‘Culture of Health Hangout’: The Continuing Evolution of Public Health Departments
Earlier this week, the Robert Wood Johnson Foundation held its first ever “Culture of Health Hangout,” a new series meant to explore what communities across the country are doing to advance and transform public health. This first foray looked at how public health departments have evolved in recent years, and are continuing to evolve to meet the changing needs of the communities they serve. The panel was moderated by Paul Kuehnert, RWJF senior program officer and Public Health team director.
According to Muntu Davis, Public Health Director and County Health Officer of Alameda County, the core role of public health hasn’t really changed—public health departments and officials continue to gather and analyze data to explain what’s happening to the health of a community. However, what has changed is where they put their focus. Now, in health departments across the country, the focus is not simply on individual decisions, but on social and economic factors that dictate which options are truly available.
“Although it does boil down to an individual choice, if there’s no opportunity there for communities, then ‘health’ is definitely not an easy choice to make,” said Davis.
One of the more innovative approaches his health department has undertaken is utilizing maternal and child health workers to provide, in addition to their traditional work, financial coaching to people who may be of lower incomes. “Studies have shown link between income, wealth and life expectancy,” said Davis, and that’s what makes it important for public health to help support not just the immediate health need but also “the full picture of what might be shaping their health.” These workers are able to provide education and assistance, while also linking them to financial coaching and tools that can help them manage the money they have.
Karen DeSalvo, City of New Orleans Health Commissioner, spoke extensively on the importance of community partnerships when it comes to advancing community health. She said Hurricane Katrina was, in a way, a “catalyst for change” that enabled the entire community to hit the reset button, assess where they were and determine how best to move forward together. One of the first realizations was that the city simply did not have a strong enough local health department.
“It allowed us to begin planning, and to decide to move away from an expensive, hospital-based system to one that was more about prevention and primary care,” she said. “And over the course of years, once we stabilized that infrastructure at the frontline of primary care and moved more toward prevention, the glaring need to have a strong public health department became obvious.”
One example of the pairing of partnerships and prevention can be found in New Orleans’ Text4Health initiative. Working with the Louisiana Public Health Institute, the program helps notify people of and connect them with community services addressing obesity and weight loss; diabetes; and cardiovascular health. The program dovetails nicely with the city’s Fit NOLA initiative, which has brought together partners from throughout the community to work toward a shared goal of making New Orleans one of the top-ten fittest U.S. cities by 2018, the city’s 300th anniversary. New Orleans is also a winner of the inaugural RWJF Roadmaps to Health Prize, which honors outstanding community partnerships helping people live healthier lives.
Jewel Mullen, Connecticut Department of Public Health Commissioner, touched on the importance—as well as the difficulty—of deciding exactly how to spend smaller and smaller budgets.
“That notion, to me at least, of doing ‘more with less,’ is after awhile no longer realistic,” she said. “What I would start to say to my staff is that we really need to talk about how we can do ‘differently’ with less, and not just ‘more’ with less.”
Her department focused on finding new opportunities in the creation of strategic and collaborative partnerships, as well as pushing for positive outcomes through policy changes, not just programmatic efforts. By working across not just governments, but also the private sector and with organizations, they’ve been able to build up and strengthen their capacity to help ensure that they continue helping their communities.
Mullen also spoke on specific community efforts that have positively impacted individual health choices, including their baby-friendly hospitals initiative. This effort, which is four to five years old, gives mothers a breastfeeding-only option—the newborns are never given formula. They’ve found this increases the number of mothers who are breastfeeding exclusively not only immediately post-birth, but also when they were home with their newborns.
Other community tactics, according to Mullen, include needle exchange to help prevent HIV (“which is a little bit different than just telling people not to do drugs”) and policies to encourage both students and teachers to start their days off together with physical activity through safe routes to school initiatives.
Michael Meit, Co-Director of the NORC Walsh Center for Rural Health Analysis, noted how rural communities by their very nature can face quite different public health challenges than you would expect to find in urban or suburban communities. They tend to have greater economic challenges, older populations, lower levels of education—all of which “tend to translate into health disparities.”
“Where you live does matter,” he said.
Like DeSalvo, he pointed toward true community engagement as one of the most effective ways of improving community health.
“I think the public health departments that function well are very savvy at engaging communities, at bringing in the volunteers and at finding the people in the communities who can be voices for public health,” he said.
In working with the community, what is the collective mission of public health and partners? Mullen said it starts with realizing that the equal attainment of health for everyone is a “human right”—and from that foundation, moving together toward our shared goals.