Summit 1: Achieving a Diverse and Effective Public Health Workforce

Good morning, everyone, and I want to wish all of you a very warm welcome to our summit. I wish we could all be together in person because that when we're in person, we're able to have a different interaction and side conversations, but I am very pleased that we're able to gather virtually for our summit today to learn from one another and take action on the future of public health, which is a critical topic for all of us and everyone in our nation. To seize this moment in history will take all of us coming forward with our best thinking, energy and action. We need to write a new script for public health and we need all sectors to play key roles in the future story of public health.

Our collective wisdom and working together is far more powerful than individual and siloed approaches. We all live in such an interconnected world. As we all know, the past 22 months of the COVID-19 pandemic have impacted every sector, disrupted economies, claimed lives, created mistrust and misinformation. The pandemic laid stark the inequities and the negative impact of longstanding structural racism. Throughout the pandemic, we have also seen public health heroes emerge.

During this time, we've been in the midst of the most dangerous health threat the world has seen in 100 years and the public health community has done, have really been heroic in their actions and often their work has been unrecognized. Our nation owes our public health workers a debt of gratitude. Of course, over the long trajectory of the pandemic, knowledge and guidance have continued to evolve as more has been learned about this novel health threat. That changing knowledge and evolving guidance have created frustrations from the public, and in turn, we have seen pushback against not only public health guidance but distressingly against our public health community, and the pandemic has occurred during the difficult confluence of challenging, long-term social issues coming to a head in an incredibly polarized political environment.

One tangible effect has been a wave of public health professionals leaving the profession, both at the leadership level as well as at the general staff level. These departures are on top of a distressing trend, which the Trust for America's Health earlier this year put into a broader context when they said, "Underresourced, understaffed, and overburdened health agencies responded to a major pandemic with inadequate systems and the country's longstanding failure to invest in disease prevention, address the root causes of poor health, and promote health equity made the nation less resilient." As the United States emerges from the pandemic, this time, the nation must use lessons learned to build a world-class, standing-ready public health infrastructure and workforce with adequate and sustained funding, least any US resident ever again experience a year like the one in the past.

Their report goes on to describe how the country spent $3.8 trillion on health in 2019, but with just 2.6% of that funding directed toward public health and prevention, the smallest share since at least 2000. As you all know, the public health system has gone through spells of underinvestment with increased but delayed funding when emergencies arise. Staffing has been another critical need in health departments and we'll hear much more about this challenge in today's sessions, as well as action-oriented approaches for how we can address it. The needs of a robust public health workforce are diverse and they span from highly technical laboratory and data analytical skills to the deep knowledge of communities and lived experience of community health workers and promotores.

While we cannot change the past, I'm pleased to see that today we're seeing significant funding come into the public health profession. It is now incumbent on the field working with our elected officials, community partners, businesses and the public we serve to ensure the funding is strategically deployed to ensure solid footing for public health going forward. This footing will also help us collectively ensure the health, safety and security for all Americans and contribute to the health of people around the world. As we look to a future state of public health, it's important to collectively consider what changes are needed to ensure that we are not only better prepared for the next pandemic but that we are adequately positioned to elevate prevention as well address the challenging health conditions that threaten our people, including those who are at most risk, to ensure everyone has a chance for a healthy future.

That leads me to today's summit and the other three upcoming summits as part of our Lights, Camera, Action: The Future of Public Health National Summit Series. The CDC Foundation is pleased to host these summits with ASTHO, NACCHO and the Big Cities Health Coalition. You may be wondering, "What does Lights, Camera, Action have to do with the future of public health?" So glad that you asked. The lights represent the guiding lights from research and thought leadership, such as Public Health 3.0 and other work, including the recent report from the Bipartisan Policy Center released just last week titled Public Health Forward.

Lights are also exemplars in the field in practice and policy. The camera represents the view of public health through the lens of the pandemic and the loss of trust, emphasizing the need for the United States to refocus the camera and create trust and a positive movement to rebuild and transform public health. The camera also emphasizes the need for all public health work to be seen through an equity lens. Action includes our local, state, tribal, and national steps that public health officials can take to address the issues illuminated by the lights and captured through the camera. Today, we can write a new script and produce a new future for public health.

In that spirit of working together, I wanna recognize our partners, United Health Foundation and the Robert Wood Johnson Foundation, both of which are stepping forward to provide initial support for the Lights, Camera, Action Summit Series and help catalyze actions needed to propel a positive movement that rebuilds confidence, fosters health equity, and transforms our nation's public health system. Tomorrow, the United Health Foundation will release their latest America's Health Rankings report.

Data from this report emphasized how it takes a variety of different types of organizations and sectors, from government, communities, business and philanthropy, all coming together to meet our health challenges. I wanna let you know that you can, throughout the summit, you can make comments in the chat and we encourage you to do so. We'd like a robust discussion in the chat. We'll be monitoring and reviewing as we prepare summaries for each summit. Also, our team will be posting live during the sessions today. If you wanna share any social media on your own channels, use hashtag #LCASummit, and finally, I'd like you to know that closed captioning is enabled for today's summit if that's helpful to you. Thanks again for being part of today's summit and I hope you'll make it a point to join all four summits.

We have much to share and learn from one another, and now what I'd like to do is welcome the other hosts for the summit to make opening comments. We appreciate the involvement of our co-hosts, including the Association of State and Territorial Health Officials, or ASTHO, the National Association of County and City Health Officials, known as NACCHO, and the Big Cities Health Coalition, and I wanna thank ASTHO, NACCHO, and Big Cities Health Coalition for joining together for this summit and for the work that each of you and your teams do to support and advance the public health protection support system of our country. First, it's my pleasure to introduce Dr. Anne Zink, who is chief medical officer of the Alaska Department of Health and Social Services, and Anne is also the president elect of ASTHO. Anne, over to you. Great, thank you so much, Judy, and thank you so much for the opportunity to be here.

I hope everyone is having a great morning or afternoon. It's a real honor. I have to say I love this title of Lights, Camera, Action and to hear your description of the reasons, the time for action and refocusing that lens, writing a new script and finding a new way forward. I just also wanna thank the CDC Foundation. Not only do you hold amazing conferences like this, but you put your words into action. The support that the states have gotten from the CDC Foundation for positions, for help throughout this pandemic has been transformational and is incredibly appreciated. I entered medicine to really care for my patients, but I quickly discovered that if I didn't care for the larger system in which the care they got, I would see them struggle, and what I discovered along this journey was you all. I discovered the most inspiring, dedicated, selfless, resilient, persistent, creative workforce known, and the public health workforce has responded during this pandemic. I now have the privilege of serving as the ASTHO president elect.

ASTHO is the national nonprofit organization representing the agencies in the United States, the different states, US territories, as well as the District of Columbia, and the over 100,000 public health professionals that we employ. Over the last 20 months, the public health workforce has been tremendous, responding to the most significant public health crisis of our lifetime. This has been particularly significant and not only in the work that has been done but the ways that we've had to operate, oftentimes with inadequate staffing, clearly with increased demand and public scrutiny for the services that we provide. The challenges that we have been facing regarding turnover, recruitment, the tools that we need to do our work, and engaging and supporting staff have remained, have been insurmountable at times.

Turnover is real. It creates less capacity, gaps in institutional knowledge, voids the direction and continuity, and a possible loss of relationships with many key stakeholders and partners. Since just January 2020, over 30 states and territories have left that have had their key health official leave their position either voluntarily or being fired, many citing backlash from public health officials and for their policy and actions. In other agency leaders, leadership positions are also oftentimes being vacated, including deputies, communicable disease directors, lab directors, immunization directors, state legislative leads and more.

There are many reasons that they cite for this and I think it's important to emphasize the burnout that they feel is not a failure for them, it's a failure in our system and the way that we support public health and it's exciting to think about the ways that we're going to be able to improve that system.

Positions which are specialized in education or skills are needed to fill that capacity. For example, epidemiologists are in demand. They can oftentimes work more for other positions, but finding ways to have them engage in the incredibly important work of state, local and territorial public health work is absolutely incredible. Like so many things, COVID-19 has really emphasized our need to bolster and support our existing and burnt-out workforce. We need to do some short-term solutions. First of all, working to ensure a culture of inclusion and belonging for all. Second of all, recruiting new workers with essential skills to ensure they represent the communities that we serve. Third, improving our systems to make it easier to work within governmental agencies, and fourth, truly giving them the tools that they need to do their job instead of asking them to do more without the tools that are needed, and then long term, having better projections of the workforce in the future, investing in new pipelines for a wide range of public health positions with the tools that they need to do their job.

