Local Public Health Leaders Research Articles

Training the Next Generation of Local Public Health Leaders: A Case Study of Community Health Organizers in Pennsylvania.

Few short-term training programs exist for persons with limited experience or training in public health to support public health initiatives. We describe a public health training designed by the Pennsylvania (PA) Training Center for Health Equity for the PA Community Health Organizer (CHO) program. The CHO program was created to address the immediate needs of underserved communities and promote lasting health equity during the pandemic. CHOs are professionals who promote community action and align efforts with local organizations to build sustainable public health infrastructure and apply evidence-based practices to program policy, planning, and development. The training content, delivered by Project Extension for Community Healthcare Outcomes (ECHO) in 12 monthly sessions, focused upon foundational public health concepts in a novel community case study approach. The ECHO All Teach, All Learn training model was successful in providing relevant public health information to this new workforce, and the pre-/post-training evaluation demonstrated a positive increase in knowledge across all domains.

For-Profit Businesses as Public Health Partners to Promote COVID-19 Vaccination: A Multiple Case Study.

This study aimed to describe the actions used by health professionals employed by large, for-profit businesses to promote uptake of COVID-19 vaccines, and factors that facilitated and hindered coordination with local public health leaders. In this qualitative multiple case study, we conducted telephone interviews with health professionals from businesses, health department leaders, and others who could provide information about local vaccination efforts (e.g., emergency managers, reporters). Businesses' self-interest (i.e., need to keep employees working), vaccine mandates, and characteristics of the businesses (e.g., ownership, expertise) facilitated leadership in COVID-19 vaccination efforts. Coordination with local health departments was influenced by the resources of the local health department and history of collaboration. Health professionals employed by large businesses can serve as key public health partners, but their role is shaped by characteristics of the businesses and communities.

Estimating Public Health Workforce Efforts Toward Foundational Public Health Services.

The Foundational Public Health Services (FPHS) include a core set of activities that every health department should be able to provide in order to ensure that each resident has access to foundational services that protect and preserve health. Estimates of the public health workforce necessary to provide the FPHS are needed. This study assessed the potential use of an FPHS calculator to assess health department workforce needs. Qualitative interviews were conducted via Zoom in December 2020-January 2021. Seventeen state and local public health leaders. Qualitative insights into the potential use of an FPHS calculator. Almost all participants expressed that a reliable estimate would help them justify requests for new staff and that a calculator based on the FPHS would help organizations to critically assess whether they are meeting the needs of their communities and the core expectations of public health. Although participants expected that a tool to calculate full-time equivalent needs by the FPHS would be helpful, some participants expressed concerns in regard to using the tool, given ongoing workforce issues such as recruitment challenges, hiring freezes, and funding restrictions. An anticipated positive consequence of using this tool was that it may lead to cross-training the workforce and result in more diverse expertise and skills among existing workers. The other unintended consequences were that an FPHS calculator would require a substantial amount of time assessing the current FPHS efforts of existing staff and the results of the FPHS gap estimate could become the bar rather than the minimum needed. The current public and political focus on public health infrastructure as a result of the COVID-19 pandemic has created a window of opportunity to create change. An FPHS-based staffing tool may help transform public health and initiate a new era.

Thoughts on Adaptive Leadership in a Challenging Time.

Thoughts on Adaptive Leadership in a Challenging Time.

What gets measured gets done: an assessment of local data uses and needs in large urban health departments.

The epidemiologic shift in the leading causes of mortality from infectious disease to chronic disease has created significant challenges for public health surveillance at the local level. We describe how the largest US city health departments identify and use data to inform their work and we identify the data and information that local public health leaders have specified as being necessary to help better address specific problems in their communities. We used a mixed-methods design that included key informant interviews, as well as a smaller embedded survey to quantify organizational characteristics related to data capacity. Interview data were independently coded and analyzed for major themes around data needs, barriers, and achievements. Forty-five public health leaders from each of 3 specific positions-local health official, chief of policy, and chief science or medical officer-in 16 large urban health departments. Public health leaders in large urban local health departments reported that timely data and data on chronic disease that are available at smaller geographical units are difficult to obtain without additional resources. Despite departments' successes in creating ad hoc sources of local data to effect policy change, all participants described the need for more timely data that could be geocoded at a neighborhood or census tract level to more effectively target their resources. Electronic health records, claims data, and hospital discharge data were identified as sources of data that could be used to augment the data currently available to local public health leaders. Monitoring the status of community health indicators and using the information to identify priority issues are core functions of all public health departments. Public health professionals must have access to timely "hyperlocal" data to detect trends, allocate resources to areas of greatest priority, and measure the effectiveness of interventions. Although innovations in the largest local health departments in large urban areas have established some methods to obtain local data on chronic disease, leaders recognize that there is an urgent need for more timely and more geographically specific data at the neighborhood or census tract level to efficiently and effectively address the most pressing problems in public health.

