PHRASES: Plain Talk about Public Health

by Mark R. Miller

Governmental public health has a communications challenge – how can health officials build partnerships and communicate their value when the term “public health” itself isn’t clear or, even worse, is misunderstood?

PHRASES, which is a clever acronym for Public Health Reaching Across Sectors, is one of the de Beaumont Foundation projects I am most excited about. Because public health is intertwined with sectors like housing, education, and business, the de Beaumont Foundation and the Aspen Institute are funding research and creating tools to help state and local public health officials better explain their value to potential partners. To form partnerships and make their communities healthier, government public health officials need to be able to explain what public health is and what they do.

PHRASES is led by an advisory committee with prominent names in health and journalism. It is chaired by Karen DeSalvo, MD, MPH, MSc, who served as Assistant Secretary for Health and the national coordinator for health information technology during the Obama Administration and the health commissioner of the City of New Orleans, and Soledad O’Brien, CEO of Starfish Media Group, host of “Matter of Fact with Soledad O’Brien,” and former anchor and correspondent for CNN, MSNBC, NBC, and other media outlets.

O’Brien brings an outsider perspective as someone who is not in the public health field but has spent her career telling stories in clear and compelling ways. “I’ve seen that public health departments and officials do incredibly important work that touches people’s lives in ways they don’t even know,” she said. “But I’ve also seen that people in the field often struggle when trying to explain what public health is in a way that engages and inspires people. I’ve heard more conversations about what they do – the tactics – rather than why they do it and the value it adds to people’s daily lives.”

DeSalvo said, “Public health professionals can’t reach their goals alone, and to build partnerships they need to be able to communicate the value they bring. This initiative will help make the role of public health visible, useful, and relevant to decision-makers in housing, education, business, and other areas.”

To better equip the field, the de Beaumont Foundation and the Aspen Institute are working with the FrameWorks Institute, which conducts and publishes research that identifies the most effective ways to frame social and scientific topics. The goal is to learn what people outside the field think of public health, the value they see (or don’t), and their likelihood of partnering with public health professionals to improve their communities.

They started by interviewing leaders in public health and found that the way they describe public health can vary significantly, as you can see from the responses below.

What public health is:

  • The field that works to understand and improve the many social determinants of health.
  • A state or local government agency that defends the population against health threats and responds to community health needs.
  • A function overseen by the federal government, which plays a key role in disease outbreaks and prevention and funds state and local health agencies.
  • The health of the public, or population health.

What public health professionals do:

  • Prevent health problems by addressing the social determinants of health.
  • Create physical, mental, and social well-being by working to ensure living conditions that facilitate health outcomes.
  • Advocate for policies that protect and preserve health.
  • Use data to assess and manage risk, make decisions, and solve problems.
  • Promote health services through education campaigns.
  • Identify and respond to disease outbreaks and other emergencies.

These statements are all accurate, but they don’t inspire and communicate the true value of the field and the relevance to every citizen. One challenge is that public health does so many things. Now that the FrameWorks Institute has helped identify the challenges, they are working with the PHRASES team to the positioning and refine the language, so we can develop practical tools to engage and inspire others. Stay tuned.

 

Public Health Has a Plain Language Problem

by Mark R. Miller

A few weeks after I started working at the de Beaumont Foundation, I was talking to a friend about the organization and our focus on public health. That led to the obvious question, “What exactly is public health?” I did my best to answer him, giving several examples and explaining what it is not, and I told myself, “I need a better answer for that.”

It turns out, the entire public health field struggles with that same question – and that’s a problem. If you can’t explain what you do and why it matters, how can you possibly build support and make others care? This lack of understanding is one of the reasons public health is underfunded and underappreciated, even though public health affects every person in the world, every day.

Professors Aaron E. Carroll and Austin Frakt recently wrote an op-ed for the New York Times titled “It Saves Lives. It Can Save Money. So Why Aren’t We Spending More on Public Health?” Citing numerous examples, they write: “Americans spend relatively little money in [public health] and far more on medical care that returns less value for its costs. Instead of continually complaining about how much is being spent on health care with little to show for it, maybe we should direct more of that money to public health.”