There's a quote by Mary Kay and she said, "People are definitely the company's greatest asset. It doesn't make any difference whether the product is cars or cosmetics. A company is only as good as the people it keeps," and I would say that the same is true with public health. Our workforce is our essential tool and we're only as good as the people we keep, so I'm excited about this opportunity to participate in today's summit, to engage virtually in meaningful conversations about the public health workforce, the actions we must take, the lenses we need to refocus, how we can create a brighter and more productive future together.

Thank you for the opportunity to be here. Thank you, Anne. Really appreciate your words and the quotes. Terrific. Next I'd like to welcome Lisa Macon Harrison. Lisa is health director for the Granville Vance Public Health Department in North Carolina and Lisa also serves as president of NACCHO. Lisa, over to you. Thank you so much. It's so wonderful to be here and I will echo a lot of Dr. Zink's passionate connection to appreciation to what we're about to embark on as this new opportunity presents itself to really design for our public health workforce a better system. I think it's so critical to think about our systems and the ways we can improve them.

Yes, as Dr. Monroe mentioned, I am Lisa Harrison, the president of NACCHO, the association that represents our nation's nearly 3,000 local health departments and hundreds of thousands of public health workers across the nation, and your own local health department, wherever you are sitting watching this, has been certainly very engaged in this public health pandemic response the last two years, and man, it's been a challenge for everyone. Our workforce, however, has risen to that challenge, has reacted with skill and experience and has built such resilience during a time that has tested not only those skills and abilities but also our character and our preparedness, and it's been hard. As Dr. Zink mentioned, we've all seen a bit of turnover that is taking us, it's gonna take us a while to rebuild from, and we didn't start out before the pandemic with an overabundance of our skilled workforce that we needed to do the work we were doing before the pandemic hit, and as we try to have conversations today to build on action around this, I think about a quote that I have in my office posted over here under the window about the public health workforce deserving to get somewhere by design, not just by perseverance, and I think we've lived out such perseverance these last two years and such incredible work ethic that I've seen displayed.

Now it's our chance to make sure that we build a system to honor the people who've been working so hard. In my district alone, we have about 14 public health nurses serving 100,000 population. We've given more than 35,000 vaccines and we're still contact tracing, case investigating. We're still testing and educating the public. We're still consulting with schools and presenting to school boards, court systems and businesses so that people can feel safe, and no other healthcare partners in our system of health in the United States of America have the same breadth of responsibilities we have. No other healthcare partners are in charge of communicable disease control and health-related policy decisions and epidemiology or lab quite like public health is.

We know our workforce is our most critical asset and we also know that the pandemic stretched thin our already lean workforce. Our bench was not deep prior. Preliminary findings from NACCHO's 2020 Forces of Change survey showed that over 80% of local health departments reassigned existing staff from their regular duties, programs and services to the agency's COVID-19 response, and that kind of response and sort of change in responsibilities is taking a toll. Turnover is up across communities and some health department staffs continue to shrink. In fact, this spring, CDC found that over half of our public health workers were experiencing symptoms of PTSD.

I've seen firsthand that turnover rate. You heard Dr. Zink mention the same for state and territorial health officials, and that means our conversations today are so critical. The public health workforce needs our attention, both today and in the future, and in order to build the public health workforce for the 21st century, we've gotta focus on three key factors: retraining our current hardworking, skilled and experienced staff, recruiting top new talent, and expanding the workforce with predictable and sustainable funding. The challenges we face are incredible, but working together, we can make a meaningful impact to support our workforce while they support communities in which we all live. Thank you for your attention today and your attention to these issues, and I'm so appreciative we're having this conversation together. I look forward to it.

Thank you. Thank you, Lisa, and now it's my pleasure to welcome Wilma Wooten, who is public health officer of public health services in the County of San Diego Health and Human Services Agency and chair of the Big Cities Health Coalition. Wilma. And Judy, Wilma may not be with us right now at the moment, but Christina is prepared to give her remarks, and Christina, you just need to unmute your line and show your video. Great. Christina, if you're having problems, send me a chat and- There we are. Great. Good morning. Thank you, Judy, for that introduction. Dr. Wooten was held up this morning, so I'm gonna share a few remarks on her behalf. I'm Chrissie Juliano, the executive director of the Big Cities Health Coalition. BCHC is a forum for leaders of America's largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the more than 60 million people our health departments serve. We wanna thank CDC Foundation and our partners at ASTHO and NACCHO in planning this very valuable summit and for the opportunity to be part of the welcome this morning.

Dr. Wooten was gonna talk about that she has been a health officer for over 20 years in the County of San Diego, and I would say that many of our members have these long tenures, and during that time, they have worked with so many amazing, passionate, dedicated, hardworking individuals, many of whom whose life work really is public health and to improve the lives of others, and as so many people here today know, often anonymously and behind the scenes, and really, in the past 21 months, they've made so many personal sacrifices for the greater good. Make no mistake about it, the past two years or so, it's been the greatest challenge of many folks in public health, their lifetime, professionally and personally, because of the pandemic. The reverberations and the challenges, the opportunities will really be felt for years to come and I think that's a key point today, the opportunity to continue to build upon the experience of the past two years and think about what we need to do to better the public health system across the entire country in all levels of government.

We all know that public health jurisdictions at the local, tribal, territorial and state level could not have responded to COVID-19 as effectively without the workforce that we've had, and I know that Dr. Wooten wanted to recognize, and I will do the same on her behalf, to really thank and acknowledge the public health workforce for all that they and you that are here on this Zoom have done today and will continue to do, the critical work that you do. I will just close by saying as we work through these summits, together, we all need to make sure that policymakers, philanthropy, elected officials, public health leaders really understand just how vital the public health workforce is and that we need to invest in that workforce, and not just with dollars, but all the other resources that we need to ensure that they and we can all do our jobs effectively.

Thank you. Judy, I will turn it back to you. Thank you, Chrissie, and so now it is my honor to welcome and introduce Dr. Rochelle Walensky, who is director of the Centers for Disease Control and Prevention. Dr. Walensky became the 19th director of CDC and the ninth administrator of the Agency for Toxic Substances and Disease Registry in January of this year after serving on the frontline of the COVID-19 pandemic as chief of the division of infectious diseases at Massachusetts General Hospital from 2017 to 2020 and professor of medicine at Harvard Medical School from 2012 to 2020. Dr. Walensky is an influential scholar whose pioneering research has helped advance the national and global response to HIV/AIDS. She is also a well-respected expert on the value of testing and treatment of deadly viruses and has conducted research on vaccine delivery and strategies to reach underserved communities. Rochelle, welcome to you. I know this is an especially important topic for you and also an especially busy time. We appreciate you being with us today. Over to you. Thank you so much, Judy, and to all of you for that kind introduction, and yes, this is near and dear to my heart and so very critically important.

I really wanna thank the CDC Foundation for convening this series of meetings on the public health of our future, a topic that's been on my mind long before I was arriving at the CDC. As you noted, you may know that the story of how I came to public health, I was a resident in Baltimore at the height of another grim period in public health and that is the HIV/AIDS pandemic, and that, I realized that in public health, you could reach an entire population at a time, and that with science, and you could do so with science-informed policy. In the decades after, I worked alongside public health professionals to improve the lives of those living and at risk with HIV and sharing their concerns as their funding was cut and their needs were ignored. I'm sure that all of you know the statistics from a pre-pandemic study that found that over the past decade, the public health workforce has shrunk by nearly 60,000 positions, primarily due to stagnant or decreased funding, and we're here today because we agree we never again wanna see public health in the position we were at at the start of this current pandemic.

With my appointment as CDC director, now almost a year ago, came a platform to talk about what it will take to create a strong, diverse public health workforce, and that platform has included six opportunities to address Congress on this very topic, and I think I have another one about to happen. We have acutely felt every single one of the public health jobs we have lost, and while the pandemic demonstrated the resilience and commitment of the public health community, it also laid bare the gaps resulting in the decades-long erosion of workforce support. We recognize that the heart of the public health system is in fact its workforce. We need the right people in the right place with the right training at the right time to protect Americans from public health threats.

