PHI Testimony on The Future of Public Health — California Investments in State and Local Public Health Infrastructure

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On Thursday, March 14, 2024, PHI President and CEO Melissa Stafford Jones was invited to provide testimony to the California Senate Budget Subcommittee #3 – Health and Human Services Oversight, for their panel discussion on the California Department of Public Health’s initiative, The Future of Public Health – Investments in State and Local Public Health Infrastructure.

The Future of Public Health: Investments in State and Local Public Health Infrastructure

Good morning, Chair Menjivar and Members of the Committee. My name is Melissa Stafford Jones, and I am the President and CEO of the Public Health Institute.

PHI advances wellbeing and health equity with communities in California, across the country, at the federal level, and in countries around the world. For sixty years, PHI has served as a convener, collaborator and implementing partner with the State of California, local health jurisdictions, and communities, as well as the federal government. In our role as a thought leader, catalyst, trusted partner and intermediary, our work includes program design, implementation, grantmaking, data infrastructure and analysis, and research and evaluation.

Thank you for the opportunity to speak to you today regarding the Future of Public Health effort to build critical system infrastructure.

Poverty, systemic racism and racial injustice, food insecurity, working conditions, lack of supported, trusted community infrastructure, and many other social determinants of health mean that not all communities have the same opportunities for health. Addressing inequities and focusing on root causes are central to everyone in the field of public health, including the Public Health Institute. We make the most powerful impacts by focusing on prevention and creating the conditions for health and wellbeing, particularly for the most underserved.

Here are our recommendations to further advance the Future of Public Health:

First, value the public health ecosystem and partnership: When we think of public health, there’s value in recognizing it as an ecosystem that includes governmental public health at the national, state and local levels, as well as community-based organizations and services, and communities themselves. Each part of the system has particular roles and capabilities. This means we have different strengths to deploy. The Future of Public Health focus on local community planning processes that engage all components of the public health ecosystem, for example, is an important reflection of this integrated approach. Building infrastructure and sustaining investment for each part of the system, and for these components to work in partnership, is critical. When each part of the system has the infrastructure, appropriate resources, workforce and capabilities it needs, we can best improve health and equity for Californians.

Second, prioritize the role of communities: The Future of Public Health pillars include a vital focus on community partnership and community health improvement, which are essential components of public health infrastructure. Advancing equity necessarily involves shifting power, including to communities, which is also critical to rebuild trust in the public health system.

During COVID, we saw the effectiveness of investing and focusing on efforts at the community level: trusted community-based organizations and partners were able to develop and implement strategies that worked in their communities. For example, PHI’s Together Toward Health worked closely with 548 community-based organizations to reach more than 27 million of our most underserved Californians. Their trusted messenger model connected just shy of one million community members to vaccines and supported more than 250 thousand with workforce development opportunities. Working in close partnership with trusted CBO partners and community-led organizations is vital to achieving our public health goals.

Future of Public Health investments should prioritize infrastructure for authentic, meaningful community partnership that is ongoing and sustainably funded, and not just in response to an emerging issue or a particular public health priority.

PHI has a long history of partnering with government on workforce, and we recognize the importance of current investments in state and local government public health workforce. These trusted messengers, rooted in their communities, should also be seen as a key part of the public health workforce. We welcome the opportunity to work creatively together to build the diverse public health workforce that California needs, which reflects and includes California’s diverse communities and brings their expertise into the public health ecosystem.

Third, integrating public health into the overall health system: I have been fortunate in my professional life to have worked across multiple systems, including safety net health care and financing, community level health and social services, and in government at the local, state and federal levels, so I appreciate first hand California’s leadership to recognize the centrality of social determinants of health and community level services in improving health outcomes for the most underserved Californians.

We have a tremendous opportunity in California to integrate public health and health care. That includes thinking through how we support and resource the public health system in the context of the Medi-Cal health care delivery and financing system, given the emphasis of CalAIM on coordination, social determinants of health, community supports and prevention. Earlier this week, a national coalition of hospitals, doctors, health plans and Kaiser Permanente announced a new effort to advance the vision of better health by collaborating with and supporting public health. Bringing public health more explicitly into the vision and health care systems’ structures for health care delivery and financing would strengthen California’s efforts to increase early and upfront prevention at the individual and community level, connect the dots between public health and health care, and build intentional cross sector strategies for reducing health disparities.

Thank you again for the opportunity to speak today.

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