Context:Declarations of racism as a public health crisis and increased awareness of racial injustice in health disparities were prominent in 2020, and 72% of 2021 Public Health Workforce Interests and Needs Survey (PH WINS) respondents agreed that addressing racism should be part of their work.Program:The Public Health Training Center Network and National Network of Public Health Institutes developed the Racial Justice Competency Model for Public Health Professionals (RJCM) and conducted a pilot test to assess its application at the organizational level across a range of public health settings.Implementation:Sixteen public health organizations participated, with funding used to develop or update competency-based training, strategic plans, organizational policies, or for novel projects addressing racism.Evaluation:Most pilot respondents (85%) reported increased confidence in applying racial justice principles, with the development of practical tools enhancing organizational capacity and partnerships. All pilot respondents affirmed changing practices to better promote racial justice as a result of implementing their funded projects.Discussion:The RJCM has potential for continued use as a framework to continue advancing racial justice within public health organizations and to empower collective action in support of health equity.

Context:Prevalence of insurance coverage in NYC varies by race and ethnicity: one-quarter (26%) of Latino New Yorkers lack health insurance, compared to 11% of Asian and Pacific Islanders, 11% of non-Latino Blacks, and 8% of non-Latino whites.Program:The Office of Health Insurance Services at the NYC Health Department implemented a tailored racial equity engagement project to identify barriers and opportunities in accessing health care and health insurance among adult Latino and Chinese New Yorkers.Implementation:We conducted 12 community stakeholder interviews and 9 consumer focus groups and used the results to develop a tailored, multilingual, data-driven media campaign in NYC neighborhoods with the highest proportions of uninsured Latino and Chinese New Yorkers. We conducted a social media post-survey to evaluate the campaign’s effectiveness.Evaluation:Stakeholder interviews indicated that cultural beliefs about medicine, insufficient access to services in appropriate languages, and limited awareness of enrollment opportunities impacted health insurance enrollment among Chinese and Latino New Yorkers. Consumer focus groups emphasized that health insurance enrollment media campaigns should focus on culturally salient themes and incorporate community input. Most post-campaign survey respondents (84%) agreed that they and their communities were represented by the implemented campaigns. Survey respondents reacted most positively to images of multigenerational families used in the campaigns.Discussion:Community input is important for public health campaigns focused on specific racial or ethnic groups. Community engagement can help local health departments effectively reach priority populations, ensure that messaging is culturally and linguistically appropriate, and align public health messaging with health equity goals.

Context:Large local health departments (LHDs) serve diverse, high-need communities and are uniquely positioned to influence public health policy and practice locally, regionally, and nationally.Objective:The purpose of this study is to investigate policy engagement as a reported training need in the 2024 Public Health Workforce Interests and Needs Survey within large LHDs, highlighting gaps and opportunities to strengthen policy capacity.Design:Cross-sectional analysis of 2024 Public Health Workforce Interests and Needs Survey data using descriptive statistics and weighted logistic regression.Setting:Large LHDs, serving populations of 250 000 or more, across the US.Participants:Study sample included 24 121 responses from individuals working in large LHDs.Main Outcome Measures:Descriptive and regression-based statistics for training needs, self-identified skill-building interests, and predictors of reporting a policy engagement training need.Results:Nearly 40% of staff at large LHDs reported a training need in policy engagement, the only domain to show an increase in need since 2021. Women had significantly higher odds of reporting a policy training need (odds ratios [OR] = 1.67; P < .001), as did supervisors (OR = 2.09; P < .001) and managers (OR = 1.78; P < .001) compared to nonsupervisors, while those with master’s (OR = 0.64; P < .001) or doctoral degrees (OR = 0.40; P < .001) had lower odds compared to bachelor’s-level staff.Conclusions:Large LHDs are well positioned to advance public health policy given their scale and connection to local communities. Targeting policy engagement training to workforce segments with the highest reported need offers a strategic opportunity to strengthen policy capacity across the US public health workforce.

Context:Chronic diseases are leading causes of death and disability in the United States and have disproportionate impacts in our communities due to demographic, geographic, and socioeconomic factors that affect health outcomes. Limitations in timeliness, representativeness, and granularity of chronic disease data hinder efforts to understand trends, factors contributing to differences in health outcomes, and community needs.Discussion:In this paper, we explore strengths and gaps in chronic disease surveillance capacity in the United States. Then we consider similarities and differences between chronic and infectious disease surveillance needs and approaches. Finally, we make the case for working towards a more comprehensive and integrated approach to data modernization that prioritizes the leading causes of death, disability, and differences in health outcomes in our communities, regardless of etiology, to build a public health surveillance ecosystem that can provide the timely, representative, and local data required to develop responsive and effective health policies and community-based interventions.

