When we talk about partnerships that truly impact health, we think of leaders like San Antonio Mayor Ron Nirenberg and his health commissioner, Dr. Colleen Bridger. Mayor Nirenberg and Dr. Bridger embraced the tools and resources of our CityHealth initiative to raise the minimum age to buy tobacco age to 21; expand access to high-quality pre-kindergarten; increase opportunity for walking, biking, and public transit; and expand access to healthier food choices.
On the role of policy in improving health at the local level, Mayor Nirenberg said, “I’m a big believer in personal freedoms — your ability to make decisions as it relates to your own personal life. But the truth of the matter is it costs us a lot of money annually to have poor health. It costs us when areas of our city are left in a cycle of generation poverty. The money that we’re investing and the balance that we create in terms of public policy geared toward improving health is benefiting people in the long run. At the end of the day, we have to rely back on the community’s vision of better health and our mission as public officials to provide it.”
In discussing the CityHealth policy package as a tool for change, Dr. Bridger said, “The thing about public health is there really aren’t normal lines. Everything we do is aimed at making the community healthier. And when you look at what makes the community healthier, it’s things like pre-K, education, and access to public transportation so that people have cleaner air and cleaner water. All those upstream factors that we like to talk about in public health, at the city level you can actually start to pass some of those policies and make a difference.”
Mayor Nirenberg and Dr. Bridger recently talked to Joshua Sharstein for the American Health Podcast from the Bloomberg American Health Initiative, a project of the Johns Hopkins Bloomberg School of Public Health.
How can health officials and other advocates partner with federal, state, and local policymakers to advance public health? Senator Tim Kaine sat down with de Beaumont Senior Fellow Karen Remley to offer practical tips for state health officials and others for an “ASTHO Experts” segment.
Dr. Remley served as Virginia’s health commissioner from 2008 to 2012 under both Governor Kaine and Governor Bob McDonnell. Among her other leadership roles, she has been CEO of the American Academy of Pediatrics, a pediatric emergency physician, and the chief medical director of Anthem Blue Cross Blue Shield Virginia.
Because of term limits or retirements, 17 states had no incumbent nominee for governor in November 2018. In all, 20 states elected new governors, and 8 saw a change in political party as well. More than 150 million Americans are beginning 2019 with new leadership presiding over the factors that influence their health, including education, housing, taxes, and economic development.
In partnership with the de Beaumont Foundation, the National Academy for State Health Policy (NASHP) released a new toolkit, “Upstream Priorities for New Governors,” in December 2018 to help governors and their teams address upstream health issues. This resource provides practical, real-world tools and strategies for agency leaders and governors to assist their residents in living long, healthy, and productive lives. While the tools were produced for governors and their senior staff, they can also help state and local health professionals and other advocates promote their priority issues.
An overview of what influences health;
One-pagers on priority issues; and
Tips on framing these issues for stakeholders and opinion leaders.
Governors are uniquely positioned to leverage state resources to address the conditions that affect health. By coordinating resources, advancing evidence-based health policies, and leading multisector coalitions, governors can advance their priorities, control costs, and improve lives. With more than 80% of health determined by social and economic conditions, one way to improve health and lower health care costs is by improving education, transportation, housing, economic development, and other areas. Transition teams and new staff have been working hard to support governors in preparing initiatives in their states—and decisions made now will affect citizens for many years to come.
In addition, NASHP conducted an assessment of governors’ state-of-the-state and inaugural addresses revealing that governors are emphasizing upstream issues including:
by Cora Burgoyne, Unified Government Public Health Department, Kansas City, Kansas
Note from Lizzie Corcoran: I met Cora at APHA annual 2018, when her professor and mentor from her MPH program, Tanya Honderick, brought her to meet some de Beaumont staff and talk about the public health governmental workforce pipeline. I was so pleased and impressed at this example of mentorship in an MPH program between Cora and Tanya! After chatting about workforce shortages and inefficiencies, combined with the public health training, we quickly realized that Cora was the perfect example of what the public health stands to gain or lose. Cora is deeply trained, passionate, creative, and ready to take on new challenges. We asked her to write about her experience in a public health department going through accreditation.
What it’s like to be a millennial working in governmental public health? Let me tell you.
Before I entered the field of public health, I was in a health psychology undergraduate program. I was pretty set on becoming a clinical health psychologist and working with people one on one. However, toward the end of my undergraduate program, I started working more in group-based health. I started to understand how the larger systems at play were inhibiting people from living their most optimal lives.
Enter public health.
Fast forward to the first semester of my Master of Public Health program, when I was granted an opportunity to serve at the Unified Government Public Health Department (UGPHD) as an AmeriCorps*VISTA member. My project involved supporting the administrative side of the county’s first Community Health Assessment and Community Health Improvement Plan. However, after a few short months, my work quickly evolved to working on many projects that supported the UGPHD’s accreditation initiatives through the Public Health Accreditation Board, which oversees accreditation for all public health departments nationwide. This opened my eyes to the work of local governmental public health, a field that I never knew existed.