But even in this insightful commentary, Carroll and Frakt fall short in defining public health, describing it this way:

Public health “encompasses efforts made to improve the health of a broad population with investments not ordinarily considered ‘health care.’ For example, ad campaigns that encourage better health behaviors – like exercising or quitting smoking. Or efforts to improve housing and nutrition for low-income populations or the quality of air or drinking water for everyone. An obvious success is vaccines. In the 1900s, polio and smallpox were eliminated in the United States. Other diseases – such as measles, rubella, diphtheria – became very, very rare.”

This illustrates the communications problem, because it’s not a clear or compelling description. As with many other attempts to define what public health is, Carroll and Frakt focus on what it is not (health care) and then list vaccines and many other examples (car safety, workplace safety, clean water, and more). Defining public health as “not health care” is similar to the problematic term “nonprofit” – which describes mission-based organizations as “not businesses” instead of explaining what they are and why.

As with nonprofits, part of the challenge is that public health does so many important things. As our CEO Brian Castrucci asks, “We have all the ingredients, but do we know what we’re baking?”

In my next post, I’ll share preliminary findings of new research funded by the de Beaumont Foundation to explore this communications challenge and uncover opportunities to better define and promote public health.

Mark Miller is the Vice President of Communications at the de Beaumont Foundation.

Unleashing the Power of the Public Health Workforce: Challenges & Opportunities

by Brian C. Castrucci

The public health workforce plays a vital role in improving the health of communities, but do they have the skills and support they need to succeed?

On July 10 at the annual meeting of the National Association of City and Council Health Officials (NACCHO), de Beaumont Foundation CEO Brian C. Castrucci previewed the findings of a new national survey of the public health workforce. The Public Health Workforce Interests and Needs Survey (PH WINS), first launched by the de Beaumont Foundation and the Association of State and Territorial Health Officials (ASTHO) in 2014, reveals concerning trends but also opportunities to build the workforce of the future.

“Public health workers influence all parts of the public health system,” Castrucci said. “They manipulate inputs, develop processes, deliver system outputs, and significantly impact the health of the communities that they serve. But we are not doing enough to ensure that we have a strong public health workforce.”

After administering the survey among all states and a pilot of local health departments in 2014, the de Beaumont Foundation and ASTHO created the first nationally representative sample of local health professionals in this latest survey.

The data will be released in the fall, but several themes have emerged from the data from local health departments:

  • A large percentage of the public health workforce plans to leave their job by 2023. While some of them expect to find another job in government public health, a large majority may leave the field entirely.
  • Two of the main reasons people plan to leave are compensation and a lack of opportunity to advance. Fewer than half the employees said creativity and innovation are rewarded.
  • A large majority of public health workers believe they should be involved in addressing health equity, but fewer think they should be involved in the areas that really drive health disparities, such as the economy, transportation, housing, and education.
  • Public health executives believe it’s important to influence policy, but few feel equipped to do so.

Castrucci said, “As the CEOs of our nation’s local health departments, you have the development of the workforce in your hands.” He encouraged local officials to consider conducting their own survey and comparing themselves with the national benchmark or to share and discuss the national findings with their staff and find ways to strengthen their teams.

We look forward to sharing the complete state and local findings in the fall.

Health Starts in the Community, Not the Clinic

by Brian C. Castrucci

We are fortunate to live in a nation where our healthcare system is filled with dedicated providers offering cutting-edge, innovative clinical care to prevent and control diseases. However, despite all the money we spend on health, the United States still lags behind other countries in terms of health outcomes such as life expectancy.

The reason this paradox exists may be found, in part, in an article summarizing a discussion recently held by the American Medical Association, “2 Ways to Spark Change in Minority Patients and Prevent Diabetes,” AMA Wire, June 18). The discussion focused on ways providers can encourage patients to take the steps needed to control their diabetes, but much of the advice is not practical for people who live in communications without access to conveniences that many of us take for granted.

