A Joint Philanthropic Initiative Looks to Mend an Ailing U.S. Public Health System

Public health in the U.S. is ailing post pandemic. Our systems have long been overlooked and underfunded, and COVID-19 laid bare its many vulnerabilities.

Last year, the Trust for America’s Health warned that the chronic lack of U.S. investment in public health puts American lives and livelihoods at risk. And according to a recent report by McKinsey & Company, “The COVID-19 pandemic shined a light on how state and local health systems in the United States, burdened with public health responsibility, have been under resourced for decades and not fully equipped to meet the public health challenges they face.”

In addition to a lack of resources, public health representatives found themselves under siege during the pandemic. Some Americans were outraged by health restrictions, mask mandates and vaccines requirements, and took their frustrations out on public health messengers. Many officials are leaving the field: Close to half of state and local public health employees left their jobs between 2017 and 2021, according to Health Affairs.

In an effort to strengthen the U.S. public health system, The Kresge Foundation, the Robert Wood Johnson Foundation and the de Beaumont Foundation recently launched an $8.5 million initiative, dubbed PHEARLESS (Public Health Regenerative Leadership Synergy), which aims to build up leadership and community collaboration in the field.

The initiative will be co-designed and implemented by faculty at the University of South Florida (USF) College of Public Health and at the USF Muma College of Business (MCOB). The partners are currently soliciting applications from around the country and will select 15 teams to participate in the program. Each team will receive a $100,000 grant and spend the year working separately and with other teams in the cohort; the goal of the program is to “help public health and community leaders build the skills they need to tackle the complex issues facing their communities today,” according to the announcement. (Applications are due on July 6, 2023).

It’s a unique program in the sense that three prominent health funders are coming together to patch up a struggling segment of the public sector. But it’s also aiming to build bridges between the sector and the public itself, thereby restoring trust and grounding the field in community.

Monica Valdes Lupi, managing director of Kresge’s health program, underscored its ambitious goal for the future of public health: “While the pandemic has definitely pushed their limits, this moment presents a truly unique opportunity for public health department leaders to reimagine their unique role in co-creating thriving community health ecosystems and delivering services that are explicitly centered in equity and racial justice,” she said.

Hand in hand with community

One element of the PHEARLESS initiative, in particular, makes it unique: Each of the 15 teams selected will include two community leaders as well as two public health officials. The three foundation partners all agree that including community leaders is essential to ensure that public health infrastructure is embedded in the fabric of the local community.

Sallie Anne George, program officer at the Robert Wood Johnson Foundation, pointed out that some swaths of the population have been better served by public health than others — a discrepancy highlighted during the pandemic.

“The most marginalized communities had the most deaths from COVID-19, and they weren't getting vaccinated at the highest rates they could,” she said. “A lot of that has to do with distrust in the system — in the medical system in general, and by extension, in public health. It brought to light that we need to do something different, to flip the system to provide better connection between community and public health. That’s one of the reasons we got involved in this investment: We don't think that only people with the highest positionality are the ones who are going to change the system and make it more inclusive and equitable. The community needs to be at the table.”

Building health leadership is something Kresge Foundation has been working on for a long time. Monica Valdes Lupi, now managing director of the foundation’s health program, participated in Kresge’s Emerging Leaders in Public Health program when she was executive director of the Boston Public Health Commision. There, she saw first hand the role community leaders can play in effective public health messaging.

“We all know that there is a lot of questioning and mistrust right now, of not just the public health agencies, but government in general, “ she said. “Community partners and community leaders play an important role, especially when it comes to health, in being that reality check in terms of… what communities are experiencing. I know from experience that what we might see in terms of public health data might not be what's front of mind for community members.”

Collaboration with the community means developing connections with members of the faith community, the education community, the business sector and more — and doing so long before a disaster hits. “You need to have that resiliency built in long before the crisis comes,” said Brian Castrucci, president and CEO of the de Beaumont Foundation.

“You can't have the health department director meeting the president of the Chamber of Commerce for the first time, they introduce themselves, and then the public health director says, ‘Hey, we're closing down the economy for the next week.’ That's a bad first date. No one's no one's swiping right on you after that. That's why I think the PHEARLESS project is so important. We need public health leaders to be out in the community, meeting with people, working with the community hand in hand to lay a path forward.”

Getting the band back together

Of the three partner foundations, de Beaumont is the newest and least well known; it's also singularly committed to public health. Its mission: “to advance policy, build partnerships, and strengthen public health to create communities where people can achieve their best possible health,” according to its website. The foundation was created by Pierre (Pete) de Beaumont, who founded Brookstone Company. De Beaumont, who died in 2010, believed public health was the area where the foundation could have the most impact.

“That’s what every foundation wants to do, to change the world, right?” Castrucci said. “That's why we're in this business, but there's no change in the world if the world's not healthy. So there was an amazing opportunity for a new philanthropy to work on issues of public health and to push policy. That's what we've been doing for 12 years. We've been on target and we've tackled some key societal issues. But these are wicked problems — connected, multisystem, complex problems — it's going to take a lot of smart people working on it.”

Kresge, Robert Wood Johnson and de Beaumont have partnered in the past, and all three representatives said they were happy to be doing so again. “This was a great opportunity to get the band back together and really commit ourselves to rethinking public health leadership,” Castrucci said.

“Think about the foundation of your house. You can debate the wall color and you can debate the drapes, but if the foundation of your house is busted, everything's in jeopardy. Right now, not only is that foundation of our house cracked, there are people actively taking jackhammers to it. We need leaders who are going to be able to work across sectors to help people understand the value of public health, and how it impacts their lives.”

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