““Good leaders are built, not born”
- Amanchukwu et al., 2015”
The health of communities where we live, work, learn, and play now and in the future is dependent on many key factors, including the capacity of the public health workforce. In a period of rising healthcare costs, increasing health inequities, increasing racial and ethnic disparities, as well as a targeted focus on population health and healthcare reform, leadership is central to the future of public health. Leadership is essential to effectively address the social determinants of health (SDOH) that contribute to health equities, including institutional barriers. Public health leadership plays a key role in changing the narrative to remove barriers to achieving health equity, requiring courageous leaders to advocate for change, use evidence-based decision making, and possess diverse skills necessary for policy, institutional, and individual change (Yphantides et al., 2015).
Structural barriers to improving health equity in rural communities are driven by socioeconomic and political contexts, including governance, macroeconomic, social, and public policies, and cultural values (Solar & Irwin, 2010). Rural health systems are often under-resourced and lack the capacity to effectively improve health equity (Health Research & Educational Trust, 2013). In addition, gaps in policy, workforce, and coordination present barriers to improving health equity.
Strategies that leaders can do to remove barriers to improve health equity and build the public health workforce now and in the future center on four key areas:
Collaboration and Engagement. It is critical to foster collaboration with cross-sector partners beyond traditional entities, such as health systems, community-based organizations, or faith-based organizations to expand the depth and breadth of influence on opportunities to improve population health. Engagement of community champions, elected leaders, and vulnerable populations impacted by health issues is important to garner local support and drive change.
Workforce Development and Support. Support for workforce development should center on building strategic skills to improve health equity, including policy development, systems thinking, communication, management, collaboration, evidence-based decision making (EBDM), cultural competency, and integration of health equity principles into practice (De Beaumont Foundation, 2019). Specifically, collaboration with academia provides an opportunity to deliver training to the workforce. Leaders must engage key decision-makers to support long-term investments in the public health workforce (De Beaumont Foundation, 2019). Moreover, fostering a culture of health equity includes, encouraging staff time to foster EBDM, provision of professional development opportunities, and improve health equity through hiring practices and job performance measures (De Beamount Foundation, 2019; Allen et al., 2018; Eyler et al., 2018).
Cultural Competence. Given the diversity of communities across the United States, steps must be taken to build cultural competence to lead and engage followers to improve health equity. Leaders must understand culture as a factor to remove institutional barriers to improve health equity given that racial and ethnic minorities are disproportionately impacted by health disparities (Solomon & Randall, 2014). Cultural competency, including cultural awareness, cultural humility, cultural knowledge, and cultural sensitivity, is important to build for leaders to engage rural and native communities and support workforce development (Solomon, & Randall, 2014).
Build Future Public Health Leaders. Leaders in academic institutions also have the responsibility to prepare future public health professionals to build diverse skills that support improving health equity. Public health education must focus on determinants of population health, health in all policies, and a collaborative approach to foster partnerships between public health and health care systems, as well provide the opportunity for students to learn through applied practice experiences and practicums (Association for Schools and Programs of Public Health, 2013; Yphantides et al., 2015).
Upstream approaches are necessary to reduce inequities and support long-term change. “Good leaders are built, not born” (Amanchukwu et al., 2015).
References
Allen, P., Jacob, R. R., Lakshman, M., Best, L. A., Bass, K., & Brownson, R. C. (2018, Oct). Lessons Learned in Promoting Evidence-Based Public Health: Perspectives from Managers in State Public Health Departments. J Community Health, 43(5), 856-863. https://doi.org/10.1007/s10900-018-0494-0
Amanchukwu, R., Stanley, G., &, & N., O. (2015). A review of leadership theories, principles and styles and their relevance to educational management. Management, 5(1), 6-14. https://doi.org/10.5923/j.mm.20150501.02
Association of Schools and Programs of Public Health. (2013). Blue ribbon employers advisory board report, Public health trends and redesigned education. https://s3.amazonaws.com/aspph-wp-production/app/uploads/2015/02/BlueRibbon-FinalRptforFTFSitein2015.pdf
De Beaumont Foundation. (n.d.). Building skill for a more strategic public health workforce: A call to action. https://www.debeaumont.org/wp-content/uploads/2019/04/Building-Skills-for-a-More-Strategic-Public-Health-Workforce.pdf
Eyler, A. A., Valko, C. A., Macchi, M., Fershteyn, Z., Mazzucca, S. L., Brownson, C. A., Lau, A., & Brownson, R. C. (2019). Adjusting the Equity Lens: Gaps in Addressing Health Equity in State Chronic Disease Prevention. Health Equity, 3(1), 86-91. https://doi.org/10.1089/heq.2018.0075
Health Research & Educational Trust. (2013). The role of small and rural hospitals and care systems in effective population health partnerships. Chicago, IL: Health Research & Educational Trust. www.hpoe.org .
Solomon, T. G., & Randall, L. L. (2014). Conducting health research with Native American communities. American Public Health Association. https://doi.org/10.2105/9780875532028
Yphantides, N., Escoboza, S., & Macchione, N. (2015). Leadership in public health: new competencies for the future. Front Public Health, 3, 24. https://doi.org/10.3389/fpubh.2015.00024