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October 5, 2023
Milbank State Leadership Network State Health Policy Leadership
Mary Louise Gilburg
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Morgan McDonald, MD, Milbank Memorial FundMichael Sparer, JD, PhD, Columbia University Mailman School of Public HealthLawrence Brown, PhD, Columbia University Mailman School of Public Health
This virtual convening on politics and the public health workforce with Drs. Michael Sparer and Lawrence Brown of the Columbia University Mailman School of Public Health included invited state and local health policy leaders from Indiana, Kentucky, Mississippi, New York, and Washington. The researchers discussedtheir Commonwealth Fund-supported study, Politics and the Public Health Workforce: Lessons Suggested from a Five-State Study, on building bipartisan support for public health. This was based in part on visits to these five states to examine the distribution of American Rescue Act public health workforce funds, as well as state-based initiatives.
Dr. Sparer gave an overview of The Milbank Quarterly research, highlighting key obstacles to rebuilding the public health workforce. Obstacles included the siloed and time-limited nature of federal funding, complicated civil service hiring rules, competition for workers in other segments of the health care system and required approvals from elected officials prior to spending the funds. In addition to obstacles, he presented the study’s key policy points:
Dr. Brown facilitated a discussion about how to make public health infrastructure politically appealing. Participants from Indiana shared how listening campaigns around the state helped them to build relationships and identify common ground on bipartisan issues like opioids, mental health, and children’s health. Indiana officials noted that allowing counties to opt into funding created ownership and buy-in for public health. Participants from Kentucky and New York echoed the importance of appealing to both local leaders and state legislators to focus issues on the community-level and avoid partisan lines. A representative from Oregon commented on the value of maintaining relationships with local and national businesses that were cultivated during the pandemic to keep the business community involved in community health and safety and their importance to economic development. State leaders from Washington discussed the need to raise the value proposition of public health by showing the return on investment, so that citizens and elected officials recognize the important role of public health in everyday life.
Dr. Sparer led a discussion about policies and practices that can facilitate bipartisan legislative decision making. A representative from Washington discussed the importance of finding bipartisan champions of public health and using messaging that is universally understood and that creates an expectation of public health similar to expectations of public safety. Stakeholders from New York and Indiana agreed and highlighted the importance of using data to connect public health with economic stability and success. Stakeholders also discussed the importance of clear and cohesive public health messaging across regions and across the country, emphasizing that citizens in every state deserve access to basic public health.
Dr. McDonald led a discussion of the resources and support needed for public health investment at the state and local levels. States and localities often have different public health structures, and state leaders explored how to navigate these structures to ensure adequate financing. Participants agreed that engaging local decision makers—including officials at the state, tribe, county, and city levels—was key to success. Participants also observed that engaging both public and private interests, and the medical community, creates momentum for public health investment.
Participants explored the effects of centralized public health systems on garnering local support. In a centralized public health system, the state health department directly operates all local health departments, while decentralized systems have autonomous local health departments. According to participants from Mississippi, the centralized system does not incentivize local officials to engage in public health decision-making, leading to disinvestment at the local level. This places strain on the state, where officials and participants must engage local voices, such as elected leaders and business owners, to reach consensus on public health investment. However, their centralized system has created an opportunity for Mississippi to create regional infrastructure and operational efficiencies.
Participants agreed that public health associations can play a key role in garnering bipartisan and local support for public health; however, not all states have public health associations. Public health associations work alongside state and local government to advocate for public health investment by conducting research, hiring lobbyists, and engaging with legislators and officials. Public health associations can provide valuable direction in public health policy, identifying best practices and supplying technical assistance at the state and local level. Public health associations not only play a role in defining public health strategy, but also advocate across different sectors, participants said. Public health associations bring together multiple stakeholders, including local health departments, tribal health departments, state legislators, medical associations, and business interests.
Key takeaways from the discussion included the following:
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