community leaders, researchers, and families. Waterbury voices are essential contributors to this process. Listening as a Path of Healing The experiences of Black mothers reflect a broader truth. Too often, our systems are not built to hear them. That lack of trust is both historical and current. It shows up in rushed appointments, dismissed symptoms, and inaccessible services. Community-based providers, such as doulas and midwives of color, are critical to bridging this gap. They do more than provide care — they restore dignity. Yet these providers are often underfunded and undervalued in mainstream health care systems. Public health must champion integrating these providers into existing systems and promoting long-term sustainability. To maximize maternal health outcomes, the next phase of this work must intentionally include structured cross-sector collaboration. It must focus on building systems that educate both providers and families on urgent maternal warning signs, provide consistent discharge education, and strengthen local surveillance and outreach infrastructure. These strategies are essential, scalable, and lifesaving. We cannot improve outcomes without acknowledging the deep cultural, emotional, and psychological work required to rebuild trust. We cannot heal what we do not hear. Re-Examining the “Public” in Public Health Re-examining the public in public health means placing the needs of our most vulnerable communities at the center. It means investing in care that is integrative and supportive with community co-designed solutions. It also means wholistically addressing other intersecting systems that influence maternal outcomes. We can start by: Expanding funding for community-based perinatal health workers, including doulas and midwives. Embedding relevant metrics into maternal health program design and evaluation. Creating statewide listening sessions and family advisory councils to ensure policies reflect lived realities. Partnering across sectors to improve access to safe housing, transportation, and mental health supports for new mothers. Supporting local initiatives like #Day43 that lead from within communities and reflect community-defined solutions. Educating families on health information and individual health rights through accessible, trusted channels. To truly care for and about Black mothers, we must act beyond awareness months and social media campaigns. We must improve current processes and design opportunities that will support them and keep them alive. Public health was created to serve the public. The most powerful way to honor that mission is to focus on the public, ensuring they are a priority and not an afterthought. article yes

Discover how leadership coaching sessions reinforced partnerships between public health and community-based organizations.