Without the right people, laboratories are just rooms of equipment, and without the right infrastructure, public health data are just numbers on a page, and without the right coordination, vaccines and other lifesaving interventions simply sit on a shelf. We must build a robust public health workforce, a workforce that is appropriately trained, that is technically expert and reflective of the diversity with the communities that they serve. We must provide stable resources that allow public health departments to adequately recruit, compensate and retain their public health workforce with adequate flexibility to respond to the emerging threats and needs, and perhaps most critically, our funding has to be disease agnostic. It must be that the person you hire for X disease can also work on Y disease. We must leverage skills in one area so that they can be used at any moment in time for another. The value of this has long been apparent to all of us, all of you in public health, and this pandemic has made that crystal clear to others.

When we needed to do contact tracing, who would we call for help? The community health workers in our sexual health clinics. Imagine how we can improve health if those some community health workers could provide nutritional consults and blood pressure checks in their local church or senior center. The good news is that there's now cause for hope. On May 13th, 2021, the president announced the investment of $7.4 billion from the American Rescue Plan to recruit and hire public health workers to respond to the COVID-19 pandemic and also to prepare us for future public health challenges, and I'll mention just a few ways those funds are now being used. Through CDC's Crisis Cooperative Agreement, $2 billion was awarded to state and local jurisdictions to support public health staffing in areas of greatest need, including vaccinators, laboratorians, doctors, nurses and others.

At least 25% of those funds will be used to support hiring school nurses and other school health personnel. CDC's investing $1 billion over 5 years to increase state and local capacity to conduct case investigations, contact tracing, outbreak response, and to link people to care and treatment for COVID-19 and other infectious diseases, with a focus on strengthening the disease intervention specialist workforce. CDC will partner with the Corporation for National and Community Service to launch Public Health AmeriCorps. This innovative $400 million program will recruit and build a new workforce ready to respond to the public health needs of the nation and provide public health service in their own communities, opening the door to a public health career to a new generation. This initial investment is expected to create up to 5,000 new Public Health AmeriCorps positions over five years. CDC will expand and build on CDC pipeline workforce programs and fellowships through a $245 million investment, which is expected to result in an additional 1,200 graduates from programs such as the Public Health Associate Program, CDC Undergraduate Public Health Scholars, the Epidemic Intelligence Service, and the Laboratory Leadership Service.

The American Rescue Plan also allows CDC to make an unprecedented investment of $3 billion grant to build a public health workforce that represents the communities in which they work. Importantly, this grant program will offer jurisdictions funding to move from their urgent short-term goals to a sustainable forward-facing approach providing staff hired for the COVID-19 response an opportunity to continue their careers beyond the pandemic as public health professionals. That is just some of the funding that has become available thanks to Congress and our nation's investment in resources to help us respond to COVID-19 and the public health challenges that are certain to follow, and the investments are not just at the national level. Calling the state's public health system its Achilles' heel in the state's economic recovery and resiliency, Indiana governor, Eric Holcomb, established a public health review commission, with Dr. Monroe as its co-chair, tasking the commission with identifying ways to better support public health, reduce health disparities, and ensure that where you live will not be the determining factor with regard to your access to the public health services you receive.

The governor asked that their recommendations be ready for consideration by the Indiana General Assembly ahead of the 2023 state budgeting process. The North Carolina Institute of Medicine created a Task Force on the Future of Local Public Health, which is being co-chaired by Dr. Leah Devlin, chair of the board of the CDC Foundation and professor at the University of North Carolina Chapel Hill, along with Lisa Macon Harrison of Granville Vance Public Health and president of the National Association of County and City Health Officials, and you just heard from Ms.

Harrison, John Lumpkin, president of the Blue Cross Blue Shield of North Carolina Foundation, and Vicki Lee Parker-High, executive director of the North Carolina Business Council. Their charge is to develop a vision for the future of local public health in the state and the recommendations it will take to achieve that vision. The work of the task force is happening in conjunction with a special initiative, the North Carolina Association of Local Health Directors, to improve the visibility and influence the public health as a critical part of the state's healthcare delivery safety net infrastructure, supported by a grant from the Kate B.

Reynolds Charitable Trust, and the Hudson College of Public Health of the University of Oklahoma launched the Achieving a Healthy Oklahoma initiative and has gathered community leaders to develop policy recommendations that will help Oklahoma prepare for future public health emergencies and improve the health of the citizens of the state. The hope is that this proactive approach will lead to an expansion of public health infrastructure and workforce, strengthened partnerships at the federal, state, and local public health agencies, evidence-based policy development, and a reduction in health disparities.

Recently I had the opportunity to hear from Dr. Tomas Aragon, director of the California Department of Public Health, serving the 40 million people of his state, about how his office has been able to use some of the funds from the American Rescue Plan to strengthen California's public health workforce. The ability to upgrade their technology infrastructure was an enormous benefit which allowed them to use their staff more effectively. Now they have five systems that work together, CalCONNECT, myturn.ca.gov, CA Notify and CalREDIE and CAIR, systems that cover everything from online vaccine appointments and vaccine inventory management, to using mobile devices to anonymously identify close contacts and includes their disease and testing surveillance system.

The new outbreak management system, CalCONNECT, also allows them to do case investigation and contact tracing virtually and helps thousands of new staff do contact investigations throughout the state. They even created what they call a virtual assistant within the system so that when there were surges, some investigations could be automated through texting, allowing staff investigations to focus on the more difficult cases. It also allows for cross-jurisdictional case management and contact tracing, say, for example, when a person works in one county but lives in another. At the end of the geographic spectrum, Robert Kirkpatrick of the Milam County Health Department in Texas, population of 25,000, has been able to grow the department's 10 employees to 18, which gave them staffing to conduct 4,000 case studies, an increase of 3,700 over what they would've been able to do before the additional funding. They were able to implement and conduct approximately 4,000 COVID tests and to increase their capacity to provide vaccinations, scaling up from providing 1,000 vaccinations per year to being able to provide 10,000 vaccinations, critically important once COVID hit.

The increased capacity was vital to the county's COVID's response as the two hospitals in Milam County closed in December 2018. As we think about a diverse and effective public health workforce, we must remember that resiliency is a key factor. An underfunded, understaffed, underappreciated, and misunderstood public health workforce with public health officials often attacked verbally and sometimes physically, deserves our collective attention to promote healing and recovery. You were welcomed today to today's summit by Dr. Anne Fink, chief medical officer for the Alaska Department of Public Health. Just a few weeks ago I heard her say, "Our public health workforce needs to hear from us that their frustration and feeling of being burned out is not their failure but our failure to have a system that supports their humanity and diversity," and Dr.

Zink added, "Sometimes just offering a simple thank-you makes a huge difference." In today's summit, you will hear from more public health leaders about what has been successful for them and where there is still much work to be done. Federal dollars can only go so far. How are states and local governments supporting building an infrastructure that is diverse and effective public health workforce, and how are we making sure that equity is at the underpinning of every single thing we do? And I hope there will be conversations about how we will measure our success. I believe that measurement should not be about how well we are doing to better support blood pressure control, although that is still an incredibly important measure, but about how well we are expanding the public health workforce with staff that look like the people in the communities they serve, and how well are we prepared for the next pandemic? I believe this summit is an opportunity for us to renew our energy for the work that lies ahead. It's a very real pleasure to be with you today among those who are working every single day to build a better health infrastructure for our country.

Let me extend my gratitude to each and every one of you, our nation's public health community, for your continued support, and indeed, for your tireless efforts. We are looking forward to charting a course for our future so that together we can build back a healthier and a safer nation. Please know that CDC and I am committed to being your partner in this work, and I really look forward to learning all that you have. Thank you so much. Thank you for your leadership, Dr. Walensky, and we all look forward to working with you as we strive to develop actionable approaches to enhancing our public health workforce, help protect America's health, safety and security. Thank you so much. We're going to make a little switch here and go to a poll question to get the audience interaction here, so if you all could answer this poll quickly. The question is, who have you had success with in moving your public health agenda forward by working with intermediaries or others, such as public health institutes, foundation or academia? That's the question and you can select all that apply, and we'll give this a moment and then we're gonna put the results up momentarily.

