A Model Practice must be responsive to a particular local public health problem or concern. An innovative practice must be -
Please state the Responsiveness and Innovation of your practice
Local health departments focused on advancing health equity must devise strategies to transition their staff from the more traditional public health education and promotion activities of the past several decades to daily work focused on advancing health equity. This work may consist of policy development, data collection and analysis, strategic community engagement, and an explicit focus on addressing root causes of health instead of health outcome-based programming. LHDs are challenged to address stubborn chronic disease outcomes which have not significantly improved in the past several decades and other barriers to health and wellness which prevent opportunities for optimum community health. These challenges are shaped by increasingly stressful budgetary constraints which dictate practice opportunities. The model put forth in Public Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure encourages local health departments to take on the role of Chief Health Strategist, address the root causes of health, and use collaboration and strategic partnerships to advance health equity.
A 7-month Root Cause Team and Skillset Lab workplan, which in practice took the majority of 2018 to complete, was created by the historical (pre-realignment) CHE staff; these staff used their knowledge of public health and health equity research to establish the workplan framework to include key terminology, research, skill and strategy development opportunities, and practice opportunities for department staff. The shift from programs focused on health outcomes to root causes of health requires committed effort and training. An entire month was spent laying the foundation of the health equity framework. Additionally, given that many ongoing grants were health outcomes focused, discussions were had with grantors to improve flexibility of employee time.
This organizational shift offered new opportunities for strategic partnerships and community engagement, and also allowed LMPHW to reexamine professional development opportunities and leadership expectations.? Trainings were offered to build staff knowledge and capacity and lay the foundation for new work moving forward. Training offerings were created by CHE staff—including through the newly formed Skillset Labs—and department partners on numerous topics. Skillset Lab goals included enriching knowledge and expertise of the skillset through professional development plans and improving the ability to effectively communicate expertise and share skills with non-experts. Skillset Lab staff members were key drivers of these topics as they worked with their colleagues to determine training needs. These trainings covered a wide range of topics, including: developing talking points and delivering an elevator speech, conducting a literature review, intersectionality, causal diagrams, basic GIS, ArcGIS Online, creating surveys, policy development, and community engagement strategies.
The target population for the development and delivery of this workplan was the newly realigned staff of the Center for Health Equity at the Louisville Metro Department of Public Health & Wellness. Prior to this realignment, CHE was comprised of three frontline staff and the Center’s director; after the alignment there were 40 staff members within CHE. In addition to CHE staff, there were a handful of LMPHW staff from the Health Operations section of the department who participated in the RCTs and the completion of the workplan. Each CHE staff was required to participate in the workplan as part of their work responsibilities. Positions and projects were shifted to align with root cause teams that could focus on the deep drivers of health, such as housing, food systems, environmental quality, and early childhood development. These root cause teams were based on the Center for Health Equity’s 2017 Health Equity Report available at www.healthequityreport.com. ?
Restructuring a department can be challenging and complex, but with appropriate planning and capacity building for staff, the realignment can maximize resources and improve a department’s ability to address health equity. While educational trainings exist to teach about health equity concepts, there exists a gap in transition plans to move existing public health staff from traditional health education and promotion strategies to a Public Health 3.0 model directly focused on the root causes of health and using health equity strategies to improve community health. This new structure—facilitated by a 7-month long workplan—increased collaboration and reduced?siloing?across the department as new expectations around communication were instituted. In order for LHDs to make the transition to Public Health 3.0, new organizational practices will need to be implemented and workforce development strategies used to build staff and departmental capacity to advance health equity.