Jennifer MandelbaumToday’s guest blogger is Jennifer Mandelbaum, MPH, a graduate assistant at the South Carolina Department of Health and Environmental Control. APHA sponsored her and 14 other students and early-career professionals to attend its Policy Action Institute, held Feb. 12 in Washington, D.C. Mandelbaum shares her impressions of the event with us.

I see, every day, how crucial policy is to advancing health equity and the uptake of evidence-based practices. Policies at the local, state and national level shape our residents’ access to resources, including healthy food, transportation and reproductive health care.

I attended the 2020 APHA Policy Action Institute to better understand how public health leaders are addressing social determinants of health through policy, expecting that experts would simply discuss their accomplishments.

Instead, the Policy Action Institute was much more than that; it was a platform for learning and a springboard for attendees to participate in their own advocacy work.

Throughout the daylong event, public health experts engaged in thoughtful discussions about what a “culture of health entails,” how progress depends on tearing down silos and the importance of using science to advocate for policies, which “undo racism, sexism, and classism.” I left the event with three main takeaways:

Health is inherently political, and public health leaders can be powerful advocates. In a rousing talk on advancing the public's health in the context of the 2020 presidential election, Abdul El-Sayed, MD, DPhil, an epidemiology professor at Columbia University, noted that “politics is the system by which we allocate scarce resources.”

He shared how issues such as mass incarceration, pre-kindergarten education, paid leave, substance use and mental health funding are “on the ballot in 2020.”

Public health scientists have incredible power to use their knowledge to advocate for positive change. Shelley Hearne, DrPH, a principal investigator at CityHealth, noted that health inequities will continue until we have policies, leadership and public understanding of what we do.

Breaking down silos is a key step to advancing health equity. Speakers at the Policy Action Institute emphasized the importance of breaking down silos and having evidence-based dialogue around issues as varied as firearms, climate change, access to care and reproductive health. “Health is absolutely the core of so many of these issues,” said Hearne. 

These issues are not separate (e.g., climate change affects access to care), and social, structural and environmental factors cannot be divorced from their health implicitizations. For example, El-Sayed noted that homelessness is a public health issue: “If you have no home, you have no space to build the foundations of a dignified and healthy life.”

Breaking down silos extends to the structure of our health care system. Bechara Choucair, MD, chief community health officer at Kaiser Permanente, said, “We expect people to get the help they need by simply interacting with the current health care system, and that’s not enough.” As public health advocates, our work should seek to question and improve the structural determinants of health.

Social policies are intrinsically linked to health. In a powerful talk on dismantling racism and pursuing racial health equity, Joia Crear-Perry, MD, FACOG, founder and president of the National Birth Equity Collaborative, noted, “We are creating, over and over again, policies and structures that devalue a group of people.”

Choucair shared similar sentiments: “We constantly encounter issues that are fueled by systemic racism and inequity...(We have to) address issues that are the structural determinants of health.”

An inclusive approach is necessary if we are to promote a culture of health. “If we don’t even know that we need to work on these things comprehensively, we risk the chance that we’ll end up with adversity-based solutions...as opposed to a prevention and well-being frame,” said Somava Saha, MD, MS, executive director of Well-Being in the Nation Network.

This theme of focusing on the strengths of communities carried through to the closing keynote with Reed Tuckson, MD, managing director of Tuckson Health Connections. “We have to view communities in the context of their wholeness, not their deficits,” he said.

As we design these policies, we need to make sure we are rallying constituencies outside of the public health sector to support us. Policies addressing social and structural determinants of health can be assessed, in part, by whom they help. Including key stakeholders in the planning and implementation stages is critical to advancing equity.

I left the Policy Action institute with a clearer understanding of how public health scientists can also be advocates and how achieving a culture of health depends on our ability to recognize the structural and social facilitators and barriers to well-being.

I would highly recommend the Policy Action Institute for anyone questioning how to use the skills they have developed to advance health equity.