Public Health Infrastructure—Centering Equity in a Modern Public Health System

New Jersey should be a place where public health systems at every level of government are equipped to address existing and emerging health threats.

These include changing climate conditions, extreme weather events, global pandemics, and other health threats to New Jersey residents. New Jersey entered the 2020 COVID-19 pandemic with drastically underfunded public health infrastructure, resulting in a disjointed system with gaps in service.

Public health agencies are increasingly on the front lines of addressing existing and emerging health threats that stretch and challenge the longstanding structure of local delivery of public health services. Despite public health workers’ dedication and hard work, people of color remain disproportionately harmed, because they are most likely to experience conditions that do not support health and wellbeing. With deliberate coordination, investment, and the persistent pursuit of equity in all actions, we can transform New Jersey’s public health system into a robust and modern one that can help all people thrive.

A Policy Agenda for a Healthier, More Equitable New Jersey recommends the state develop a public health infrastructure that centers equity in a modern system.

Policy Recommendations

1. Provide adequate, flexible funding and maximize existing assets to support public health services and capabilities

• New Jersey should reinstate dedicated state funding so its public health system can respond to existing and future needs. New Jersey public health officials report that inadequacy of unrestricted funding is the biggest challenge to delivering a 21st-century public health infrastructure.
• To be most effective, funding should be adequate, sustainable, and flexible so health professionals can invest it in areas with the greatest health challenges and disparities.

 2. Establish a state public health institute to facilitate collaboration within and across sectors to improve health equity

• A state public health institute—an organization like those advancing public health practice and capacity in 33 states—could help enable a more stable and robust New Jersey public health infrastructure.
• The institute could help promote coordination across sectors to complement the work of state, local, and regional public health departments in being more responsive to health and social needs. It would be the first in the nation to include achieving health equity as a founding principle.
• To operationalize that principle, the institute should prioritize addressing root causes that perpetuate disparities and support community engagement and empowerment in advancing equity and quality of life. 

3. Invest in transforming public health data systems to center equity and include practical, flexible data-sharing processes

• New Jersey can begin ensuring state policies for public health data collection, sharing, and analysis enable exploration of the influence and consequences of structural racism on health and wellbeing. For example, the state could examine community-relevant metrics on structural factors that influence health outcomes, particularly “upstream” causes of inequity, by measuring the extent to which systems segregate, discriminate, and exclude.
• Efforts to collect self-reported race, ethnicity, income, education, gender identity, sexual orientation, and disability are needed, as New Jersey does not consistently or uniformly collect data critical to understanding a person’s health, wellbeing, and lived experience. This limitation constrains the ability to understand the scope and reach of inequity and develop data-driven solutions.
• State public health officials can lead multisector collaboration around public health data sharing to improve timeliness and quality of data to strengthen local decision making. This can include partnering with local health departments and others that provide public health data. 

We must hold ourselves accountable to eliminating public health barriers that undermine the work of public health professionals and bolstering the state’s public health infrastructure and preparedness. Together, we can achieve a reality in which everyone can experience the best health and wellbeing possible.