San Diego Academic Health Partnership Strengthens Service During COVID-19 and Beyond San Diego Academic Health Partnership Strengthens Service Mayela Arana Learn how the Academic Health and Human Services Department in San Diego strengthens service, research, workforce development, and more in the region. In San Diego County, the connection between academia and public service continues to grow stronger, shaping the future of health and human services. With over 8,200 employees serving a diverse population of 3.3 million residents, the County of San Diego Health & Human Services Agency (HHSA) plays a crucial role in advancing health, housing, and social services across the region. Recognizing the immense value of bridging education with real-world public service, HHSA and San Diego State University (SDSU) formed an Academic Health and Human Services Department (AHHSD): the Live Well Center for Innovation & Leadership (LWCIL), a first-of-its-kind initiative in San Diego County. This partnership is more than just a collaboration; it’s a transformative effort to strengthen education, research, workforce development, and service in the region, inspired by collaborative successes during COVID-19. A Vision Years in the Making Even before the COVID-19 pandemic, leaders at HHSA, SDSU, and SDSU’s College of Health and Human Services (CHHS) recognized the opportunity to deepen their relationship through an Academic Health Department (AHD) partnership. Many of those contributing to HHSA’s success began their journey at SDSU, with over half of the agency’s leadership team and a significant portion of its workforce having graduated from SDSU, particularly from CHHS. With a long history of partnering to provide real-world experiences for students, collaborating on research, and developing practice-informed curriculum, formalizing the partnership to integrate academia and health and human services practice was a natural next step. An Academic-Public Health Partnership in Action HHSA and SDSU’s longstanding relationship initially focused on student field experiences, research collaboration, and workforce development across select schools and decentralized departments but went on to have a major impact on the ground — most notably, enhancing HHSA’s COVID-19 response. Mobilizing Promotoras for Outreach and Support SDSU and HHSA worked together on recruitment, training, and community outreach. They successfully recruited 40 community health workers for a Promotoras program, which initially helped with contact tracing within the highest-risk communities. The Promotoras also identified where people needed assistance (e.g., food, services). SDSU provided support by organizing food pantries in high-risk areas, while the Promotoras took food to those in need. As vaccines became available, HHSA trained the Promotoras on messaging and communications to dispel misinformation and to encourage vaccine uptake. The Promotoras also helped those in the highest-risk communities get appointments at the county vaccination sites. Expanding Public Health Capacity with Nursing Students In addition, SDSU and HHSA worked together to train and deploy nursing faculty, students, and recent graduates in county vaccination efforts. From January through March of 2021, the SDSU School of Nursing partnered with Champions for Health, the local nonprofit arm of the San Diego Medical Society, to train 200 vaccinators. Once trained on the proper storage and administration of the COVID-19 vaccine, faculty-led groups of undergraduate nursing students administered vaccines at community sites in primarily underserved areas of the county — many organized by the San Diego Black Nurses Association. In addition to providing surge capacity staffing to support community and public health efforts, the partnership allowed students to complete clinical hours required for graduation during the pandemic when students were restricted from other clinical sites. Many of the students and graduates who served as temporary contact tracers and case investigators transitioned into full-time positions within HHSA as the COVID-19 response scaled back. Formalizing Collaboration for Lasting Impact Given the tangible value of their collaboration demonstrated during the COVID-19 pandemic, HHSA and SDSU chose to use and adapt the national AHD model — gaining access to the growing, nationwide network of AHD partnerships that inform their goal of sustaining a high-impact academic-practice partnership. They formalized the partnership with a public signing of an overarching five-year memorandum of agreement (MOA) in October 2022 that launched the bold vision of creating San Diego County’s first and only AHHSD. They assigned an additional MOA specifically addressing joint research and data sharing in December 2024, and an addendum supporting agency-wide student field experiences is underway. With formal agreements across all key areas, the foundation will be in place for increased