Top 10 Ways to Build Bipartisan Support for Public Health Infrastructure 

While much has been written regarding what needs to be done to strengthen public health for future preparedness and public safety, little attention has been paid to how to get it done in increasingly politically charged environments.  

We at Milbank recently convened 30 state and local elected and public health officials to learn from their experience in making the case for strengthening state and local public health infrastructure, and discuss Politics and the Public Health Workforce: Lessons Suggested from a Five-State Study, a Commonwealth Fund-supported study published in The Milbank Quarterly. While not minimizing the role of federal funding and infrastructure, this convening focused on authority and funding under state or local control.

Based on the input of these leaders, we propose a “Top 10 List” of ways to build bipartisan support for state and local public health. Many of these takeaways can be applied to other population health priorities as well. 

1. Build local communication pathways for direct listening and follow-up. Trusting relationships are built between state and local officials and communities when bidirectional communication is prioritized and structured. Such communication facilitates realistic expectations and follow through. Some states have accomplished this by creating a public forum and/or a formal commission. Others rely on regularly scheduled regional calls. In-person visits to local communities in the context of strategic planning are a core public health engagement strategy, and making those visits regular occurrences builds trust and relationships. 

2. Encourage local officials to participate in public health. Local officials know what local needs are and can hold state elected officials accountable to meeting those needs. While state legislators want to help the communities they represent, if local officials and communities aren’t prepared to ask for public health support, they are unlikely to get it. 

3. Ensure everyone wins. As with any negotiation, understanding the motivations of the party across the table and configuring a win for them is the best way to get a proposal across the finish line. If one entity proposes priorities in the order of 1, 2, 3, and the other entity proposes 5, 3, 2, just getting 2 and 3 done might be win for both. And when the winning is done, spread credit widely for victories. 

4. Look for allies who are bipartisan in nature. Those who immediately look for ways to sensitize and polarize potential solutions are not going to be the best planning partners. Businesses that recognize how public health and government infrastructure can improve the health of their employees, however, are essential partners. Likewise, local public safety, health care, and education colleagues, who work daily with public health departments, are often effective spokespeople. Several state officials in the convening suggested building local support among potential allies by using local data on health outcomes, as well as highlighting the benefits of improving the public health infrastructure on jobs, incomes, and more. Having a conservative champion who sees the importance of public health — and can convince others one-by-one — has contributed to the success of those states that built solid public health infrastructure coming out of the pandemic.  

5. Find a playing field. Find issues with bipartisan common ground. Core public health functions, such as data collection, community education and engagement, and strategic planning, are critical to common community health priorities like substance abuse prevention, mental health, maternal and child health, or rural health. Similarly, local public health servants are integral to local communities and provide valued services including immunizations, school health education, and the supplemental nutrition program WIC (Women, Infants, and Children). 

6. Distribute public health funding locally and allow people to do the work their way. Communication is not the end of the road. Local public health needs to be funded in ways that local officials can control. Avoiding state mandates can be difficult when statewide strategies need to show statewide results in a consistent way to maintain either state funding or federal grants. But engaging local public health in developing plans, and giving them implementation freedom the degree possible, can generate local demand and capacity.  

7. De-weaponize language. Say things in a way that people can hear them. The essence of what public health does — save lives, make sure everyone has access to resources, and collaborate across sectors to improve the health of communities — is not controversial. How public health is done and the language practitioners use can be. Public health advocates should describe what is being done and not be wed to jargon or politicized language. Public health is public safety, and non-government and non-public health partners are often the best messengers. 

8. Share investments in public health across state and local governments. Local–state partnerships enable ownership of, and connectivity throughout, public health. A well-resourced state public health infrastructure is needed for coordination, dissemination of best practice, and technical assistance to counties, and to assure state and federal funding is distributed where it’s needed most. Likewise, local governments need to give local public health departments ownership of planning and funding to the degree possible. States structure public health services in different ways to achieve this balance. Some states have departments report only to local government (de-centralized system), some have all public health employees report to the state public health entity (centralized system), and others have a hybrid model. With each type of structure, it’s important that local and state officials are invested and accountable. Using comparative data on salaries and funding can be an effective tool in generating the case for additional investment locally and at the state level.  

9. Partner with associations representing county officials and public health. These associations bring the voice of the local health official into the political process, and elected officials listen to them. Moreover, those associations that have been able to hire lobbyists to carry a non-partisan message have been highly successful in managing fast communications during legislative sessions and in building bridges between public health and elected officials around common goals. 

10. Follow through on promises to develop influence. Commitments made by legislators and state executive branch entities to local entities need to be realistic and meaningful. Following through on agreements and continuing to communicate are key to building trust, influence, and ongoing commitment to the cause.