Okay. We have the early results from this poll, and here we go. Look at this. The lead actually is local, state and regional foundations, has a little bit of a lead over academia, and then pretty even between public health institutes and national foundations. Really goes to show the importance of all of these, I think, with this distribution, but certainly what's happening in your own areas. We're going to now move to our first panel discussion of the day and focus on how we got here and a way forward for public health, with a particular focus on the workforce, which we're all here to discuss today. As a reminder, continue to post comments in the chat. I see that we've had a very active chat, and leading this first panel, I'm very happy to introduce Dr. Georges Benjamin, who is the executive director of the American Public Health Association.

Georges, thank you for joining us today, and I'm gonna turn it over to you to introduce the panelists and for you guys to get into a robust discussion. Thank you. Hey, Dr. Monroe. Thank you very much for allowing me to spend a little bit of time with you today. We have an actually amazing panel. I have two panelists. My first panelist is Dr. Nadine Gracia. Nadine is the president, CEO of the Trust for America's Health, and I'm gonna ask her to talk a bit about Public Health 3.0 and, of course, the new Essential Public Health Services, and our second panelist is Dr.

Anand Parekh. Anand is the chief medical advisor for the Bipartisan Policy Center, and they just put out a new report called Public Health Forward, and we're gonna ask Anand to talk a bit about that. As we think a little bit about this update for both the 10 Essential Services and Public Health 3.0, Dr. DeSalvo and Cardica pointed out that many of our public health agencies, quite frankly, don't have the capacity, are not really configured to really deal and deliver those 10 Essential Services. Let me just ask both of you, really, what are some of the suggestions that we have to strengthen the public health workforce to better position us for health equity? Georges, would you like me to start? Yes, Nadine, would you please start there. Yes. Okay, great. Thank you and it's wonderful to be with all of you today, and I just wanna acknowledge as well Dr.

Judy Monroe for her leadership with this summit and our colleagues at ASTHO, NACCHO, and Big Cities Health Coalition for leading and hosting this summit and all of our partners. Such a pleasure to be in this discussion with Dr. Benjamin and Dr. Parekh, who are longtime colleagues. At Trust for America's Health, just to share a little bit about our organization, we are a nonprofit, nonpartisan public health policy research and advocacy organization that's based in Washington, D.C., and we have long been advocating to strengthen the nation's public health system at all levels and providing policymakers with evidence-based policy recommendations to do so because of the very reasons that you're hearing about with regards to how critical the public health workforce and our infrastructure is to assuring and promoting and protecting the health of the nation, and when we talk about where we are now, such a critical moment in history, of the history of our nation, that we are at such a pivotal moment where we can truly help to transform, strengthen, modernize our public health system, and that importantly means addressing the needs of the public health workforce.

Georges, you talked about specifically with regards to Public Health 3.0 and certainly some of the efforts with regards to where we are in seeing public health being able to address cross-sectoral issues, as you noted with regards to the capacities and the resources, because we know that our health is impacted not only by the care that we receive in a physician's office or at the hospital, but by the community conditions and social, economic and environmental conditions, and so with regards to that, it means that we have to focus on leadership and workforce, the workforce ensuring the recruitment and retention of a diverse and inclusive workforce that has the capacities and competencies to address 21st century public health challenges, that we need to have those competencies to be able to address and engage in cross-sectoral partnerships and strategic partnerships that cut across a whole host of sectors, and I'm sure we'll talk about it today, as well as the infrastructure and organizational competencies of these systems and departments, and then the data that are used specifically to be able to drive policies and programs, and then to assure that we have sustainable and flexible funding.

I've been seeing in the chat the need for sustained and flexible funding, and that is an area that Trust for America's Health is doing a great deal of advocacy in. Dr. Walensky pointed to the investments that are being made through the American Rescue Plan Act. There are the opportunities for investing as well in the public health workforce or the Build Back Better Act, which is currently being deliberated in Congress. We at Trust for America's Health, commonly known as TFAH, are advocating for long-term investment in public health infrastructure and workforce through the creation of a public health infrastructure fund, an annual $4.5 billion fund that would support long-term cross-capabilities to support health systems, public health systems at all levels, at the federal, state, local and territorial systems and tribal health systems to assure that we have the workforce that can meet these 21st century needs. Excellent. Anand, you folks, your report also picked up and talked a great deal about workforce. That's right, Georges, and thanks to you and Nadine for your leadership, and Judy and the CDC Foundation, and really to everybody who's listening today, all of our public health workforce, and you all are heroes.

We had this that we thought we lost the 60,000 workers and there's been some discussion. The de Beaumont Foundation and others put out a report that talked about the need for another 80,000 workers at a minimum. It's clear that we don't need the same kind of workers as we go forward. We need to really try to build the system right and we also wanna have a more diverse public health workforce. Let's hear your thoughts about how we build that workforce to really meet the needs of the changing environment in which we have 21st century public health to work for. Nadine. To begin, I will say, one, it's certainly increasing recruitment of the workforce and ensuring that's there actual greater outreach to assure that students and people in the pipeline actually are aware of public health. Obviously public health is certainly at the front lines of a lotta the national dialogue now because of the pandemic. We need to assure that students and people that are early in their careers are aware of public health opportunities, and in particular, governmental public health, and that means that we have to be very intentional and strategic about the organizations and entities to whom we do that outreach and recruitment.

That's partnering, for example, with academic institutions such as minority-serving institutions, like historically black colleges and universities, Hispanic-serving institutions, tribal colleges and universities, and Asian American, Native Hawaiian, Pacific Islander-serving institutions, working with organizations that have outreach into the very communities that we are trying to serve that have longstanding trust and relationships with those communities to raise awareness of these opportunities, and that we have internships and fellowship programs that are equitably accessible to a diverse pool of candidates and assuring, for example, that those internships and fellowships are also paid because the very workforce that we may be trying to recruit, if there are not opportunities to assure that they can actually afford to be in those types of internships and partnerships, then we're just perpetuating some of the inequities that we see in our nation, and we see some examples of great internships and fellowships, such as what has been mentioned before, like CDC's CUPS program, the Undergraduate Public Health Scholars program, and there are a whole host of others that we can also invest in, and we have to ensure that it's not only public health but other sectors that are seeing this as an imperative and working to address this.

It's academia, it's the business sector, and certainly it is public health and healthcare, but also in philanthropy and nonprofit organizations that we assure that we increase that outreach and engagement, and with regards to retention, build the skills, provide the network, and support an inclusive and welcoming environment to a diverse workforce. Recently ASTHO has partnered with the Satcher Health Leadership Institute at Morehouse School of Medicine with support from CDC to launch a Diverse Executives Leading in Public Health, a DELPH initiative, which aims just to do that, strengthen the capacity and the network, especially for public health professionals who are at mid career to be able to expand their opportunities, because one of the strongest things that we can do with regards to, in particular, addressing health inequities is also to strengthen the diversity of our governance and leadership when it comes to our governmental public health system.

Thank you. I'm gonna go back to Anand. I know he was talking about his report and obviously the idea of building a workforce a little differently than we've talked about in the past. Yeah, that's right, Georges. Sorry about that technical difficulty there. I think over the last six or eight months in Washington, D.C., the buzzword has been infrastructure and we hear about roads, bridges, tunnels and the electric grid, water, energy. We've heard about just about everything and I think it's time that we communicate to the nation as well as policymakers that if public health isn't part of our nation's infrastructure, I don't know what is.

It's exactly what everyone takes for granted and yet it's necessary to assure the conditions that populations can be healthy, and as, I think, Nadine said, there is a potential down payment in terms of the public health infrastructure in the Build Back Better legislation, and I think when we talked about public health infrastructure, what we're really talking about, the most important aspect, is investing in people and investing in our workforce. That's exactly what's needed to ensure public health capabilities occur, to ensure that our public health foundational areas, the work of public health is done, and that was really the essence, Georges, you mentioned this, of what was released last week by a bipartisan task force of the Bipartisan Policy Center, our Public Health Forward task force. This was a group of local, state and federal current and elected officials who came together, as well as multi-sectoral leaders too, came together and said, "Let's chart a five-year vision for governmental public health in the United States and an actionable framework for state and local elected officials and public health officials," and this was work done over the last nine months, which really included all of you through focus groups and surveys and town halls and round tables and advisory group meetings.