and accelerated collaboration by summer 2025. Building on the regional collective impact vision called Live Well San Diego, the AHD partnership adopted joint branding as LWCIL. An active Steering Committee, co-chaired by HHSA’s Deputy Chief Administrative Officer and CHHS’s Dean, meets quarterly and represents the highest-level leadership for each organization. Members include key leaders in HHSA operations, human resources, and strategy, and the directors from each of its eight service departments. On the academic side at SDSU, the Steering Committee includes representatives from the six schools and multiple institutes within CHHS. Setting Partnership Priorities LWCIL co-created and recently adopted a joint, multi-year Strategic Roadmap to guide the next three years of the partnership’s development and its contribution to a healthy, equitable, safe, and thriving San Diego region. It is organized around four high-impact priority areas: People Success: Build a diverse, competent, and engaged health and human services workforce​, including students and both partners’ workforces.​​ Research & Data Excellence: Inform and improve academia, policy, and practice with rigorous and relevant research. Service to Community: Integrate academia, practice, and community to advance equity and eliminate health disparities. Leadership & Sustainability: Create a nationally recognized academic-practice model with innovative leadership committed to improving academia, policy, and practice. Subcommittees for each priority area, co-chaired by leaders from both organizations, have launched and created action plans tied to advancing the Strategic Roadmap. In addition, emerging workgroups are aligning ​work plans​. Next steps include: Assessing what is already in place and integrating it into the partnership. Developing a standardized and streamlined process for students to complete internships at HHSA. Leveraging opportunities to bridge research and practice and, where appropriate, in collaboration with the community. Investing in capacity has been essential in moving the partnership forward and providing coordination. The director of LWCIL is a “boundary spanning” position, co-funded by SDSU and HHSA. Additional staff support has assisted the partnership, including two HHSA Management Fellows engaged in a year-long program. Advice for Others Seeking to Establish AHD Partnerships HHSA and SDSU offer the following tips to agencies looking to develop or expand AHD partnerships, based on their experiences: Secure leadership commitment: Ensure the highest-level leaders are committed to the partnership’s success and sustainability. LWCIL started with the support of the dean, deputy chief administrative officer, and directors within both organizations who continue to be actively involved as members of the Steering Committee and subcommittees. By doing so, they have helped set priorities, identified staff to participate, and continuously champion the partnership within their respective organizations. Start small: Build from what already exists between the partners, leverage willing internal resources, and celebrate early successes. LWCIL started with conversations focused on workforce development because of existing relationships and shared interests. Those conversations eventually evolved to include collaborating on rigorous equity-focused research and partnering to address needs identified by the community, such as housing stability for our older adult population and food insecurity. The subcommittee structure was created to support those shared priorities; however, it began with smaller, more narrowly focused conversations. Be strategic: Create a common agenda/plan that aligns with the goals of both organizations, making it easier for already-stretched organizations to commit to and benefit from the partnership. LWCIL's co-creation of a multi-year Strategic Roadmap allowed the partners to discuss the many opportunities for collaboration and integration, and to prioritize. It now guides where the partnership is going and helps keep everyone focused on what they collectively decided is important. Then, grow: By getting systems in place and understanding the benefits and challenges between two organizations (HHSA and SDSU), LWCIL is setting the stage for expansion to include other local universities. Take time to plan and set up structures: Creating the LWCIL ​Strategic ​Roadmap was a six-month process that engaged leadership from both organizations. This was critical for identifying priorities and direction, including what structures and systems needed to be organized so the work could move forward. Learn more about San Diego’s Live Well Center for Innovation & Leadership and AHD partnerships, or explore other workforce development resources from the Public Health Foundation. If your health agency wants more information about planning support, please submit a PHIG technical assistance request through PHIVE or contact