As the head of the de Beaumont Foundation, which focuses on public health, and as a type 2 diabetic myself, I found the advice valuable but incomplete. In pursuit of the dream of “no new cases of preventable type 2 diabetes,” Dr. Niva Lubin-Johnson recommends that providers should “stress things the patient can control” like “diet, exercise, and getting enough rest.” She advises physicians to talk to patients about what they are willing to do, and she notes possible barriers to behavior change like time management. Because “it’s not easy for a single mother with school-aged children to go grocery shopping or find time to exercise,” she encourages providers to “spend the time to talk with them about how it can be done.”

While this advice is reasonable from a medical perspective, health professionals can’t ignore the indelible link between individual and community health. If we stop at simply identifying what the barriers are, and don’t intentionally look at why they are there, we miss a critical opportunity to address the root causes of chronic diseases like diabetes. A clinical approach alone to preventing diabetes — or any chronic disease — places the burden on the patient and his or her willingness to make necessary behavioral changes.

Yes, that single mother may have challenges finding time to exercise or go grocery shopping, but challenges with time management aren’t unique to any person or group in our culture. But maybe she doesn’t have access to places that offer affordable exercise options, or safe places to walk, bike, or run after dark, or grocery stores where she can buy fresh fruits and vegetables. Maybe her employer doesn’t have policies that allow her to take time during her workday to exercise, even though it might be in its best interest. (Each year, $90 million is lost in reduced productivity due to diabetes.) These community factors shape our individual choices, and no amount of talking can change them.

The truth is, health starts — and is sustained — in the community. If the places where you live, work, and play don’t allow you to achieve optimal health, there is very little that can be done in a doctor’s office that can change that. And that’s not a criticism of healthcare. It’s just a reality. A large percentage of Americans get a 30-minute wellness visit once a year, but what about the other 525,530 minutes?

To be honest, I am the type of person who would have benefited from the interventions Dr. Lubin-Johnson described. My community fully supported any choice that I wanted to make to improve my health. I have access to at least four large grocery chains that sell every fruit and vegetable there is. I can afford a gym membership and extended day care for my children. There’s a safe and well-lit park in my neighborhood with outdoor exercise equipment. In my case, it was my health choices — a poor diet and a general disregard for exercise — that led to my disease, but my behavior also led to control of my diabetes when I made better choices.

For people who have chronic conditions but don’t share my privilege, no amount of clinical intervention will make them healthy. Achieving and maintaining health requires the efforts of not only physicians, but also urban planners, housing experts, political leaders, educators, and many others. Only when we pair clinical intervention with smart policy and intentional planning will be able to envision a world free of preventable disease.

A Year at the de Beaumont Foundation: Q&A with Public Health Fellow Lizzie Corcoran

Lizzie Corcoran (left) with leaders of the de Beaumont Foundation, CityHealth, and Kaiser Permanente

This month marks the end of Lizzie Corcoran’s one-year fellowship with the de Beaumont Foundation, and she has played an important role in our work, including leadership in shaping new initiatives. The Association of Schools & Programs of Public Health, which sponsored her fellowship, interviewed her about her experience. This Q&A was first published on www.aspph.org.

ASPPH offers a variety of fellowship opportunities for recent graduates of ASPPH-member, CEPH-accredited graduate schools and programs of public health. The fellowships provide practice-based, mentored training that advance the skills and capacity of early-career public health professionals. ASPPH periodically highlights the work of our fellows and recently interviewed ASPPH Public Health Philanthropy Fellow, Elizabeth (Lizzie) Corcoran (Saint Louis University College for Public Health and Social Justice), who will complete her one-year fellowship this month. As her fellowship comes to an end, ASPPH asked Ms. Corcoran to reflect on her fellowship experience and how it has advanced her career in public health. Here is what she had to say.

ASPPH: What were your expectations as you started the ASPPH Public Health Philanthropy Fellowship Program?

Ms. Corcoran: When I came to the de Beaumont Foundation on the first day of my fellowship, I suspected I would work hard, write, learn, and explore the role of philanthropy in public health. I had no idea I would develop numerous and diverse mentors from across the field of public health, discover a sincere passion for the public health workforce, speak out on the workforce from the new graduate perspective, manage a textbook, or stick around to help develop the policies, partnerships, and tools that the de Beaumont Foundation invests in. This time of year, it’s enlightening for me to look back and reflect on the learning moments from my time as a fellow and point to the lessons and progress.