This wasn't meant to be a top-down Washington, D.C., process and I think what was put together last week included some high-level recommendations, some of which focused on workforce, exactly the ideas that Dr. Gracia just talked about related to recruitment and retention, doing assessments and building pipelines, as well as then improving hiring and promotion and competitive pay and merit pay and building learning environments, so many of the things that you've heard about that you'll be discussing today is exactly where this bipartisan public health task force came out, and I think as we think about leveraging the investments that are coming our way from the American Rescue Act as well as COVID relief dollars, I think that's important, but we also need to talk about the long-term sustainable funding and that's where the public health infrastructure funding comes into play.

I think we're at a really critical time. I think this conversation is absolutely essential and this is our time to explain to policymakers as well as the nation that without the public health workforce, public health can't do its work. Public health doesn't do its work, we all suffer, and so I think it's an important conversation we're having. One of the challenges we've had, we've seen this picture before. Something bad happens, they throw some money at it. Sometimes it's enough, sometimes not, and sometimes more than we need in a short period of time but usually not in a sustainable way. The problem gets controlled but not completely goes away. The resources then dramatically go away, but the performance expectation extends far beyond both the money or the event.

How do we prevent that, and advocating building for that public health workforce is gonna be so important to keep this issue on the minds of Americans. I saw an article in "The Wall Street Journal" that pointed out the fact that, surprise, surprise, public health events can crash the economy. How do we make sure that people understand the return on investment when we advocate for public health? Georges, I think you highlighted such a key issue, that boom and bust cycle of funding, that the emergency happens, the crisis happens, you get the influx of funding, and then after the emergency, it's directed elsewhere or the funding ends, and so I think that's a critical reason why each year in our annual funding report, we are advocating specifically that we need long-term investment in public health infrastructure, and that entails, as we're talking about, these cross capabilities, the public health foundational capabilities that are not specifically categorical funding for specific diseases which are important but not sufficient to be able to build the foundation of public health that we need to assure that we have the assessment and surveillance, to assure that we have the communications capacity, the community partnerships and the policy development that is going to be needed, and so while we have these current legislative efforts that are underway that are important to providing that down payment, we have to continue to advocate at all levels, to be clear that when we make these investments in public health, that it actually is a benefit not only to the health of communities but it also is an economic imperative, as we're seeing as an example through this pandemic, that it's also addressing the inequities that we have long seen in our country, and to know that the messengers don't always have to be the public health officials, but we also need to be able to encompass other leaders who can be able to speak to the importance of building and strengthening the public health system and serving as partners in that regard.

We have reports, for example, that are talking about policies that policymakers themselves can be implementing that show the health and economic evidence when you implement policies that even go outside of the healthcare sector that are related to promoting health and cost control in states. When we can tie these messages around health with economic impact, as well as a story of direct, how it's directly impacting communities, these can be powerful tools in which we can actually raise awareness of the importance of investing in public health, but it's gonna take all of us, really, to be able to champion those messages and to not lose sight of this as we continue to navigate through the pandemic, that we have to continue to then explain what does public health do on a day-to-day basis, because often public health is invisible outside of the crisis and yet we know how important and critical public health is on an everyday basis to promoting and protecting community's health.

Absolutely. Absolutely. Anand, your report talked a great deal about partnerships and how to bring those unanticipated messengers in a nonpartisan slash bipartisan way to the table. You wanna talk a bit about that, particularly from the support and advocacy perspective? Yeah, sure, and getting back to the prior question, I think Nadine's exactly right. I think the messaging has to be around jobs, think the messaging has to be around trust and that starts locally and that helps with our health equity challenges as well, but it's also about the message and the messenger.

It's the message getting out of our public health speak talking about what families want, whether it's clean air and clean water and injury prevention and disease control, and then it's the messenger. It's not only us, but to your point, Georges, the partners out there, the business community, the faith-based community. They're critical partners, the healthcare community, sectors including food and housing and transportation.

I think we all work with all of these sectors, but having them as allies, being spokespersons helping us as we talk to state legislators or we talk to other policymakers about the importance of the work of public health and sustainable investments needed for our workforce I think is absolutely critical. I think redoubling our efforts in partnering with various sectors, various stakeholders I think is gonna be really important for public health. It's gonna be really important also to meet our health equity challenges as well. One of our challenges, of course, is defining who we are. We always talk about our best work is done when nothing happens, and of course, when nothing happens, nobody wants to support anything, and then when something does happen, the first response of people is to blame the messenger. It is to sit here and say, "Okay, how did that happen?" and not understanding their own culpability in the lack of investment or engagement, and we had this webinar the other day as part of your program, Anand, where we, Governor Kasich and I, had this important conversation about what public health is and I was fascinated when he said, "We gotta do a better job of telling people that public health is about clean air and clean water and making you safe." How do we get the messaging right? Because at the end of the day, I think we all used to chuckle about the fact that we are all in public health, but even our family members didn't know what we did.

Yeah, no, I think it's great, a great question, and it reminds us, and I've said this before, very elementary, which was told to me first before assistant secretaries now who I worked under, that public health is made up of two words and we focus a lot on the health part, as we should, the evidence, the science, the interventions, the implementation, but if we don't focus as much on the public part, the populations that we're trying to serve, understanding their aspirations, their perceptions, what they think about issues, if we're not able to meet them where they are, if we're not gonna be able to partner with them, we're not gonna optimize the population health that we all wanna see, and so I think, Georges, it's about redoubling our efforts in how we partner with the populations we serve, and it's not what you do with communities, it's not what you do for communities, it's what you do with communities, and then I think it's also making sure as we talk to policymakers and others and partners, explaining what it is public health does in a way that people can understand.

I know this has been a perennial issue, but certainly I think we all agree that public health communications has come to the forefront, terms of how we explain our field. The work that we do, so important. And I know that, Nadine, Trust for America's Health and I know APHA and we've partnered on lots of things to really, we do sign-on letters and we advocate together and we've gotten a whole range of big coalitions to call in, knock on doors on the hill, and now that we're doing everything virtually, virtually to engage members of Congress and other elected officials, but it doesn't seem to be that's enough. What's the next phase of our work here? What do we need to do to have the clout that when public health speaks, they all listen? And I'm at the point, in many ways, of saying, "I told you so," when we talk about the return on the investment and the crashing of the economy because COVID certainly has been an equal opportunity disease. Georges, you raise an important point because we say we've been here before.

Obviously this is an emergency and a global pandemic that is unprecedented in a century's time, but we have been through these emergencies before and it's critically important that we continue to engage in that advocacy and share the data, share the evidence, but also bring the story and bring the narrative that can help to compel action, but I'll tie back to some points that Anand had raised with regards to the messengers and the importance of communications.

One is to recognize that we should also involve, as far as those strategic partners are the communications experts, because even as we've been communicating through this pandemic, we recognize how information can be misconstrued, how to assure that information is actually being conveyed in a way that it reaches the people that we're tying to reach and understand that, to assure that it's culturally appropriate, that it's linguistically appropriate. The same goes with regards to really explaining who public health is and why it's so important that we have a strong and robust public health system which is inclusive of having a diverse workforce.

That sitting down with community and community leaders and faith leaders, other organizations who have trust in communities that also do that type of direct engagement and advocacy with leaders, with legislators, with other policymakers and decision makers, with the business community, with healthcare system leaders and others to really be able to build that kind of a narrative that shows that when public health suffers, the nations suffer, communities suffer, and you see what we're seeing now within the context of the pandemic and that there will be another emergency unless we actually address the gaps and the weakened infrastructure and assure that we have a strong and robust public health workforce. When we face another emergency, we will see the same challenges that we are experiencing now in the context of the pandemic. One of the things we now know is that public health, of course, we do our work, quite frankly, through policy change. Our best work is also done when we make great policy change, but policy is politics. It becomes very political very quickly, and we often say, "We really don't wanna play the political game," but we have to work in a political environment.

We have to understand, I think, how to work in that political environment and maintain the respect and trust of all of the people that both provide us oversight, our elected officials, our bosses, as well as the public. How do we make sure that we have a workforce as we go forward? And of this, now we've identified a highly charged political environment. How do we build that workforce in a way that we maintain our trust and respect, and of course, put the public back into public health, because the only reason we do what we do is to make sure people are healthy and that the public gets the best outta what we do. I think two things come to mind, Georges. The first, of course, is while each of us may have our individual ideological bent, as public servants, we have to realize of the people we serve, roughly half the people may have a little bit of a different ideological bent, and as we advocate, in terms of policymakers, roughly half will have a different ideological bent.