Academic Health Partnership Prioritizes Workforce Development in Florida Florida Academic Health Partnership Prioritizes Workforce Development Mayela Arana Learn how an Academic Health Partnership in Florida focuses on workforce development and get inspired. In Hillsborough County, the Florida Department of Health (DOH-Hillsborough) and the University of South Florida (USF) have a long history of working together. Their partnership took on a new level of structure and purpose in 2022 when they formalized an Academic Health Department (AHD) partnership agreement, focused largely on workforce development. This collaboration, supported by the Public Health Infrastructure Grant (PHIG), creates opportunities for DOH-Hillsborough staff to enhance their skills through USF’s public health programs. By providing structured training and education, the partnership is helping to build a stronger, more prepared public health workforce to serve the county’s 1.5 million residents. A Longstanding Partnership Embraces a New Opportunity When CDC released a notice of funding opportunity for PHIG in 2022, the DOH-Hillsborough health officer and the dean of USF’s College of Public Health (COPH) worked together to co-write a successful proposal. One of the resulting contracts formalized their partnership in the name of strengthening the public health workforce through recruitment, training, and retention. Like many public health agencies, many of DOH-Hillsborough’s employees do not have degrees in public health. The health department is focused on upskilling through coursework and certificate/micro-certificate programs directly related to job tasks. These opportunities are available to every staff member including those categorized as “other personnel services,” non-career services, and certain contracted employees — as DOH-Hillsborough recognizes the importance of extending these educational opportunities to all employees. Initial PHIG funding was critical in establishing the necessary dedicated staffing and infrastructure for workforce development program offerings at the health department. Current funding continues to support infrastructure, new custom program development, and the educational offerings. Infrastructure: USF works with DOH-Hillsborough to conduct staff training needs assessments and has provided training at agency-wide “all-staff” meetings. USF also developed and provides a Certified in Public Health (CPH) exam preparatory course that is open to any health department employee who is eligible to sit for the exam, at no cost to them. Custom program development: Additionally, the university, in collaboration with DOH-Hillsborough and two other local county health departments, developed a custom leadership program that groups emerging health department leaders with community partners of their choice (e.g., Healthy Start, Homegrown Hillsborough) and includes two full days of instruction over a six-month period. Educational offerings: The health department is also using PHIG funds to cover tuition for current staff to take graduate and undergraduate courses at USF’s COPH and across the university. Representatives from DOH-Hillsborough and USF hold virtual information sessions for staff about available educational offerings, the university enrollment and registration process, and completing internal agency requirements for pursuing and participating in the PHIG-funded opportunities. Measuring Impact and Continuous Improvement Given that the bulk of activities in this AHD partnership are currently PHIG-funded, PHIG performance measures provide a clear and valuable opportunity for evaluation. DOH-Hillsborough is focused on three of the PHIG measures that address hiring and retention: Number of PHIG-funded positions filled by job classification and program area. Overall agency staff retention rate. Median number of days to fill a position. Tracking performance of these measures both contributes to the agency’s overall PHIG evaluation and provides the AHD partnership with a clear process for quality improvement. Advice for Others Seeking to Establish AHD Partnerships Learning from the success of USF and DOH-Hillsborough’s partnership, considerations in developing or expanding AHD partnerships include: Appreciate the unique nature of each organization. For example, while the health department and university may have a common vision, they may also have different funding category restrictions to consider prior to solidifying the partnership. Be mindful that each organization has its own legal considerations. Allow ample time for the proper review of contracts, agreements, and external communication about the joint endeavor. Know that, at times, the collaborative process can be complex and challenging. Take a few steps back. Work together to find solutions, and don’t give up. Be flexible, humble, and willing to pivot, remaining confident that the partnership will have a bigger impact than your organization would alone. Learn more about AHD partnerships or explore other workforce development resources from the Public Health Foundation (PHF). If your health agency wants more information about planning support, please submit a PHIG technical assistance request through PHIVE or contact performanceimprovement@astho.org. 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Learn how boundary spanning leadership can help develop more robust and productive public health workplaces.