ASPPH: What does the de Beaumont Foundation do? What did you focus on during your fellowship?

Ms. Corcoran: The de Beaumont Foundation is dedicated to transforming the practice of public health through tools, policy, and partnerships. Surprised at how little my formal training prepared me to understand public health agencies, I positioned myself to learn from and about health departments. I shadowed the Baltimore City Health Department and witnessed the day to day work of health departments, including observing a needle exchange van, going on restaurant inspections, and listening to a local policy conversations. The Big Cities Health Coalition, where health commissioners from the 30 largest cities gathered to share, challenge, and work together, was one of my favorite groups to learn from. Through soaking up their experiences and perspectives, I gained enormous insight on what it takes to lead a health department that serves hundreds of thousands of people and lead on complex issues like violence and racial inequality. I had the opportunity to interview Dr. Colleen Bridger, the health commissioner from San Antonio, who helped me imagine more possibilities for the path and skills of a health commissioner without medical training.

ASPPH: What did you learn or take away from these experiences?

Ms. Corcoran: These experiences, and many more, grew my passion for not just the field of public health, but the people who comprise its workforce. I still have a lot to learn about practicing in health agencies and maybe someday I will join one. However, there are a few concrete lessons I know I will bring with me wherever I go.

Health departments must learn to engage in cross sector partnerships and collaborations. Through my work managing the Practical Playbook textbook and learning directly from health department leaders, it is clear that improving the social determinants of health can no longer be the sole responsibility of health agencies. Health departments must share the burden of creating healthy social and physical environments with other sectors beyond their walls.

Health departments must learn to affect policy. Local, health-promoting policies, such as the ones promoted by CityHealth, are upstream, sustainable tools to improve complex health issues. Policies that enforce and legislate healthy housing, healthy food procurement, safe and accessible transportation, and clean indoor and outdoor air, are the new work of health departments in the 21st century. Programs and services are necessary, but not sufficient without the policies that can make an entire population safer, healthier, and more productive.

Health departments must learn to communicate. Public health is valuable because we are the invisible workers that make communities livable, safe, clean, and productive. Communicating that value to lay people, potential workers, students, and elected officials is crucial, not just for funding. The conversation around health is shifting from the individual experience to a communal good. Health systems, business, and other nontraditional allies are joining the fight for healthy communities. Public health must contribute meaningfully to this conversation, locally and nationally, in order to find partners and progress towards healthy people.

At the de Beaumont Foundation, we envision a workforce that uses policy as a lever, communicates effectively, builds multi-sector collaborations, and improves the social determinants of health. I am thrilled to join a philanthropy that is taking risks and advancing the daily practice of turning this vision into reality.

ASPPH: What really stands out to you as you reflect back on your fellowship year?

Ms. Corcoran: I started writing this year by leaning on my fresh MPH degree and new graduate perspective. This perspective quickly developed into the soap box of a young public health professional, brand new to the workforce. There is a widening disconnect between Millennials and health agencies, culminating in a workforce that has great difficulty recruiting, retaining, and training young new workers to continue the essential work of health agencies. When I think about the call to action of Public Health 3.0 and the Chief Health Strategist, I see where the skills of young people, such as passionate advocacy, systems change, and innovation and creative technology solutions, advancing these visions. The authentic engagement and passage of generational public health knowledge to the youngest generation of workers can bolster the workforce and advance the practice of public health. To be able to write and speak from the young perspective and garner genuine interest was the best part of the fellowship experience, one I am extremely grateful for!

ASPPH: What was the effect of the Fellowship on your public health career in a nutshell?

Ms. Corcoran: When I think about the effect the ASPPH Public Health Philanthropy Fellowship has had on my career, I think of the incredible public health leaders I have met this year, the innovative public health institutions I have learned from, and the wonderful support I was granted to try new things, manage a project, write, and chase ideas. Giving young professionals opportunities like the ones I have had this year can integrate and energize a new generation of public health workers to join and – more importantly – change the field of public health for the better.