PHAB’s 21^st Century Learning Community (21C) Affinity Groups provide space for leaders in statewide public health systems transformation to connect with colleagues from other states and share strategies around various public health topics. 

From December 2022 to May 2023, 21C members participated in Affinity Groups focused on topics prioritized by 21C members – Assessment and Costing, Data Modernization and Transformation, Service and Resource Sharing, and Workforce Strategies.

Participant highlights included:

• Increased understanding of national alignment on transformation efforts.
• Learning about resources and experiences in states at different stages in their transformation journey, including plans for the future.
• Making connections that extend beyond Learning Community events.
• Thinking about how to establish “baseline knowledge” requirements for data.

Brief summaries/takeaways from each Affinity Group can be found below.

Assessment and Costing

Assessment and costing helps states understand the vital role of governmental public health in communities, identify capacity gaps, determine the cost for assuring Foundational Capabilities and Areas, justify funding requests, and achieve equitable outcomes for all.

States engaged in this work are considering:

• Defining and engaging all parts of the governmental public health system.
• Defining what the future state of public health should be (‘full implementation’).
• Identifying the resources necessary to conduct the assessment.
• Establishing methods to conduct the assessment.
• Completing an assessment to determine the current costs and capacity by Foundational Capability and Foundational Area.
• Estimating the staffing and funding needed for full implementation and developing recommendations for funding.

Several 21C states have/are assessing current and needed capabilities and costs of providing Foundational Public Health Services. These states have typically moved past the beginning stages of their transformation journey, which includes setting their transformation goals, and are implementing strategies using data from these assessments to plan and to advocate for sustainable investments in public health infrastructure and systems.

Through 21C, states that are earlier in their transformation journey are learning from and gaining insight from more experienced states.

The national Foundational Public Health Services (FPHS) Capacity and Cost Assessment was launched in 2023 to support health departments and state-wide systems to understand the needed costs, expertise, and capacity toward the national FPHS framework, and can be used to determine how best to allocate resources to meet the needs of their states; consider options to shift resources within organizations; identify opportunities to share resources and/or services across agencies; and advocate for funding.

Data Modernization and Transformation

Existing data systems do not meet emerging public health needs; without modern, real-time, hyperlocal data and tools, governmental health departments do not have the information they need to make data-driven decisions in a timely manner or provide the Foundational Public Health Services:

• Align with the Foundational Public Health Services and 10 Essential Public Health Services.
• Embed equitable data principles throughout the data lifecycle. Data equity frameworks, such as the ‘DASH Framework 3.0,’ ‘Pathways to Yes, or ‘We All Count,’ should be used to make data in public health more equitable, accessible, and accurate.
• Consider how to incorporate the Robert Wood John’s Foundation’s (RWJF) National Commission to Transform Public Health Data Systems recommendations.
• Prepare for future public health needs, not just current ones.
• Allow for timely data collection and analysis.
• Utilize technology that is interoperable; data needs to have the ability to be shared safely and securely within the public health system and with cross-sector partners. Through collaboration, interoperable data systems can reduce duplication of work, increase the speed of informed decisions, and remain flexible and dynamic to meet local needs.

In alignment with the RWJF’s National Commission to Transform Public Health Data Systems recommendations, Affinity Group participants shared that establishing clear communications about why a state is transforming their data system is critical in recruiting the workforce needed to do the work and training the existing workforce on how to use it. Communication may include shifts in the language used, recognition of lived experience as data, and historical, political, and social context of data; this can help gain buy in, build trust, and increase understanding of its value. Health departments also need to prioritize collecting data that matches organizational values and strategic priorities; the misalignment of data collection and data needs has created barriers to data-driven decision making, including not having the correct or complete data when needed. Employees should be trained in how to use and benefit from a modernized data system. Additionally, changes may be needed to the governance of existing data infrastructures in order to put equity at the center of this work.

Several 21C states have experience with service and resource sharing arrangements (SRSA) as a system strategy to improve public health infrastructure and several other states are considering taking this approach. State-wide public health systems considering this strategy have the benefit of learning from the wisdom gained through experience by others. SRS can take many forms and there is an array of models that can be adopted or adapted to suit state specific context and needs.

Affinity group members shared experiences and reiterated some best practices from the Roadmap and Success Factors:

• Be clear about expectations and value for all involved; recognize that SRSAs offer more than financial benefits.
• If the SRSA requires hiring an employee and/or sharing an employee, develop a clear understanding of who the supervisor is for the shared position, a process to make the supervisor aware of performance feedback, and alignment on where the employee works/is located.
  • Agencies involved in the SRSA should build trust with the identified supervisor and create a process for making decisions related to the share position.
• Be cognizant that dynamics change when the people involved in a SRSA change (e.g., due to staff changes); this requires communication and relationship building to ensure you are still working towards the same goal.
• Define what urgent looks like to all stakeholders; this may include developing back up plans or triaging.
• Lead with humility, especially in approaches to work in rural communities, recognizing there are influential histories that may not be connected to public health at all.

Cumulative and historic knowledge about SRSA, combined with conversations with Affinity Group members, led PHAB to expand how we characterize the range of SRSA. Together, we are developing a new graphic depiction, built on the original cross-jurisdictional sharing spectrum, which focused on locally driven efforts to share, and broadened our view to include efforts generated at the state level as well as those generated for regions or districts. The original spectrum still “stands,” and the additions are intended to further describe the vast array of possibilities.

Additionally, PHAB is currently developing guidance for state-wide systems considering SRSA. Affinity Group members have been instrumental in contributing learnings to the guide and ensuring it is applicable to the practice community by reviewing drafts (including drafts of our new graphic) and offering critical commentary.

Workforce

Workforce development, recruitment, and retention challenges are not new to public health, but we cannot achieve public health transformation without changes.

A transformed public health workforce should:

• Effectively communicate relationship between job duties and the Foundational Capabilities and/or core competencies.
• Develop career paths, in alignment with positions that provide the FPHS, that demonstrate the variety of opportunities in public health and the skills and experience needed to achieve them. This will benefit current and future employees because it outlines opportunities for growth and what it takes to get there.
• Foster a culture of support, learning, and innovation.
• Include employees with diverse backgrounds and skillsets.
• Provide training and professional development opportunities related to gaps in the needed workforce.

We cannot achieve broad implementation of the Foundational Public Health Services in the United States with the existing workforce – more employees, new skillsets, and attractive benefits are needed to recruit and retain the future workforce. Workforce policies and practices often outlast the workforce that developed them, requiring a forward-thinking approach to prepare for the future public health workforce.

Thank you to all Affinity Group participants for your contributions.

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