Explore key actions, indicators, and supports to enhance workforce recruitment and hiring in governmental public health.

This brief examines the ways states can support certification for community health workers.

An ASTHO brief on the importance of understanding moral injury and burnout, with recommendations on areas of organizational focus.

ASTHO engaged Oklahoma public health officials, members of the Oklahoma Harm Reduction Alliance, Health Minds Policy Initiative, and representatives of the Southern Plains Tribal Health Board, and others in a Boundary Spanning Leadership workshop.

Board-certified forensic pathologists play a critical role in public health by investigating death so as to better serve the living. Despite forensic pathology’s contribution to public health surveillance, prevention, and response, the discipline remains largely under-resourced and over strained. These briefs spotlight the critical role that international medical graduates play in minimizing forensic pathology workforce shortages and spotlights a local effort to address financial disincentives for medical graduates entering the field and highlights federal funding opportunities and resources for state partners looking to minimize forensic pathology workforce shortages.

The opioid epidemic has exacerbated the shortage of board-certified forensic pathologists, presenting a major workforce challenge for public health systems.

This brief highlights four top takeaways from the experience of six public health agencies working to establish and strengthen their own performance management systems.

Wraparound Services for All: How Public Health Departments are Connecting Communities to Critical Support ASTHO, Association of State and Territorial Officials, wraparound services, astho delph, diverse executives, linkage to care, medical care, health care, community well being, public health, health outcomes, evidence based, quality of life, strength based, local community, health promotion, improvement health, infectious diseases, maternal and child health, local health departments, public health services, mental health services, public health practices, public health leaders, public health systems, behavioral health ASTHO Staff How health departments across the country are working to link clients to diverse public health services and supports to address their specific challenges and help them succeed in different aspects of life. As the heartbeat of community well-being, health departments find strength in collaboration. Services provided by health departments cannot stand alone when supporting their residents and communities significantly, as several simultaneous and interrelated factors can influence health. In this blog post, ASTHO’s DELPH scholars from cohort #3, Tosha Bock and Sam To, share how their organizations across the country are striving to implement systems to link clients to a diverse range of public health services and supports to address their specific challenges and help them succeed in different aspects of life. Give an overview of your organization and the ‘linkage to care’ efforts. TOSHA: The Oregon Health Authority (OHA) is a government agency in Oregon. OHA oversees Oregon’s health-related programs, including behavioral health (addictions and mental health), public health, Oregon State Hospital for individuals requiring secure residential psychiatric care, and the state's Medicaid program called the Oregon Health Plan. The nine-member Oregon Health Policy Board oversees its policy work. OHA’s goal is to eliminate health inequities in Oregon by 2030. Addressing health inequities in Oregon is crucial as it ensures everyone has equal access to healthcare resources regardless of socio-economic status or background, promoting a more just and inclusive society while improving public health outcomes. One way OHA does this is by supporting investments in Community Information Exchange (CIE). CIE is a network of collaborative partners using a multidirectional technology platform to connect people in Oregon to services and support. Through CIE technology, users can search a shared resource directory, document consent, and make and hear back on the referral status (closed loop). Communities across Oregon are implementing CIE. SAM: Within the Division of Preparedness at the Arizona Department of Health Services, the Office of Rapid Response Disease Investigation (ORRDI) was established during the COVID-19 pandemic and launched statewide case investigation and contact tracing (CI/CT) to support local health jurisdictions (LHJs) with critical investigative support. Soon after, a referral process to connect residents to community organizations was incorporated into all investigations; this provided the ability to directly link residents with vital resources and assistance programs while they navigated their situation. Give an example of the work and why it's impactful. TOSHA: Below is an example of the importance of CIE expressed by a Community-Based Organization interviewed for the CIE: Community Engagement Findings and Recommendations Report. Community-based organizations, peer-run organizations like ours, we are, you know, feet on the ground organizations, we're grassroots, and I think this tool to be able to reach out because we're always underfunded, we're always understaffed, you know, and this cuts down on hours and hours and hours of time that we would be on the phone, we have to do one referral, we can send it out, we can make notes, we can talk back and forth with other people, we only have one consent form, you know, all these things have made it a lot easier for us to operate, making it to where we can spend more time with our feet on the ground. – Interviewee SAM: Throughout Arizona, especially for the state’s most vulnerable populations, isolating or quarantining was found to be a hardship, with adherence to guidance greatly dependent on each individual’s ability to access medical care, attend work, pay for rent and utilities, and to acquire food or medication; those who struggled became a risk for increasing the spread of COVID-19. Community navigators offered a personalized approach to providing services and programs aimed at helping residents achieve self-sufficiency. During one of the most substantial periods of COVID-19 response (between July 2021 and June 2022), ORRDI connected 17,290 cases and 939 contacts to community navigator organizations and successfully administered 18,229 referrals. The top three requested resources across the state were utility assistance, eviction prevention or rental assistance, and emergency food box delivery. This partnership connected various established services and magnified trust with the ORRDI team and within Arizona communities. What do you wish could be done to enhance your programs? TOSHA: CIE networks are foundational to building a more equitable system in Oregon. Additional funding must be provided to implement systems change and expand these networks to create statewide coordination across organizations, sectors, and systems. These investments should also include technical assistance, training, education, and advancing privacy and data protection. SAM: The ADHS ORRDI programs continue to manage COVID-19 CI/CT for much of the state and leverage this partnership to support the needs of Arizona residents affected by COVID-19. However, they have also taken on several other morbidities of public health significance. The objective of the Office is to maintain current community navigator partnerships by offering supportive services, continually improving outreach efforts to cases and contacts, and encouraging enrollment in referrals. Concluding Thoughts In conclusion, breaking down the silos between public health and health care opens avenues for a more holistic approach to community well-being. By simultaneously addressing various determinants of health, organizations can create a comprehensive and interconnected system that fosters lasting improvements. This collaborative effort enhances the effectiveness of interventions and paves the way for a healthier and more resilient community. In embracing this integrated approach, we move closer to a future where the boundaries between public health and health care are blurred, giving rise to a more cohesive and impactful model for community health and wellness. website yes