Governmental public health is a part of the public health system that did not get talked about enough in my education. In fact, in my 500-page textbook, it was just a section in one chapter. Looking back, I wonder, why aren’t we being taught about one of the largest public health systems in the country?
At UGPHD, as I became embedded in the work, I began to notice a sharp contrast in the way that I was approaching projects compared with some of my colleagues. It seemed as if folks had lost their sense of urgency, lost their fire. And here I was, all bright-eyed and bushy-tailed, ready to create large infrastructure changes to the entire way the health department operates, working with people who had been in the same job for 20 or 30 years. It took me a while to not feel frustrated about the slow rate of change when I walked out of meetings. Maybe it’s because some of my colleagues had been in the system for too long. Maybe it was because some were just waiting out retirement. Or maybe it’s because they had become so entrenched in the way things have been, this was the only way they knew how to operate.
While I am familiar with being the youngest person in the room, I was unfamiliar with being the youngest person in the room and making decisions and being the driver of change. There were weeks when I was learning about public health administration in the classroom, then turning around and using those concepts and theories at my job. Which is really amazing, a great way to get real-world experience during schooling. But at the same time, I was learning about best practices, then going to work and realizing, oh dang, this is the way it reallyis.
Never fear, I am not shying away from governmental public health. In fact, I am diving deeper. The communities that we serve deserve everyone’s best effort. I will not stand for stagnation in the workforce when there are so many bright individuals (including many millennials) who are so ready to engage and learn and make their little area of the world better. That’s why I support and enjoy working on accreditation initiatives, because it is practical, actionable wake-up call for how behind we have allowed our health departments to fall.
There are certain things that we can do to move public health departments into public health 3.0. In my opinion, the most important is supporting health department accreditation. While some health departments might not have capacity to pursue the entire accreditation process, the standards and measures set by the Public Health Accreditation Board truly reflect the role that public health needs to move to. Standards like how we communicate, how we interact with our governing bodies, choosing evidence-based practices over convenience, and how we view social determinants of health.
I finished my service year as an AmeriCorps VISTA member in February and was immediately hired to be an intern to continue my work until the end of the summer. This transition from AmeriCorps VISTA to paid intern has never happened at the health department. Being offered this position made me feel valued and supported, and it validated my desire to continue working in this field.
I won’t lie. It was, and still is, incredibly frustrating to be so passionate about creating these infrastructure changes while working with people who don’t share that same drive. But let me tell you, when you find a few people, classmates, colleagues, and mentors who share your same vision, anything is possible! One of the greatest things that has come out of my year working in the health department are the allies who have stepped up to the plate. Some of these people haven’t had any formal public health training but understand the importance of the work and cross-sector collaboration. When I check in with these folks, because 9/10, they will have thought of a solution that I never would have. You can’t change the system alone.
So what am I doing next?
I’ll be focusing on all my energy on finishing my MPH degree and graduating in the spring. Then I’ll hopefully continue working in governmental public health, because I love the work and everything that comes along with it. So as a millennial entering the workforce along with many other young public health professionals I say this: please don’t try to fix the world by yourself. Find your allies, invite others to the table, make a plan…then get to work.
Cora Burgoyne is a paid intern at the Unified Government Public Health Department in Kansas City, Kansas. She previously served at the department as an AmeriCorps VISTA member. She will earn her MPH in Social and Behavioral Health from the University of Kansas Medical Center in May 2019.
The BUILD Health Challenge is now accepting applications to support up to 17 innovative collaboratives that include a community-based organization, hospital or health system, and public health department working together in dynamic ways to address upstream challenges and drive sustainable improvements in community health. Inclusion of additional cross-sector partners such as health plans, businesses, foundations, and others that are aligned with the proposed efforts is encouraged. Learn more.
Each award includes:
Up to $250,000 in funding over two and a half years;
A robust array of coaching and support services;
Specialized trainings and capacity building opportunities;
Participation in a national network of peers engaged in similar work; and
The opportunity to spotlight your local work on a national level.
Applications are due April 5, 2019. Get information about this opportunity, eligibility requirements, and how to apply.
The de Beaumont Foundation is proud to be a founding partner for the BUILD Health Challenge. The third cohort is made possible with generous support from our funding partners Blue Cross and Blue Shield of North Carolina Foundation, the Communities Foundation of Texas, the Episcopal Health Foundation, the Kresge Foundation, Methodist Healthcare Ministries of South Texas, Inc., New Jersey Health Initiatives, the Robert Wood Johnson Foundation, and the W.K. Kellogg Foundation.