7
Reflections on the Day and Closing Remarks
Joshua Sharfstein from the Johns Hopkins Bloomberg School of Public Health concluded the day by reflecting on the reasons for the workshop and key takeaways. Sharfstein noted that one reason was the importance of considering who is responsible for addressing the many factors related to population health. The planning committee decided to focus on training for public health and medical professionals, community health workers (CHWs), and other sectors in a single workshop because these three workforces are all important for promoting population health.
Sharfstein highlighted some opportunities and challenges presented in each panel. In the first panel, Perspectives from Professional and Accrediting Organizations, he sees as an opportunity the fact that some people in public health aspire to be effective population health leaders. Challenges include large training gaps and the lack of a direct connection between the current public health and health care education and accreditation system and population health needs. With respect to the second panel, The Community Health Workforce, Sharfstein highlighted as opportunities the enthusiasm of CHWs, their combination of lived experience plus additional training, and the examples of how they can make a significant difference in people’s lives. He noted that challenges include that CHWs are often not well employed and not incentivized to be leveraged by the health care system, which limits training and professional development opportunities. He sees a particularly promising model in Maryland; it involves using millions of dollars from the health care system to train and hire many CHWs. With respect to the third panel, Cross-Sector Workforce:
National and Local Examples, Sharfstein shared that a key takeaway is the potential interest among other sectors in receiving training on and further engaging with public health. He noted that a limitation in making public health training relevant to other sectors could be the language, or framing, that is used. He also noted that there may not be many job opportunities available for a public health–trained planner or transportation official.
Sharfstein stated that he supported addressing the three workforce issues in a single meeting in order to demonstrate how the three workforces could come together to address problems. He suggested that a future need is for foundations, governments, and others to invest in the workforce at the juncture between public health, health care, CHWs, and other sectors. One way to do so could be to bring these three areas of training together in an interprofessional conference that allows workers from multiple disciplines to jointly receive training on how to work together to achieve specific goals. In regard to the small group exercise, Sharfstein explained that he also expects that a political priority—such as school absenteeism, affordable housing, or food insecurity—could provide an opportunity for increased investment in the workforce across all three areas discussed during the workshop.
Finally, Sharfstein offered an opportunity for workshop participants to offer their own reflections and concluding remarks. Lourdes Rodriguez from the Center for Place-Based Initiatives at the Dell Medical School at The University of Texas at Austin suggested that if public health recommends a “health in all policies approach,” in which other disciplines apply public health principles to their work, public health could similarly learn from other sectors that have mastered other skills, such as logistics, communications, customer satisfaction, and engineering, and apply these principles to public health work. Rodriguez also highlighted some key issues for future consideration related to CHWs, including the science to support their use, sustainable funding strategies, and the importance of training not just them but also the “ecosystem” in which they work. She also noted the importance of cross-sector funding for initiatives that bring a broad range of stakeholders together.
Cathy Baase from the Michigan Health Improvement Alliance added that, in addition to workforce training needs, an enabling framework of multi-stakeholder collaboratives and partnerships is important in addressing the issues discussed. She noted that “integrator organizations” could be useful in pulling together multi-stakeholder collaboratives at the community level. This type of entity could be jointly funded by multiple stakeholders and provide a vehicle to bring together public health, health care, businesses, community-based organizations, and other partners. In response to a question from Sharfstein about what could be done to strengthen these entities from a workforce training perspective, Baase
stated that she is not aware of any training or credentialing specific for multi-sectoral entities, as each sector typically provides its own training, but it could be something to consider for the future.
Noelle Wiggins from the Oregon Community Health Workers Association highlighted a few takeaways regarding strategies for fully integrating CHWs in population health work. She noted that it is important to recognize CHWs as a discrete and uniquely important group of individuals and pointed to the value of the CHW model as providing more than navigation to health services. As the profession is rooted in political and social justice organizing within communities, Wiggins suggested that with community organizing training, CHWs may be able to play the role of community organizer to address pressing issues, such as a housing crisis.
Marthe Gold from The New York Academy of Medicine suggested an option could be to change the term “CHW” to “community worker,” as the role may reach beyond health and health care. She noted that this revised terminology may make it easier to obtain funding for community workers from entities focused on improving quality of life and well-being in communities.
Terry Allan from the Cuyahoga County Health Department in Greater Cleveland highlighted Figure 3-3 from Kalpana Ramiah’s presentation demonstrating the spectrum of community-integrated care using food security as an example. It noted that there are upstream and downstream strategies for addressing the issue involving individual patients and the community at large. Just as multiple strategies may be needed to address food insecurity, the workshop demonstrated that multiple workforces may also be needed.
Sanne Magnan from the University of Minnesota noted that a key question stemming from the public health panel is whether the right people are being targeted for the right training and professional development opportunities. Another important question, she noted, is how to keep equity at the forefront of population health work. She also addressed Shreya Kangovi’s analogy of whether the goal with population health workforce development is to train firefighters or put out fires. While Kangovi had recommended that the focus be on the end goal of putting out fires, Magnan suggested that it is important to both maintain focus on the end goal and train workers to be good at their jobs. She pointed out that without training, the firefighters—or other workers—would likely become overwhelmed. She also suggested that more training is needed to prevent fires from being started (prevent the problem from arising in the first place).
Regarding the cross-sector panel, Magnan noted that she appreciated that Anna Ricklin from the Fairfax County Health Department was
embedded within the zoning and community development office. She suggested that it is important for the health sector to “learn the language” of other sectors, noting that the reverse (trying to force health in all policies) could be perceived as arrogant. One option could be to develop common framing and terminology that is used across sectors. Magnan also acknowledged that while the meeting called for systemic changes to support population health, change is difficult, and it initially may not be easy to accept new ways of doing things or new partners. Points made by the speakers in this section are highlighted below (see Box 7-1).