PHIG: A Transformative Infrastructure Grant for Health Equity and Inclusive Workforces ASTHO, Association of State and Territorial Health Officials, phig grant, infrastructure grant, public health, health equity, public health grant, inclusive workforce, public health infrastructure grant, health departments, public health funding, public health institutes, data systems, public health workforce, community engagement, federal grants, restrict spending, health disparities, community partnership, underserved populations, diversity equity inclusion, educational institutions, high risk and underserved, ethnic minority, rural communities, overall capacity, minority institutions Amber Williams, Lindsey Myers The Public Health Infrastructure Grant (PHIG) program provides flexible, non-categorical funding to help public health departments across the United States build their infrastructure and capacity to meet their unique needs and address barriers in health equity and workforce development. Following the COVID-19 pandemic, Congress made a historic investment in public health workforce and infrastructure, presenting a game-changing opportunity for public health transformation. In the fall of 2022, CDC rolled out a first of its kind, five-year grant program called the Public Health Infrastructure Grant (PHIG) to address critical governmental public health workforce and system improvement needs. This program is all about supporting health departments across our states, territories, and freely associated states to ensure every community has the people, services, and systems needed to promote and protect optimal health for all. Along with funding 107 health departments, CDC also partnered with three organizations: the Association of State and Territorial Health Officials, the National Network of Public Health Institutes, and the Public Health Accreditation Board to help agencies modernize data systems, recruit and retain a skilled public health workforce, and address longstanding public health infrastructure needs. Challenges in Public Health Funding and the Pivotal Introduction of PHIG The majority of public health department funding comes from topic-specific federal grants, which usually restrict spending to prescribed programmatic activities and do not allow agencies to build foundational capabilities—like improving hiring or procurement processes, communication, and community engagement. For example, while advancing health equity and addressing health disparities is often emphasized as a central goal of public health practice, many jurisdictions face barriers to fully incorporating health equity into their strategies. Additionally, the public health workforce often does not reflect the communities they serve, which can impact their ability to build community partnerships and fully respond to the needs of underserved populations. PHIG is different in that it provides flexible, non-categorical funding that health departments can use to build their infrastructure and capacity to meet their unique needs and address barriers. PHIG Impact: Advancing Health Equity and Promoting Inclusion in Public Health Agencies Many agencies are using their PHIG funding to boost efforts to tackle health disparities in their jurisdictions and promote diversity, equity, and inclusion within their agencies. Internally they are focusing on examining compensation, assessing equitable pay, developing leadership programs for staff of color, streamlining hiring processes, and assuring unbiased hiring practices. Some agencies are creating paid internships, hiring people with lived experience, and building new workforce pipelines through engagements with minority-serving educational institutions. Plus, they are training managers and staff to create more inclusive workplace environments and partner with and serve diverse communities better. Other approaches include: Taking lessons learned from other funded programs, such as the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities grant, to focus and build on successes. Strengthening the overall capacity of the agency to address health equity, such as by incorporating health equity into agency-wide performance improvement offices and ensuring equity principles are embedded in health assessments and strategic plans. Improving partnerships with community organizations—looking at opportunities to simplify processes; support minority-owned institutions in competing for and managing federal funding; and hiring new staff dedicated to health equity, liaisons with special populations including tribes, and community health workers. This is a remarkable time for public health. Improving public health infrastructure and strengthening the workforce will lead to better health outcomes for all. These grants are critical, providing much-needed funding and flexibility to make real progress in promoting diversity, equity, and inclusion in the workforce and ensuring health equity in public health strategies. Author card spacing 2 Related Content-Blog - DELPH Magazine 3 OE22-2203 PHIG website yes

