The State(s) of Public Health Advocacy: Turning to the States during a time of Federal Transition
December 11, 2024
Overview
It has become increasingly important for public health to navigate the disruptiveness of a capricious political climate in our continued efforts to protect the health of communities across the country. State-level advocacy is not just beneficial, it is essential to maintaining and advancing community health. The newly released 50 State Scans of Public Health Advocacy Capacity report provides valuable information for advocates, public health practitioners, policymakers, and funders to identify partners who can work together and leverage their collective resources to achieve large-scale positive—and equitable—health outcomes for communities.
Public health is not immune to political polarization, indeed polarization between administrations has created instability in the laws and policies that govern public health. This dynamic has intensified over the past 50 years, as the politicization of public health has eroded public trust, and created an environment where harmful policies win out. Prime examples of these detrimental policies include the 2019 rollback of the Clean Power Plan, which aimed to reduce carbon emissions from power plants, and was vital to mitigating climate change impacts and reducing health disparities among vulnerable populations; and changes to the Affordable Care Act, such as the elimination of the individual mandate, ultimately increasing the number of uninsured individuals, and disproportionately affecting people of color and low-income communities.
It has become increasingly important for public health to navigate the disruptiveness of a capricious political climate in our continued efforts to protect the health of communities across the country. State-level advocacy supporting equitable and sustainable public health measures is key to doing so.
State-level advocacy is not just beneficial but essential to maintaining and advancing community health. The newly released tool, 50 State Scans of Public Health Advocacy Capacity, funded by the Act for Public Health initiative and developed by a team of public health lawyers and policy analysts through Frey Evaluation, provides valuable information for advocates, public health practitioners, policymakers, and funders to identify partners who can work together to improve the public’s health in their states. For those looking for a better understanding of a state’s public health and political landscape—or wanting to see what is going on in other states—these scans provide a valuable snapshot.
For example, if you access the scan for Indiana, you quickly learn that this is a state that has a Republican governor, Republican supermajorities in both the House and Senate, and a 2021 law limiting the authority of local boards of health or health officers from filing more stringent actions related to emergency orders. Nonetheless, the state scan for Indiana also documents the following assets:
- The Governor established a Commission in 2021 to assess the public health system in Indiana and recommend ways to: 1) improve the delivery of public health services throughout the State; 2) improve funding for the public health system; 3) promote health equity; 4) ensure the sustainability of our local health departments; and 5) improve responses to future public health emergencies.
- The Commission issued a report in August 2022 with 32 recommendations.
- In 2023, the Indiana General Assembly approved an unprecedented 1,500 percent increase in public health funding, approving $225 million over the 2024 and 2025 fiscal years. The funding required a 20% match by participating counties.
- In FY 2024, 86 of 92 counties chose to contribute to the match, to participate in Health First Indiana funding.
These state scans build on a 2023 study commissioned by the Network for Public Health Law, the CDC Foundation, and the de Beaumont Foundation, which explored state-level capacity for public health advocacy and how it could be strengthened. The resulting report from the study, State of State-level Public Health Advocacy: Findings and Implications from a 50-state Scan, identified themes and opportunities from interviews conducted of key respondents in all 50 states and the District of Columbia. The findings affirmed that COVID, the restrictions that followed, and an increasingly polarized political landscape made it harder to advocate for public health; it also identified that many opportunities to strengthen it exist in every environment.
I was part of the team that wrote this report and learned so much from conducting over half the interviews with advocates in states. Across the board, I was deeply struck by how committed advocates in all states were to fighting for public health victories, regardless of the political perspective. For example, in one state, I talked with a lobbyist who was not able to use the term “social determinants of health” when talking to lawmakers, but found he could use the term “non-medical factors” to reach legislators that were not open to hearing about “health equity,” but were receptive to values associated with health and equity. It is this kind of commitment to public health and health equity across all states, and the practical knowledge of how key partners are doing it in the states, that needs to be a source of stability during these times of transition at the federal level.
The report and state scans identify opportunities to strengthen public health across a broad range of strategies, such as engaging local advocates and community members to customize public health messages to local/state contexts to increase understanding, trust, and support; building capacity and motivation among the existing and future public health workforce; sharing examples of successful resistance to (and preparation for) challenges to public health authority; rebuilding public health infrastructure, workforce, and funding with sustained investments; and sharing multiple ways to express the concept of health equity that can be adapted to different situations. In particular, there is tremendous promise in amplifying examples from more politically conservative states nonetheless passing public health promoting policies using language promoting economic framing, community loyalty, prosperity, rural investments, and faith-based values to assert a range of advocacy goals.
These strategies highlight the multi-faceted approach required to advocate for public health improvements, especially amidst a politically charged atmosphere. By tailoring messages to resonate with local values and leveraging diverse advocacy tools, public health efforts can gain wider acceptance and drive meaningful change. This harmony between advocacy and public health is crucial, and especially important at the state level right now.
After all, advocacy and public health are inextricably linked. Advocacy enables public health professionals to translate research into policy changes, influence laws and regulations, and raise awareness about health issues; it creates supportive environments that promote population health by acknowledging upstream factors like access to healthcare, environmental hazards, and social determinants of health, which cannot be solely addressed through individual interventions alone.
Moreover, advocacy is a collaborative effort. Building coalitions and partnerships with community organizations amplifies the voices of affected populations, ensuring their needs and challenges are urgently addressed. By leveraging these partnerships, we can achieve large-scale positive—and equitable—health outcomes for communities. These efforts involve a lot of moving pieces, many of them different in every state. This new tool—the 50 State Scans of Public Health Advocacy Capacity— offers a menu of opportunities for better understanding how such action can occur at the state level. Please check it out for yourself and let us know through our technical assistance portal how we can support your efforts.
This post was written by Quang (“Q”) Dang, Interim Co-Executive Director, Network for Public Health Law.
The Network promotes public health and health equity through non-partisan educational resources and technical assistance. These materials provided are provided solely for educational purposes and do not constitute legal advice. The Network’s provision of these materials does not create an attorney-client relationship with you or any other person and is subject to the Network’s Disclaimer.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.