I think we have to redouble our efforts and appreciate that, and then in terms of the workforce, I think the best workforce is the workforce that comes locally, where there's trust. At the end of the day, that's the most important word in this discussion. How do you build trust? And as we can build pipelines at the local level to engage in public health and be public health leaders who really already have the trust of community members, I think that's how you partner with the public locally, and so I think it's just really important.

I think federal programs are gonna be absolutely important, but at the end of the day, the building of trust and ensuring that the workforce represents the communities, it's gonna be critical for that local leadership, but certainly it requires federal and state support for that to happen. Georges, just to add to the important and great points that Anand raised, we've seen this, certainly as you said, with regards to the pandemic, and when we were seeing, in particular, just the politicization of public health and the messages that were coming across, Trust for America's Health partnered with the CDC Foundation, the de Beaumont Foundation, and with supporting organizations such as yours at APHA and others to launch this Public Health Communications Collaborative to help support local and state health officials to be able to communicate specific messages, especially in such a climate where politics were really challenging the public health messages, especially for an evolving pandemic, and providing resources to help support that messaging and being able to then get those messages to other trusted messengers in communities, whether it was how to answer some of the tough questions that communities are raising and where that might be politicized, to having graphics as well as addressing misinformation, all of these types of tools.

This is how we have to continue to be able to be flexible and nimble and to assure that we have these kind of cross-capable, cross-functioning capabilities when it comes to the ability and skillsets of the workforce to be able to operate in climates such as these. We certainly don't want to see inappropriate political influence with regards to the decisions that have to be made in public health, but we know that, yes, politics is there, is present through these crises as well as in the day to day, and so helping to provide the resources and capacities to our workforce to be able to address those are important and that's some of the ways we've been addressing that through the Public Health Communications Collaborative.

Listen, I want to thank you both for this important conversation. We've got our work to do. We know that we have lost over 60,000 workers, that we need more than 80,000 workers as we go forward. I think what I heard today was that we need to build this system differently. Obviously, the fundamentals are people who are well-educated, skilled in their disciplines, but trusted in their communities. They're from community with partnerships across the sector and engagement with our elected officials, and I know that one of the big things we've gotta do is figure out how we build a new way of partnering with our elected officials, because somewheres along the way, that got lost in this crisis that we had called COVID. I would also encourage all of us to spend some time just listening more than talking and engaging with our elected officials across the political spectrum so that we have a joint mission, 'cause at the end of the day, our goal is to ultimately protect the public's health.

Dr. Gracia, Dr. Parekh, thank you very, very much for your time, and I'm gonna turn this conversation back over to Dr. Judy Monroe. Judy. Thanks so much to all three of you. That was a wonderful discussion, and I gotta tell ya, the chat is really, really robust. We are going to have so much information from all of you participating today responding to the speakers, but also with your suggestions in how we go forward in this moment in time. We're gonna take another moment here to have a poll question, but your question is, many jurisdictions have received an influx of federal funds to support the public health workforce. How is your jurisdiction using these funds? And again, you can select all that apply, and we will, and we don't have the music playing while you're answering, but we'll go for it. And we should have at least the early results here. Have folks voted? Are we ready to take a peek? And there you go, so we're talking about workforce.

The largest percentage in answering this was, in fact, hiring new staff, supporting operations and infrastructure, which is really great to see, and as I think we've all heard, we need sustainable funding for those, for the infrastructure in our workforce, but it's pretty evenly distributed. A lot of funding going to different things. Okay, so moving on, I am very pleased now to welcome to our virtual stage Dr. Patricia Simone. Dr. Simone is the director of the Division of Scientific Education and Professional Development at CDC, where she leads public health training and education programs as well as efforts to strengthen the public health workforce, from training the current workforce, to offering in-depth, on-the-job fellowships, to attracting students and early career professionals to the field of public health. She joined CDC in 1992 and has since held multiple CDC positions, including in 2020, from 2020 to 2021 serving as the acting deputy director and subsequently the acting director of the Center for Surveillance, Epidemiology, and Laboratory Services during CDC's response to the COVID-19 pandemic. Pattie, the stage is yours, and welcome. Thank you, Judy. I greatly appreciate CDC Foundation hosting this summit and I'm very pleased to be here today and to be part of these important discussions as we shape the future of the public health workforce.

I think you'll hear some similar themes in my remarks to what's already been discussed today, but I look forward to learning from all of you in the discussions that follow. Next slide. As you've heard, the public health workforce is our first line of defense against disease outbreaks and other public health threats, and yet, decades of underinvestment have undermined the public health workforce with shrinking numbers and capacity. COVID highlighted the critical role of the public health workforce in responding to emergencies and the consequences of that underinvestment. There are various estimates about the staffing deficit, as we've already heard, the recent Staffing Up report which estimated the need for an additional 80,000 full-time staff just to provide minimal public health services, but, next slide, when we talk about rebuilding the public health workforce, we can't just think about staffing.

We need to include all parts of workforce development, such as recruitment, hiring systems, fellowships and other pathways, training and upskilling, data to understand what is needed, and diversity, and yet, next slide, public health has fallen behind in many important areas of workforce development. For example, skills have not kept up with changes in technology and we don't have the systems and data to assess and monitor what's needed. There are issues with diversity and hiring barriers exist at federal, state and local levels. Funding is the first step in solving these problems, but even with increased funding, substantial barriers remain. Next slide. The American Rescue Plan specifically addresses expanding the public health workforce. The ARP policy announced in January proposed expanding the public health workforce by 100,000 to address the needs of COVID and build long-term capacity.

The legislation passed in March provided $7.66 billion to the Department of Health and Human Services for expanding the public health workforce. Some of these funds have been allotted to CDC. Next slide. We are now at a critical juncture, and looking forward, we have a great opportunity to make important progress in workforce development. We can't make up for 20-plus years of infrastructure erosion overnight, but there are critical issues on which we must make progress. We can think of the way forward for state and local public health as a three-pronged approach: bridge, build and sustain. First we have to bridge with innovative interim solutions to address urgent needs. Building on lessons learned during COVID, we need to implement a combination of interim solutions, such as through public-private partnerships, and while federal solutions aren't going to replace the 80,000-plus deficit, they can help in the short term while we learn more to understand what is needed and identify solutions for the long term.

Then we need to apply what we learned to build the public health workforce with hiring by state and local jurisdictions to start reducing reducing the staffing deficit, but longer-term solutions will be needed to sustain the public health workforce, including reliable, ongoing federal funding and commitment at the state and local levels. Next slide. Two examples of bridge activities include CDC Foundation funding to hire staff to be placed in jurisdictions, building on a very successful smaller program last year, and a two-year funding through the Crisis Cooperative Agreement to support staffing, including school nurses.

Next slide. Three examples of building the public health workforce include a five-year program to fund disease intervention specialists in jurisdictions to support contact tracing and outbreak response for COVID and more broadly. We are very excited about Public Health AmeriCorps, a new pathway program in partnership with CDC. Grants will be made to organizations who can recruit and place over 1,000 members per year in public health jurisdictions and who reflect the communities they serve. We will also be expanding some of our most successful CDC internship and fellowship programs, as you've already heard, such as the Epidemic Intelligence Service and other programs where young professionals are placed in public health jurisdictions to support response activities and help build capacity. Next slide. To begin to move us to a more sustainable approach, CDC will launch a new grant program focused on public health workforce.

This is a unique opportunity to address workforce needs broadly across the jurisdiction rather than categorically by disease or being now disease agnostic, as Dr. Walensky said. There will be a focus on building a workforce that represents the communities they serve. We are beginning to schedule listening sessions to get input from jurisdictions and other partners to inform the design and focus to make sure this program will be successful, and I will talk more about that in a moment. I also want to emphasize that rebuilding and sustaining the public health workforce can't rely on federal funding alone. It will also need a commitment from state and local jurisdictions to develop plans to spend the large amounts of federal funds already awarded, address systemic barriers that have led to the current state, and develop plans to rebuild and sustain the public health workforce long term. Next slide. We're at a time of great opportunity. There is a lot of funding, but now we have to deliver. It is not as simple as having money to hire.