Objectives:This study engaged state and local health agency employees involved in the hiring process to examine the impact of hiring laws and civil service requirements on recruitment processes. Additionally, we identified innovative approaches to improve recruitment.Design:Key informant cross-sectional qualitative study.Setting:State and local U.S. governmental public health agencies.Participants:Health department hiring managers, human resources/workforce development directors and assistant directors, program managers, deputy commissioners, and other HR representatives.Main Outcome Measures:Experiences and perceptions of public health hiring approaches, processes, and civil service requirements.Results:Three themes emerged as solutions and innovations for public health agency recruitment: marketing strategies, organizational workforce development changes, and applicant experience improvements. Marketing strategies to improve recruitment included the expanded use of job wrapping and social media platforms. Organizational workforce development for recruitment and retention initiatives included paid fellowship programs, salary comparisons and market adjustments, expanded benefits, and the enhanced role of HR teams. Discussion of civil service requirements and hiring laws revealed that organizational and governance factors, such as hiring authority, were perceived as more consequential to effective recruitment than specific components of the law.Conclusions:Organizations should improve inefficient recruitment and hiring processes and systems where possible. Much of this is achievable through quality improvement initiatives rather than legal or regulatory changes. However, tracking the hiring process to identify inefficiencies is essential, as barriers likely differ across agencies and states. Finding ways to shorten the applicant review timeframe and improve communication with applicants throughout the hiring process may yield more successful recruitment efforts. Lastly, Public Health Infrastructure Grant (PHIG) funding and programming have led to recruitment innovations. Flexibility to adapt recruitment approaches to changing workforce and labor market dynamics is needed for an adequate workforce with the capacity to address foundational needs and public health challenges.

In September 2020, the Public Health Center for Innovations and the de Beaumont Foundation released the updated version of the 10 Essential Public Health Services (EPHS).1 The new EPHS, developed 25 years after the original framework, finally centered health equity—one of the core components of public health practice today. As health inequities drive the differences observed in mortality by race among the top 3 causes of death in the United States2 (heart disease, cancer, and COVID-19), the focus on health equity is long overdue and has never been more urgent. The framework includes direction to develop systems that enable equitable access to individual services and care needed to be healthy.1 The diverse group of public health leaders who informed the refreshed EPHS framework included the need for health departments to "build and support a diverse and skilled public health workforce" and "build and maintain a strong organizational infrastructure for public health." As a leader of color who has worked in governmental public health at the local and state levels, I can attest that these present a challenge to many public health departments. The 2021 Public Health Workforce Interests and Needs Survey (PH WINS)3 reported that today's public health workforce remains less diverse than it needs to be. It is primarily White (54%), female (79%), and 40 years or older (63%). Only 14% of the public health workforce has a degree in public health.3 Lived experience brings a greater awareness and confidence to address health equity and is vital to informing appropriate public health approaches.4 Our lack of diversity, training, and lived experience is preventing us from reaching our collective vision of achieving health equity for all. The gaps in representation in the public health workforce are particularly alarming considering the situational context within which we operate and events over the last few years. Between March 2020 and January 2022, the period in which PH WINS was conducted, we faced the COVID-19 pandemic, which has taken an unprecedented toll on communities and public health professionals' mental health and well-being.5 Deaths of unarmed black men and women at the hands of police led to a racial reckoning across America that has had a devastating impact on communities of color and political discourse that has undermined the essence of public health practice. More than a quarter of the public health workforce plans to leave their positions for reasons other than retirement in the next year.3 With new federal funding to support infrastructure and workforce development, public health has a unique opportunity to rebuild our workforce in a way that is more representative of the populations we serve and better equipped to support health equity. To truly make a difference, we need to create policy and make systems change. Here are some ways you can act quickly to build capacity for health equity work by diversifying your team: Build a strong pipeline of diverse public health professionals and invest in developing diverse leaders: To address the lack of diversity in certain roles, I have found it helpful to start early by reaching out to local high schools and early college programs. Prior to the COVID-19 pandemic, few people were aware of what public health does. Now is the time to sell public health job opportunities and make sure we are educating future professionals about the array of opportunities our field has to offer. Collaboration with higher education is a great opportunity to develop symbiotic relationships between learners and health departments. In my earlier work, I was responsible for the oversight of an academic health collaborative at Worcester Department of Public Health in Massachusetts. The collaboration between public and private universities and the local health department provided numerous opportunities for diverse groups of learners including internships, practicums, doctoral research, and policy consulting. We often saw that interns who performed well were good candidates for future job openings. Focus on diversity, equity, and inclusion (DEI) in recruitment, hiring, and retention: Employees who feel that their organization prioritizes DEI are more satisfied and less likely to leave their positions; this is more pronounced among people of color.6 While racism has been declared a public health crisis in many jurisdictions across the nation, employees, and particularly employees of color, want to see the real change in terms of policy and practice. Increasing diversity on a team starts from the recruiting process: Is your human resources/recruitment team diverse? If not, that is the first opportunity to make a change. I have recently had the opportunity to collaborate on a pilot initiative called the Diversity Hiring Team (DHT) working across administrations at Michigan Department of Health and Human Services (MDHHS) and with support from Michigan Public Health Institute to build capacity for a diverse, inclusive, and equitable interview process. DHT takes a diverse group of employees from various program areas and levels and places them in partnership with hiring managers to review position descriptions, screening and interview questions, and job applications. DHT members complete a series of required trainings covering topics including systemic racism, communication, conflict, DEI in hiring and elective modules such as disability cultural competency, and ADA Title I inclusive hiring practices. Engage and build capacity among your partners: At the state level, MDHHS has a DEI plan and an active DEI council. I was also proud to work for a local health department that chose to identify racism and discrimination as the first domain area in its Community Health Improvement Plan. Whether you choose to explicitly identify addressing racism and discrimination as a goal in your community/state health improvement plan, provide training on Culturally and Linguistically Appropriate Services (CLAS), and/or create new trainings for your public health network. Follow it up with actionable items that will lead to real change, including an equity impact assessment, policy reviews, programmatic changes, and new initiatives to move health equity work forward. It is not always easy and if there are not examples to follow, I have learned it is important to have the commitment to build your own.