DELPH Reflections: A Journey Towards Creating a More Equitable and Just Democracy Fredrick Echols DELPH has helped public health professionals reflect on their purpose, cultivate compassionate leadership, understand system dynamics, and build a community of advocates to create a more equitable and just democracy. As an African-American male living in the United States, I have encountered numerous obstacles in life, particularly in my efforts to reform systems that fail to support marginalized and vulnerable populations. These systems have had devastating effects on myself and other individuals belonging to Black, Indigenous, and People of Color (BIPOC) communities as they restrict access to essential health and social services. As a Black physician and public health professional, I continue to encounter this stark reality that engenders a sense of hopelessness in communities across the United States. These systems obscure their true intentions and deceive individuals into believing that they operate in the best interest of marginalized populations while perpetuating inequitable and disparate health outcomes. In consideration of these personal and professional experiences, the Diverse Executives Leading in Public Health (DELPH) program has played a significant role in shaping my career and purpose: Fostering Critical Reflection: It provided me with a journey that encouraged me to think critically about my future and how I can leverage my platforms and relationships to help propel the public health ecosystem toward a system that embraces the humanity of all individuals and prioritizes uplifting and empowering the most vulnerable and marginalized populations. Important note: That said, the presence of silos, political posturing, and missed opportunities due to inefficient and ineffective operational practices resulting from insufficient fiscal investment continue to plague the public health ecosystem—limiting its ability to make strides toward a system that wholeheartedly supports the pursuit of health equity and social justice. Cultivating Compassionate Leadership: The program also provided access to experts and public health thought leaders who helped my colleagues and I understand the evolution of health and social service delivery in the United States (particularly for indigent populations), increase our capacity to embrace divergent thinking, and engage in constructive dialogue. The availability of such a space provided us with an opportunity to establish a secure and conducive environment, one that upheld the virtues of compassionate leadership and fostered effective relationship building. Our ability to engage with stakeholders, both like-minded and those with differing opinions, was characterized by a spirit of intentional listening that sought to comprehend their perspectives. Through this, we were able to create an atmosphere that supported open dialogue and nurtured mutual understanding. Understanding System Dynamics: The experience has enriched my comprehension of the intricacies that drive the amplification of inequality and the resulting health disparity gaps that are pervasive among communities and individuals across the nation. The knowledge thus obtained is of paramount importance to ensure my competency in identifying and avoiding perpetuating the issues that I aspire to address. This, in turn, will prevent any inadvertent harm to the communities I seek to uplift and empower. Building a Community of Advocates: Moreover, the program has enabled me to connect with individuals who are unwavering in their commitment to upholding justice. Despite our diverse backgrounds, we set aside cultural differences to work toward a common goal: the accessibility of quality healthcare and the delivery of justice for all humanity. The DELPH program's fundamental principles and culturally sensitive support structure have played an instrumental role in shaping my professional growth as a public health expert. As I chart the course for my future professional endeavors, I intend to leverage the lessons learned and the tools provided by DELPH to strengthen the public health ecosystem. My ultimate goal is to foster collaboration across various segments of society to create a more equitable, just democracy. The DELPH program has equipped me with invaluable knowledge and skills that will enable me to make meaningful contributions to society's betterment. For this, I express my profound gratitude to the Association of State and Territorial Health Officials, the Morehouse School of Medicine's Satcher Leadership Institute, and CDC for their unwavering commitment to advancing BIPOC leadership in public health. Their steadfast support for this program has enabled me and countless others to acquire the skills and knowledge necessary to effectively lead and drive the transformative change that public health requires. I sincerely appreciate their continued investment in this vital initiative, which has empowered many to become the change agents that public health needs. website yes

Get insight into the successes and challenges of integrating race/ethnicity data in public health and future directions in this field.

