Public health’s ability to protect and promote healthy communities is being directly impacted by the politicization of once-widely accepted practices such as vaccinations and the declaration of public health emergencies. In light of the current climate of eroding trust and falling investments in public health, a critical question has emerged: How do we strengthen public health advocacy at local, state, and national levels?

This feasibility study, commissioned by the Network, includes insights gathered from personal interviews with public health advocates and leaders from 45 organizations. The purpose of this report is to stimulate wide-ranging discussion and engage those who share a sense of urgency in collective, purposeful action to strengthen public health advocacy in the United States.

In this Q & A, Maddy Frey, President of Frey Evaluation speaks on behalf of study-coauthors, Martha Katz, consultant and former deputy director of policy and legislation for the Centers for Disease Control and Prevention, and Gene Matthews, principal investigator at the Network’s Southeastern Region Office and former chief legal advisor to the Centers for Disease Control and Prevention, about the findings and recommendations highlighted in the Report.

Q. Can you talk about how the study was conducted?

A. Between January and July 2022, we interviewed over 90 leaders and advocates from close to 50 public health, advocacy, philanthropic, and related organizations. To identify study participants, we sought to interview those already working to strengthen public health advocacy who represented a diversity of experiences, backgrounds, and political views.

Q. Your report uncovered several of what you described as undercurrents of tension rippling through public health. Can you talk a bit about that.

A: These tensions started emerging during the interviews, and then appeared in bold when we began to pull the themes from the interviews and do sense-making with other groups. It felt important to name these tensions up front as a backdrop for the study findings. In our increasingly complex environments, it helps to recognize that both parts have some truth, hence the tension from the pull to one direction or the other.

We’ve attempted to embrace “both/and” thinking throughout the study, particularly as study participants shared diverse and sometimes divergent views on problems and solutions with regard to public health advocacy. Acknowledging the complexity of this work also helps to lift viewpoints that can get obscured via more definite “findings.”

Q. Your report also identified six distinct opportunities to strengthen public health advocacy. Can you outline those for us.

A: Certainly!

First, we saw the need to develop and advocate for pro-public and community health policies. Public health has played so much defense over the past few years, it’s time we played more offense. This could include advocating for policies that modernize public health, advance equity, restore public health’s legal authority, ensure sustainable funding, lead with our values and restore trust with the American people.

Second, we need to cultivate friends of public health at all levels and across aisles. Hospitals, the business community, and grassroots groups are ready to fight for public health, but we need to arm them with the tools to do it.

Third, it’s time to start replicating some exciting models we learned about in states that are further along toward safeguarding public health through strong advocacy efforts. Organizational structures could take the form of a new or expanded 501c3, 501c4 or 501c6, depending on existing efforts and capacity.

Fourth, public health needs to reach new audiences – the public, policy makers, new and existing members of the public health workforce, funders and donors, and the allies and champions mentioned above. The art and science of influence is missing from public health training and practice. Much improved toolkits; social media strategies; effective messaging; and a cadre of public health’s own influencers to deploy these tools would make it easier for friends of public health to become stronger champions.

Fifth, in interview after interview, we heard one word used repeatedly to describe how public health’s workforce views advocacy: skittishness. As a result, their voices and expertise are missing from the public discourse, leaving the field wide open to anti-public health views. The public health workforce of the future, current and soon-to-be students in the nation’s undergraduate and graduate-level training programs, will benefit from a significant expansion of small- scale but promising efforts to imbue advocacy training into skill sets and mindsets.

And finally, unless and until we unlock adequate funding for public health advocacy, other public health goals will remain out of reach.

Q. What do you hope this report provides in the way of insights and guidance for next steps?

A. The purpose of this report is to stimulate wide-ranging discussion and engage those who share a sense of urgency in collective, purposeful action to strengthen public health advocacy in the United States. As a field, we have some catching up to do, which is daunting, but we also offer a menu of options that we hope will be galvanizing.

We are interested in hearing from others in the public health community. Please take our brief survey to share your input and ideas: https://forms.gle/nxdvoNWxjgt2GsXM6