Responding to community crises has most often rested on the shoulders of law enforcement officers. Police are typically first on the scene of an emergency—whether it is a drug overdose or an episode involving psychiatric distress or homelessness—but we are asking too much when we expect them to handle these encounters on their own and without sufficient training. They are trained, first and foremost, to maintain public order, not to diagnose and remediate complex medical and behavioral health problems. Besides, the presence of an armed officer can heighten stress and exacerbate tensions in these situations, leading to less than desirable outcomes. For years, public safety officials and public health professionals have operated somewhat comfortably within the zone of expectations they and society have created. In fact, jails and other correctional facilities have become our nation's de facto behavioral health treatment facilities. For far too long, we have been working in silos, relying too heavily on the justice system to fill gaps in treatment. The pattern toward criminalizing our response to behavioral health crises is unmistakable, unsustainable, and counterproductive, and especially in light of the surge in overdose deaths, it must be broken. Fortunately, a change in mindset is evident in policies and practices being instituted in jurisdictions across the country. Many communities are seeing these calls for service as opportunities for intervention and treatment rather than purely as law and order matters. A number of cities have begun to deploy innovative co-response and/or community responder models in which treatment providers and other health professionals are dispatched separately or alongside law enforcement officials on 911 calls. The recent launch of the new 3-digit crisis line, 9-8-8, provides even more opportunity to innovate and reimagine how health and safety professionals can more effectively work together to transform how we address the complex needs of individuals in our communities. The Department of Justice, through its largest grantmaking division—the Office of Justice Programs (OJP)—has invested hundreds of millions of dollars in programs that help communities develop comprehensive systems to address the behavioral health needs of their citizens. These funds have helped agencies form collaborations aimed at diverting people with mental health and substance use conditions away from the justice system and steering them to services that can respond appropriately to their needs. For more than 2 decades, OJP's Justice and Mental Health Collaboration Program (JMHCP) has promoted innovative, cross-system collaborations to improve responses to individuals in crisis. Just last year, OJP's Bureau of Justice Assistance (BJA) launched an effort under JMHCP called Connect and Protect to support enhanced partnerships between law enforcement and behavioral health professionals to develop effective crisis response strategies. Another OJP initiative—the Comprehensive Opioid, Stimulant, and Substance Abuse Program—has delivered resources to scores of communities to plan, develop, and implement comprehensive efforts that identify, respond to, treat, and support those impacted by substance use. The program includes funding for efforts such as medication-assisted treatment, overdose fatality review teams, and the Overdose Detection Mapping Application Program, which helps communities collect and share overdose data so that they can tailor their responses accordingly. We must continue investing in these strategies and be willing to support partnerships between justice system officials, health, substance use, and mental health professionals, and community providers. There is no one-size-fits-all approach to reducing overdoses and mitigating the public safety and public health impact of substance use disorders, but we are on the right path when we work together to deliver the appropriate treatment and other support services to those in need while reducing arrests and diverting individuals from the justice system. A just and healthy society is one in which we are able to meet the basic needs of people without imposing unnecessary punishments and inflaming community tensions. By bringing public safety and public health officials together, we are helping chart a course for responding to the mental health crisis and overdose epidemic facing our country today and in the future.