South Carolina Levels Up Public Health Leadership With New Program Avalon Warner-Gonzales Learn in this blog post how South Carolina’s Department of Public Health is fostering strong leaders with a new public health leadership development program. CDC’s Public Health Infrastructure Grant (PHIG) is a substantial investment in public health infrastructure, supporting initiatives in health departments across the nation to develop cutting-edge programs and bolster department operations. The South Carolina Department of Public Health (SCDPH) used this funding to pilot Leading the Way, a program that provides leadership development and network building for SCDPH staff. ASTHO spoke with Cynthia Naasira Taylor, coordinator for Leading the Way, about the program and its inaugural cohort. What inspired SCDPH to create the Leading the Way program? We created the program to address a gap in leadership development opportunities for the department. Staff developed a pilot that met the same requirements as the state Associate Program Manager program and included additional wrap-around leadership sessions. The staff who developed the pilot then presented it to the Executive Leadership Team, who approved using PHIG funding to formalize the program. Leading the Way is designed to develop, connect, and challenge SCDPH leaders to grow and improve key leadership skills while building strong, effective professional networks. Following the theme of “iron sharpens iron,” the program underscores self-improvement, education, and teamwork. The program envisions leaders coming together, rubbing blades (experiences, knowledge, strategies), forging alliances (networking, building relationships), and making their edges (competencies, skills) sharper and more efficient. How did PHIG support the development of the program? We used the PHIG funding to establish a dedicated staff position for formalizing and implementing the program, which has been critical to its success. We were able to bring in experts in team leadership, presentation mastery, and strength-based leadership to facilitate three primary leadership workshops. We were also able to provide one-on-one feedback sessions for cohort members, acquire supplies, and secure spaces for the workshops and graduation ceremony. Olivia Gomez - SC Leadership Program Tell us a little more about the inaugural cohort. The 2024 cohort is a well-rounded group of individuals who are directors, managers, nurse consultants, and program administrators. There is also a training instructor, microbiologist, intervention specialist, nutritionist, and nutrition educator. These individuals work across many fields throughout the department, including finance, IT, health equity and inclusivity, public health laboratories, and more. What were the goals of the program, and what activities supported those goals? Leading the Way is a seven-month program designed to challenge, stretch, and propel participants into their next level of leadership with four goals: Attain the Associate Public Manager Certification by completing classes offered by the SC Department of Administration. During the classes, participants receive in-depth training on coaching skills and techniques, supervisory skills, and goal setting and productivity training. Increase participants’ knowledge and competency of key leadership skills through workshops and activities. Activities include: a Team Players Style Survey to assess the participants’ natural team tendencies; the Teams Presentations Project in which the cohort—divided into four teams—researched, developed, designed, and facilitated presentations on current and relevant issues in public health; and a Networking with the Boss event during which participants networked with each other’s managers and directors. Advance strength-based leadership principles. Individuals complete the StrengthsFinder 2.0 online personality/behavioral assessment and receive personal feedback on their results from a licensed professional behavioral coach. The cohort received training on the CliftonStrengths domains and themes, how to implement strength-based leadership in their own professional growth, and how to promote strength leadership in their teams. Increase leadership competencies and strategies through networking opportunities. The Iron Sharpens Iron sessions provided a framework for cohort members to connect and identify competencies and strategies to integrate into the workplace. The cohort had the opportunity to bring awareness to challenges and best practices in their respective areas, and how they can solve problems in other areas across the state. What are your biggest takeaways and lessons learned from this first cohort? Without the PHIG funding for the program and for dedicated staff, we would not have been able to successfully launch the first official cohort. Even with the dedicated funding, it was a feat—while we were developing the program, we were also undergoing a significant agency restructure as the former SC Department of Health and Environmental Control split into SCDPH and the SC Department of Environmental Services. Our first cohort of participants and program staff demonstrated remarkable resilience and dedication throughout the program as they juggled it with the restructuring, their regular duties, and personal responsibilities. As program manager, I learned the importance of bridging new connections with agency leaders during the development phase. I also learned to allow the cohort space to dance to their own tune and let the rhythm of the group evolve naturally. The reward is seeing a cohesive band of leaders emerge and continue their relationships after graduation. Marcus Lara - SC Leadership Program Have you seen any early impact of the program? Since graduating, the cohort has continued to stay connected. They have established a dedicated Teams channel to continue collaborating and sharing experiences. Cohort members reached out to the facilitator for a workshop they attended on self-care and mental health to schedule a more robust session for later this fall, demonstrating their continued commitment to their mutual development. We’ve seen two cohort members receive promotions to director positions immediately following graduation. One of the recently promoted graduates manages a newly organized team. She wanted to charter her group and I offered to provide information. Since then, I’ve worked together with her team and facilitated several meetings to help them build their team charter. So, our connections have grown stronger since the inaugural program’s culmination. Adrienne Whitney - SC Leadership Program Looking ahead, how do you anticipate leveraging PHIG funding to support future efforts in South Carolina? The original pilot cohort identified the need for an agency mentoring program and created an outline for such a program. We are now in the process of developing an agency-wide mentoring program. The PHIG-funded position created for managing Leading the Way was also budgeted to develop the mentoring program. Additionally, PHIG funds have been allocated for tuition assistance. While this has been a necessary benefit to employees and the agency to fill critical positions, we have realized that this educational pathway is just one approach to ensuring a robust, qualified, and diverse public health workforce. SCDPH would like to use PHIG funds to support staff interested in pursuing shorter-term educational offerings such as certifications in public health, project management, human resources, and more. Kristen Smith - SC Leadership Program OE22-2203 PHIG article yes

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