We need to modernize antiquated hiring systems and conduct comprehensive workforce planning. We need to focus on professional development, mentorship, and training for the needed strategic and technical skills. We need to work with academia to give more students applied learning experiences to better prepare them for jobs in public health and figure out how to get more of the large number of public health graduates to choose public service and jobs in governmental public health. Through pathways like Public Health AmeriCorps, we can reach a more diverse group of students who previously never considered a career in public health. We need to strengthen recruitment with a focus on diversity and health equity and address the important role of student loan repayment and loan forgiveness for public service. There can be a lotta pessimism about whether anything can be really done about the hiring systems in government, but venues like this can be incredibly important to provide the opportunity to hear from jurisdictions who have had some successes and share best practices and lessons learned with others, like we are doing today.

As we design the new workforce grant, we want to incorporate those lessons learned and gather other input to make the grant successful and contribute to sustainable solutions. We started with some internal listening sessions to see how this can complement existing CDC categorical programs and other emergency funding programs. Next slide. What we heard from our CDC colleagues was the need to ensure flexibility to account for different jurisdictional needs and capacities and to conduct needs assessments during the initial stages of the grant.

Given the large number of other CDC and federal programs, we need to map related activities and resources to ensure the grant will complement and leverage existing programs. To increase the availability of skilled staff, the grant should support a variety of options for hiring, recruiting, training and upskilling, and we must coordinate and collaborate with academia, public health partners and other federal agencies to improve hiring and recruitment and support future sustainability. We are currently scheduling external listening sessions which will involve many of you. We will invite representatives from state, local, tribal and territorial jurisdictions, non-governmental organizations, academic partners, national organizations and others. We will also meet with our federal partners to ensure our investments are complementary to existing workforce programs. Next slide. Some of the questions we will ask are, how can we make the grant successful considering the challenges from COVID? How can organizations support sustained success beyond the funding provided? How can this be structured to complement existing funded efforts and succeed in your organization? What types of systems, facilitators, supports or services could CDC or its partners provide to support your organization? And what are the main workforce barriers this can help address? We look forward to hearing your thoughts on these questions in these upcoming sessions and learning from you.

Next slide. Of course, for sustainability, we would all prefer to have reliable long-term funding, but the large amount of funds available now provides a tremendous opportunity to address short-term needs and begin finding sustainable solutions. We need to be able to measure our success and make the case for the long-term investment. I call this approach learning while spending. We aren't trying to rebuild the public health system of 30 years ago, but rather we want to, in fact, build it back better. Many jurisdictions are already trying innovative approaches and we need to support learning communities and other ongoing ways to share what works.

As these new programs are implemented, we need to collect, analyze and use more comprehensive data about the public health workforce and conduct more robust workforce planning and forecasting, and we need to do more to support public service and careers in public health, including expanding student loan repayment. Next slide. Right now, we face difficult challenges but also tremendous opportunities. I think the future is bright. The steps we take now will have an impact for years to come. A strong, diverse public health workforce is essential to address the ongoing work of COVID, and those we hire now will be the public health leaders ready to address the challenges in the future. Thank you. Thank you so much, and I will tell you, in the chat, there was a, I couldn't follow all of it because it was very active, but there was a lot in there about the innovative hiring.

A lot of thumbs up and a lot of support for that. For those of you all active in chat, take the opportunity to put your comments in and answer the questions that Dr. Simone had on her list for the listening session. The more that we collect, the better. We have a couple of minutes left, Dr. Simone. Would you be able to give a little bit more specifics about the grants? Can you dive a little deeper into the funding? Right, so it's still being worked out, and of course, we want to shape the specifics of the grant based on what we learn from the different listening sessions that we're having and from the things we learn today, but it was originally planned that the grant would be over three years. We're hoping that can be extended to five years, which I think would be helpful. I think it will be important to make sure that we can, that jurisdictions can choose to use this funding to support foundational capabilities.

This is one of the unique opportunities we have to do something in a cross-cutting, non-categorical way, and making sure that all jurisdictions are able to address the foundational capabilities with the essential services would be really important, I think, to take advantage of this funding to do that and then can complement all the other funding that's out there and the different programs that are out there. The other thing is, as I alluded to, learning as much as we can, including doing more planning and forecasting so that we can see what's really needed long term. We can make a case for more specific recommendations about what's needed in different jurisdictions and as the nation as a whole so that we're using data more in the public health workforce space to inform these decisions. We made a lot of progress, I think.

The Staffing Up report is a really great first step, but we're really far behind in terms of maybe what is known in the health workforce and we wanna make more progress so that we can be more data-driven in our response to the public health workforce needs. Yeah, thanks for that. I can only imagine folks are applauding to hear you say that there could be funding for the foundational capabilities. Folks have been, for a long time, wanting the ability to do the cross-cutting types of activities. Thank you so much. We really appreciate you joining us today. We look forward to collectively working together with you and the CDC team as we all seek to build and prepare the workforce of the future, and with that, I'm now pleased to go to a spotlight, a feature of our summit today. I'm pleased to introduce Vincent Lafronza, who is president and CEO of the National Network of Public Health Institutes, or NNPHI. For those of you not familiar with NNPHI, they mobilize more than 40 member public health institutes. There is many of them across the country with over $1.4 billion in annual funding, as well as 10 university-based regional training centers and 40 affiliates, so a lotta work being done.

Welcome, Vin, and we look forward to your update for us here in the spotlight. You're in the spotlight. Might need to unmute. It's showing off mute. Can you hear me? Yep. Yes, now we can. Okay, sorry about that. Thanks so much, Judy, and I'm so glad to be here with everyone today. Thank you for everything you do everyday to protect the public's health, all of you on this call. This is one of the most challenging times in modern history. We know that and that's been said by many of the speakers today. I'm so honored to work in this important field, and more than ever I appreciate all of the work that's going around right now with the nation and the globe. On behalf of NNPHI and our growing family of public health institutes and public health training centers, today I'm just delighted to share with you a report regarding the future of public health. Specifically, this report synthesizes recently published literature and highlights tangible recommendations regarding the core components needed to build a modern and more effective US public health system that is capable of protecting and improving the public's health in a post-pandemic environment.

We're trying to get more tactical with this report, and I commend my colleagues at the Texas Health Institute for their dedication to this work. As my terrific colleague, Dr. Benjamin, says, "Public health is a team sport," so this was truly a team effort, but the experts at Texas Health Institute did the heavy lifting in a lightning speed way along with my colleagues at NNPHI who helped us get to the finish line. I would also like to give special thanks to Monica Valdes Lupi and the whole team at the Kresge Foundation for their generous support that made this possible. It's my privilege to work with you, Monica, and thanks for the work that you're doing, Judy, on this whole series with Lights, Camera, Action. In this report, we include findings that appear in the literature only during the period of January 1st, 2021, and October 18th, 2021. This is important because we fully recognize and appreciate that more reports are emerging as we speak, but we believe it was more important to push this out now for you so that you can use this in your own strategic planning with the transformation underway and the unprecedented investments in public health supporting capacity-building opportunities, and we appreciate that this work is iterative and ongoing.

The report assessed 48 publications and is intentionally short, so I encourage you to share this with your full teams and your organizations, all health departments, nonprofit organizations. It's a quick and easy read, but it can help you with your strategy, and we do welcome any feedback. Can I have slide number two, please? It will not surprise any of you in this session that the following seven core areas emerged as priorities for change or improvements, data infrastructure and systems, workforce development, recruitment and retention, funding, public health law, public health policy, multi-sector system partnerships, health department capacity to advance quality improvement, and of course, building trust in public health, and we've heard a lot of those themes today through the different speakers. For the data infrastructure and systems, there are five components of our national system, of course, which is electronic case reporting, laboratory information management systems, syndromic surveillance, electronic vital records systems, and the National Notifiable Disease Surveillance System. All of these systems can be enhanced and there are substantial opportunities that exist to augment our surveillance by building in structural, social, and environmental determinants in social service use, social media and internet-based data.