Local Public Health Resource Allocation

Local health department leaders are expected to improve the health of their populations as they "use and contribute to" the evidence base for practice, but effectively providing and utilizing data and evidence for local public health decision making has proven difficult. This study was conducted in 2011 and initiated by Washington State's public health practice-based research network to identify factors influencing local resource allocation and programmatic decisions among public health leaders facing severe funding losses. Quantitative data informed sampling for the collection of interview data. Qualitative methods were used to capture diverse insights of Washington State's local public health leaders in making decisions regarding resource allocation. Local decision-making authority was perceived as greatly restricted by what public health activities were legally mandated and the categoric nature of funding sources, even as some leaders exercised deliberate strategic approaches. One's workforce and board of health were also influential in making decisions regarding resource allocations. Challenges were expressed regarding making use of data and research evidence for decision making. Data were analyzed in 2011-2012. Programmatic mandates, funding restrictions, local stakeholders, and workforce capacity appear to trump factors such as research evidence and perceived community need in public health resource allocation. Study findings highlight tensions between the literature descriptions of what "should" influence decision making in local public health and the realities of practice. Advancements in practice-based research and evidence-based decision making, however, provide opportunities for strengthening the development of evidence and research translation for local decision making to maximize resources and promote effective service provision.

Evaluation of public health professionals’ capacity to implement environmental changes supportive of healthy weight

Community-based interventions to promote healthy weights by making environmental and policy changes in communities may be an important strategy in reversing the obesity epidemic. However, challenges faced by local public health professionals in facilitating effective environmental and policy change need to be better understood and addressed. To better understand capacity-building needs, this study evaluated the efforts of the Healthy Start Partnership, a university-community project to promote healthy weights in young families in a rural eight-county area of upstate New York. Qualitative interviews (n=30) and pre/post surveys (n=31) were conducted over three years of the intervention. Challenges faced by partners significantly slowed progress of environmental interventions in some communities. First, many partners did not feel their “regular” jobs afforded them sufficient time to do community work. Second, many partners did not feel they had the personal political power to work on broader environmental, policy, or system change issues. Third, facilitating and policy change and reaching out to non-traditional partners, like businesses, required developing a new set of public health skills. Fourth, the long-time frame of environmental and policy work meant that many efforts would exceed the grant period. Building local public health leaders for environmental and policy change necessitates that these challenges are acknowledged and addressed.

Estimating the Financial Resources Needed for Local Public Health Departments in Minnesota

This study presents a model for determining total funding needed for individual local health departments. The aim is to determine the financial resources needed to provide services for statewide local public health departments in Minnesota based on a gaps analysis done to estimate the funding needs. We used a multimethod analysis consisting of 3 approaches to estimate gaps in local public health funding consisting of (1) interviews of selected local public health leaders, (2) a Delphi panel, and (3) a Nominal Group Technique. On the basis of these 3 approaches, a consensus estimate of funding gaps was generated for statewide projections. The study includes an analysis of cost, performance, and outcomes from 2005 to 2007 for all 87 local governmental health departments in Minnesota. For each of the methods, we selected a panel to represent a profile of Minnesota health departments. The 2 main outcome measures were local-level gaps in financial resources and total resources needed to provide public health services at the local level. The total public health expenditure in Minnesota for local governmental public health departments was $302 million in 2007 ($58.92 per person). The consensus estimate of the financial gaps in local public health departments indicates that an additional $32.5 million (a 10.7% increase or $6.32 per person) is needed to adequately serve public health needs in the local communities. It is possible to make informed estimates of funding gaps for public health activities on the basis of a combination of quantitative methods. There is a wide variation in public health expenditure at the local levels, and methods are needed to establish minimum baseline expenditure levels to adequately treat a population. The gaps analysis can be used by stakeholders to inform policy makers of the need for improved funding of the public health system.

Leading Change Through Collaborative Partnerships: A Profile of Leadership and Capacity Among Local Public Health Leaders

Collaborative partnerships have grown in prominence as vehicles for systems change and organizational development among a network of organizations, particularly in the complex field of public health. Likewise, supporting the functioning and effectiveness of collaborative partnerships has become a key interest among organizational development scholars and community psychologists alike. In the question of capacity-building, no aspect of collaborative capacity has received greater attention than that of leadership. Research on collaborative partnerships has highlighted the importance of shared leadership while at the same time acknowledging that specific individuals do and often must emerge and assume more prominent roles in the partnership in order for the work of the partnership to move forward. However, we have limited knowledge of these key individuals and the roles that they play in non-hierarchical, voluntary partnerships. The present study is a comparative case study of prominent leaders in three regional public health partnerships. The aim of this investigation is to explore the questions: (1) What does it mean to be a leader in a context where no one is “in charge?” (2) What roles do those individuals identified as leaders play?, and (3) What are the specific capacities that enable the enactment of these roles? We find that those viewed as leaders by their partnerships shared a similar profile both in the range and types of roles they play and the capacities that enable them to carry out these roles. Further, we find that while individual attributes such as passion, knowledge, and leadership skills are important, some of the most prominent capacities are rooted in the organizational and institutional contexts within which the leader is nested.

Structuring a Framework for Public Health Performance-based Budgeting

The ability of public health to meet its functional mandates of assessment, assurance, and policy development footline is driven by the system's capacity to meet basic financing needs. To do so, state and local public health leaders must be able to articulate financing needs in terms that are understandable to policy makers and that link funding to anticipated community impact, benefit, and performance. "Rational" budgeting demands imposed by performance-centered budgeting in the states have proved particularly challenging for public health programs. This Georgia-based case study explores one approach for program budgeting in state and regional public health systems and finds the framework to be normatively sound and appropriately descriptive of the "core functions" of public health. The structure clearly distinguishes between personal health services and population health and allows for the future establishment of measurable program targets, an essential feature of a performance-centered budgeting system.