The LHD should have a role in the practice’s development and/or implementation. Additionally, the practice should demonstrate broadbased involvement and participation of community partners (e.g., government, local residents, business, healthcare, and academia). If the practice is internal to the LHD, it should demonstrate cooperation and participation within the agency (i.e., other LHD staff) and other outside entities, if relevant. An effective implementation strategy includes outlined, actionable steps that are taken to complete the goals and objectives and put the practice into action within the community.
Enter the LHD and Community Collaboration related to your practice
Goals:
MCPHD partnered with the MCPHAB to house the public health ethics committee within the advisory board structure. The goal was to have broad community representation and input on all public health ethics deliberations, regardless of the topic.
The committee works through established public health ethics frameworks and has included an equity lens specific process in all deliberations. The second goal has been to expand on the questions of justice and distribution of burdens and benefits and examine each public health issue explicitly from an equity perspective.
Implementation:
MCPHAB agreed to include the function of public health ethics committee in December 2017. Charter, bylaws and training based on NACCHO materials followed.
Recruitment for MCPHAB emphasizes representation from all parts of our county and actively seeks members from racial and ethnic communities, seniors, youth, faith leaders, and business leaders.
Our current membership includes individuals with experience in hospital systems, the homeless/houseless populations, philanthropy, corrections, transportation and elder advocacy. Other members represent the Asian/Pacific Islander community, disability, faith and Latinx communities, unaccompanied minors, and a recent MPH graduate with local ties.
Members of MCPHAB self-select for participation on the ethics committee. With 13 members total, a quorum consists of a minimum of eight members. They select a chair and vice-chair who serve on the executive committee, helping MCPHD staff to vet and shape questions for deliberation and identify additional stakeholders. They provide input on the type of content background needed for each question so that all may participate in the deliberation. With MCPHD staff support the committee has set up a structured process for identifying, refining, and presenting questions (including background and in-person deliberation). The chair facilitates each meeting with staff support, drawing on existing public health ethics framework(s) and including the equity lens “5P” process in each deliberation.
Committee members and public health staff have co-created an evaluation plan described elsewhere.
Criteria:
Through an iterative process we have learned so far that the best questions to bring to our public health ethics committee are:
Open-ended (as opposed to yes/no)
Elevated through public health program staff to public health leadership
Approved by health department leadership as needing community input
Approved by the executive committee: chair, and vice-chair (both advisory board members) and MCPHD staff
Questions that represent a genuine opportunity for input
Timeframe and other stakeholders:
The first attempts at convening a public health ethics committee were in 2016. The version described here started in December 2017 with the most recent meeting in August 2019.
The committee identifies and invites additional community stakeholders. Examples of stakeholders invited to specific deliberations include a representative of Latino Network (a local Latino-led education non-profit), members of the Future Generations Collaborative (a local Native-led effort to address alcohol-affected pregnancies), and colleagues from the Multnomah County Mental Health & Addictions Division.
Planning and implementation:
MCPHD leadership and the public health advisory board chartered the group together along with the evaluation process. The chair and vice-chair routinely vet questions for deliberation with MCPHD staff. Committee members and MCPHD staff co-created the evaluation and improvement plan detailed elsewhere.
Collaboration with community stakeholders:
The desire for authentic community input into local public health practice led to a public health ethics committee that is primarily made up of community members, with public health staff, subject matter experts, and other stakeholders as needed. This approach differs from current NACCHO guidance suggesting primarily public health and program level participants with some community stakeholders. In the MCPHD model every question gets examined by a broad cross-section of community members, including those of color. This approach means program staff and subject matter experts must describe the issue in terms that non-experts can understand, one of the first steps of genuine community engagement.
The MCPHD supports community engagement by providing ethics training to new members and offering food and meeting incentives in the form of small gift cards to anyone who is on the advisory board so that they can attend meetings. Acknowledging the gift of time from our stakeholders has helped support attendance and engagement.
Finally, we apply principles of popular education and adult learning methods:
Meetings open with a dynamic activity in which members intentionally connect with others to build an atmosphere of trust so members can share their ideas and experiences.
“Think, pair and share” allows members time for reflection, connection and dialogue with another member. Pairs then report out any highlights that came up during their discussion.
Reflection activities in which members record their thoughts onto post-it notes in response to prompts. A “gallery walk” allows everyone to see others’ responses and note any similarities or differences.
Incorporating popular education principles into our deliberations breaks down the dominant culture norm of having large group discussions that may only allow for more assertive voices. Each activity also allows members to connect in different ways which has often prompted further thought and dialogue.
Funding considerations:
The MCPHAB public health ethics committee estimated budget is approximately $4,000 per quarter ($16,000 annually).
The majority of the cost is staff time including the Health Officer, Public Health Division Deputy Director, a Public Health Project Manager and an Executive Specialist.
Staff prepare and refine questions and materials with the executive committee, support meeting logistics, scheduling, communication, deliberations, trainings, membership, and incentives.
Staff time total = 63 hours quarterly = $3,550
Public health project manager = 15 hours quarterly (includes meetings, logistics, communications, preparing other materials)
Health Officer = 6 hours quarterly (question identification and refinement; meeting facilitation)
Public health deputy director = 30 hours quarterly (question identification, refinement, meetings with the executive committee)
Executive specialist = 12 hours quarterly (meeting and logistics support)
Incentives quarterly = $300
Food quarterly = $150
Quarterly Total = approximately $4,000
Yearly Total = approximately $16,000