How Can We Prioritize Equity in Public Health?
RWJF leads the design and development of an independent public health institute in New Jersey.
We are proud to live in one of the most racially and ethnically diverse states in the nation. Our home state of New Jersey is also a national leader in areas such as expanding health care coverage, enacting paid family leave, and maintaining low smoking rates.
Unfortunately, however, these bright spots are offset by glaring disparities with roots in our nation's long history of racism that persists to this day. For example, a Black woman in New Jersey is seven times more likely to die from pregnancy-related causes than a White woman and Black babies are more than three times more likely than White babies to die before their first birthday.
The COVID-19 pandemic exposed and worsened these inequities, especially along racial/ethnic lines.
In addition to the role played by social determinants of health, a major contributor to these disparities is a state public health system strained for decades by lack of funding and insufficient coordination across health and related sectors. Experts agree the system lacks the capacity to simultaneously achieve its core missions while equitably responding to and managing public health emergencies such as the COVID-19 pandemic.
New Jersey ranks 31st in the United States in state funding for public health, according to the Trust for America’s Health. And a report from Rutgers University found that New Jersey has the lowest median per capita state appropriation for public health among states the study examined. New Jersey’s public health workforce, on a per capita basis, is among the smallest among states in the comparison—only half that of regional neighbors Connecticut, Maryland, and Massachusetts, the Rutgers report stated.
Another part of the problem is New Jersey’s unusual governance structure. The Garden State has a heavily fragmented system for delivering services, hampered by its “home rule” fondness for local control. The result is a state divided into 565 municipalities and over 600 school districts. “Seizing the Moment,” a report supported by the Robert Wood Johnson Foundation (RWJF), the Nicholson Foundation (Nicholson), and National Network of Public Health Institutes (NNPHI), notes that this arrangement impedes cross-sector, cross-regional collaboration that—in other states—helps attract funding, develop expertise, and build capacity to more effectively deal with public health problems. A public health institute in New Jersey could offer the health coordination our state sorely lacks and complement the work of the state, local, and regional public health departments.
Charting a Path Forward
Public health institutes are nonprofit organizations that support efforts toward a more stable, robust, public health infrastructure to address health and social needs in the context of community amid intolerable barriers to good health along racial, ethnic, and other divides. There are 45 public health institutes in more than 30 states.
In Virginia, the Institute for Public Health Innovation in 2020 assisted in rapidly building up human capacity to respond to COVID-19. In under a month, the Institute recruited, hired, and trained 80 new staff. By the end of January 2021, it had added over 640 people, including case interviewers, contact tracers, community health workers, epidemiologists, environmental health specialists, call center staff, wellness specialists, and response team managers. As the pandemic response shifted to vaccine access, some team members began assisting that effort. More than half of the Institute’s deployed staff are people of color, and staff report speaking over 60 different languages.
In 2017, the Public Health Institute of Metropolitan Chicago conducted a landscape analysis of home-visiting services in partnership with the city’s Department of Public Health to improve services for pregnant women and children and reduce system inefficiencies. This helped guide a strategy for developing a vision and strategy to coordinate maternal child health and early childhood home-visiting services in Chicago.
In these instances—and many more across the nation—public health institutes contributed to significant accomplishments well beyond the capacity of other health entities.
For many years, public health leaders have explored the possibility of establishing a public health institute in New Jersey. In 2013, and again in 2019, studies and convening processes were conducted that strongly supported the creation of a public health institute in the state. Key conclusions emerged that are still valid today:
- A public health institute could help the state overcome longstanding challenges, such as health inequities and underfunding of public health infrastructure and initiatives.
- An institute should have a close, clearly-defined relationship with the state Department of Health (NJDOH).
- An institute should be established through an incubator organization that would facilitate it becoming an independent Section 501(c)(3) organization. The feeling was that a newly-created, independent entity stood a better chance of winning the trust of public health leaders throughout the state.
The joint RWJF, Nicholson, NNPHI report capped a 10-month planning effort that built consensus on mission and values. Establishing a public health institute would be a key part of a reimagined public health system for New Jersey. In the wake of a deadly pandemic for which the state was unprepared, and amid intolerable barriers to good health along racial, ethnic, and other lines, all who envision a state with better health and greater equity for all residents need to seize this moment.
ABOUT THE AUTHORS
Sallie George is a program officer at the Robert Wood Johnson Foundation, working in several key areas to support the Foundation’s health and leadership efforts in communities nationwide.