Choosing a Health Equity Focus

Back in 2019, I was still in the DC area at the Public Health Accreditation Board (PHAB) as their CEO. PHAB accredits governmental public health departments and— when I was there — we used a think tank approach to update our standards for accreditation, meaning we would gather 20-25 experts from a particular field that aligned with our domains for accreditation — including workforce development — to talk about what changed in the field since we developed our last version of the standards.

As a leader in public health workforce development, the de Beaumont Foundation was part of that think tank. And that’s when a de Beaumont Foundation staff member suggested that there should be synergy between the National Consortium for Public Health Workforce Development and the standards established by the Accreditation Board and that I should join the National Consortium’s Founders Committee. (I was just delighted to be included.) At the same time, the Public Health National Center for Innovation (PNHCI), a division of PHAB, was leading an effort to update and refresh the 10 Essential Public Health Services.

Why is all that important? It’s important because these two separate and distinct expert panels both recommended — nearly simultaneously — that health equity be at the center of this work. In fact, there was consensus about centering equity among public health leaders in almost every circle in which I was involved. Public health has always talked about the social determinants of health and health inequities, but this was different. There was the recognition that there’s a real difference between issuing statements that we support health equity and taking meaningful action. 

Let me give you an example. One of the Public Health Accreditation Board’s standards for health department accreditation was that the health department have a recruitment plan that includes the goal of having a workforce that looks like the population it serves. But when you get to the stage of implementation, you need to ask: Do we have enough people who are interested in public health or educated to do public health who look like the population? And if we don’t, how can we work with our academic institutions to build the pipeline? In other words, health departments can’t simply post that they’re an equal opportunity employer; they need to be intentional and work with academic institutions to do meaningful recruitment.

One of the key roles of the National Consortium will be to rebuild the confidence of the public health workforce, because they are not only tired; they’ve been battered. I went to work for a local public health department in Mississippi in 1977. I’ve clearly been around state and local and federal public health for a long time. There have always been peaks of politicization of public health, but I must tell you I have never seen — in the 40 years I’ve been in public health — community members and elected leaders going after local public health officials who are just doing their job. NACCHO recently shared with me that — between April 20, 2020 and September 12, 2021 — 303 public health officials in this country have retired, quit out of desperation, or were fired for doing their job. On top of that, our public health workforce, like the workforce in general, is aging. And, while I don’t think anyone has quantified the impact, we can’t forget that some of our workforce has died due to COVID. 

It’s a problem that is only amplified in rural areas, which already faced difficulties with finding qualified people who are willing to relocate or stay to live there. In my state, this has been an issue in the Delta for years: it’s a hard part of the state to live in because it’s socially and economically deprived. Yet most of the health departments in this country are small health departments. And the majority of those small health departments are also rural. And because a lot of those small rural areas tend to also be conservative politically, it’s been tough to do public health at all. I’m concerned that the difficulty of recruiting well-qualified public health workers in those rural areas will, for a while, be exaggerated by public health workers’ justifiable reluctance to step into a very anti-government, anti-public health, political environment.

In the Common Agenda, our intention is to make it clear that this is complex and that it will require a unified effort to succeed. The National Consortium for Public Health Workforce Development is not duplicating what others are already doing. We are supporting and enhancing the work that is underway; we are serving as a hub for those who share our vision. 

The Founders Committee didn’t have to go far to reach consensus. We recognized that a window of opportunity is open for the National Consortium to take a leadership role by saying — as the Common Agenda does — that there is a clear relationship between equity and the goals of public health and that avoiding institutional racism and organizational biases requires real introspection and skills. And that there are skills that the workforce not only needs to have, but to be comfortable in implementing. It goes well beyond cultural competency. 

The National Consortium for Public Health Workforce Development is coming together at probably the most opportune time in the work of public health because the workforce must be reinvigorated, reconstructed, and reaffirmed for the infrastructure of public health to survive.