I've seen some of these comments in the chat today. With respect to workforce development, recruitment and retention, which is what today is really all about, there are tremendous opportunities to strengthen how we all work together to build a workforce for the future. I encourage you to review the suggested strategies in this report, and remember, we are here as a resource for the workforce development for all health departments, so please be in touch with us as we can be helpful to you. We are building more public health institutes now as we speak. Certainly with funding recommendations, we've heard lots in the report about ensuring sustainability.

Enough said on that. Everybody's on the same page. For public health policy and law, it emerges as no surprise coming off of our recent experience with this global pandemic that it's a massive frontier that will require new approaches, local engagement and new partnerships, and it has been also mentioned our partnerships with elected officials have to be strengthened. For our public health system work, so that we can both protect and produce health, we have always needed and now more than ever we need a strong multi-sector partnership approach and a set of strong backbone organizations that support public-private sector muscle building. It will also not surprise you that the health department capacity to advance quality improvement remains a priority for the field. This work is ongoing and there are many resources available to help departments to support this journey. NNPHI has recently released a new resource guide on operationalizing anti-racism, social justice, and health equity principles through performance improvements, so you can check that guide out as well.

It's on our website. We also lift up the need for greater efforts at trust building so we can achieve better health outcomes in all communities. These improvements are within reach, but we will only get there with greater focus and strategy. Slide three, please. In addition, we explored the extent in this report which recent publications included a focus on advancing health and racial equity. Findings suggest that while 44% of the publications reviewed included some mention of equity, only 13% included specific recommendations intended to improve public health system capacity to advance health and racial equity, and 6% of the publications exclusively focused on health and racial equity. Specific recommendations on health and racial equity clustered around workforce diversity, we've heard those themes today, local community engagement, and to a lesser extent, improving data specificity to inform equity-based practice. As we engage in our strategy work for the future, we need to beef up this whole area.

We will be doing a lot with many of you around the country on this area. Slide four, please. The report, along with our first report of a deeper dive that included recommendations from a national expert panel, is available to all. Both can be found online and are freely available for public consumption. Appreciating that we are all drinking from fire hoses right now, for the next phase of our work, NNPHI will be funding the development of a strategy guide that health departments and other public health organizations can use to guide their strategic planning processes in creating the future public health practice. This guide will be based on the findings and expert panel advice, some of the proceedings from this Lights, Camera and Action event today and future events, and the guide will also be available to all. We are all working to build a growing family of public health institutes that are partners of yours and we wanna focus on stronger outcomes-based strategies that address health and racial equity, so we look forward to working closely with you and your health departments and many other public health partners to do this together.

Thank you all for what you do. Reach out to us for technical assistance anytime, and please enjoy the remainder of this Lights, Camera and Action event. Thank you, Vin. Thank you so much for spotlighting this important work and for having this ready for the summit today. Really appreciate this. This is really valuable. Thank you also for all the work that you and NNPHI do in support of our nation's public health system. Now we're going to move to our next panel and we're getting into now a series of panels that are going to really get to the how and examples of how and talk to folks that are on the ground working everyday. This next panel is going to explore how we invest in a diverse and inclusive workforce. Remember again that you can post comments into the chat, and if you wanna share anything on your social media or on your own channels, use the hashtag #LCASummit. This panel will be led by Dr. Rodney Lyn, who is dean of the Georgia State University School of Public Health.

Rodney, I'm going to turn the virtual stage now to you and you all can introduce your panel or have them introduce themselves, and take it away. Great, Judy. Thanks so much. It's really a pleasure to be with you and what looks like hundreds of our colleagues for this vitally important session on Investing in a Diverse and Inclusive Workforce. We've got a wonderful panel of guests with us and I'll introduce them shortly, but I just wanna start by saying that I'm really excited about this topic. It's near and dear to me because here in our School of Public Health at Georgia State University, we're especially committed to making a significant contribution to producing a diverse and inclusive workforce. We train and educate public health researchers and practitioners here, and over the past several years, our school has grown from a small public health program to a fully accredited school of public health, and much of that growth has been a result of inclusivity. We use holistic review in our admissions process, and among other things, this has meant that high test scores have not been sufficient for admission and low test scores have not been a reason for exclusion.

We know that test scores and those requirements have served as a barrier to admissions, especially for individuals from backgrounds underrepresented in higher education, and last year we took additional steps and eliminated the GRE as a requirement for admissions into our Master of Public Health program and our Doctor of Public Health program. We're really working hard and training students at the undergraduate level as well and we're really proud that 69% of our student body are individuals who identify as one of several racial minority populations. Our students here at Georgia State are really talented. They're committed to public health and social justice, and they're really ready to diversify and strengthen the public health workforce. The importance of building a strong, competent, committed, diverse and inclusive workforce really couldn't come at a, be on this agenda and come at a more critical time. Many articles and reports, as well as many of the speakers that have come before me today, have covered some of those challenges that we face in this area, and we know those include inadequate and inconsistent funding for public health, poor retention of staff, insufficient resources for professional development and training, inadequate diversity to meet the most pressing challenges that we face, and those include the enduring inequities and disparities across so many health outcomes.

If we really wanna reach the populations who are in greatest need, we really are gonna need to diversify our workforce at all ranks, and that includes at the leadership level. It's at that level that we really direct resources and determine the best programs, interventions, and messages for advancing population health. The last thing I'll say before introducing our panel is just that key to these efforts is really a need for partnership and collaboration. No one sector can do this alone and I think that's reflected in this wonderful event that the CDC Foundation has organized today. If we're gonna achieve a diverse and inclusive workforce, we really have to bring together state, local and federal public health, NGOs, academia, community-based organizations, as well as the private sector, and we're gonna have to recognize and think about the workforce in new ways and ensure that community health workers and promotores play an important role in that workforce as we go forward.

With that, let me just say we've got three wonderful panelists with us today. Let me introduce them and then ask them to help us think through this topic. We have Nicole Alexander-Scott, health director at the Rhode Island Department of Health, Antonia Blinn, director of performance management and quality improvement at the Massachusetts Department of Public Health, and Maria Lemus, executive director of Vision y Compromiso. Thank you all for being with us today. Let me start maybe by asking each of our panelists to share their thoughts on what successes we can draw on, what we can draw from to increase diversity and inclusion in the public health workforce. Maybe Antonia, I'll start with you. Sure. Thank you so much, Rodney. One area that we are definitely focusing on is our relationships with our academic partners and some unusual partners. I'm going to be talking and responding to questions regarding our Academic Health Department, how we expanded it to include a program that focused on supporting local public health in response to the pandemic and how it has really led to a more permanent part of our workforce development pipeline, really having strong collaborations with undergraduate programs, community colleges, graduate programs, postdoctoral programs because we need people in all levels to support public health both at the state and at the local level.

We had a really strong collaboration because of the Academic Health Department to really build upon and support local public health. We ended up having over 900 students, faculty and alumni coming together to support 138 local communities. In Massachusetts, we have a total of 351. That's a pretty large chunk and that's just in 20 months. We know there's an opportunity to help support those applied learning experiences, as was shared earlier, and the importance of really building a prepared workforce to support our 21st century needs. Great. Thanks. Maria, let me ask you to chime in. Thank you, Rodney, and thank you, Dr. Monroe, for inviting us to join this conversation. I was struck by the words of Dr. Walensky, where she remembered how a community played such a role, an important role, the HIV/AIDS epidemic, and I worked for the San Francisco AIDS office in the County of San Francisco during the late '80s in the epidemic, and at that time, what they found was community was necessary to be able to reach, to send information, education out.

It's the same thing now. We have found that promotores and community health workers have been the essential workers and have been critical in fighting the pandemic and with vaccinations. We've been lauded for our ability to go out into the community to be able to reach those that are hard to reach because we know where to find them, and what we believe and we've always believed, that the integration of the promotor and the community health worker model is essential to a partnership with institutions and with agencies.

Vision y Compromiso has a national network of promotores and community health workers, as well as our alliance of community-based organizations that form a link to be able to educate and advise on how is it that county systems, state systems and federal systems can best develop systems of partnerships. We've been doing this work forever. I started, my mother started as a promotora. Promotores and community health workers at the local level have been around since great-great-great-great-grandmothers and they're in every racial and ethnic group, these wonderful, mostly, women. What we'd like to do is look at the integration of that promotor community health worker model in a way that's sustainable and recognized and is really a true workforce pathway to employment. Thank you. Dr. Alexander-Scott, do you have thoughts? Yes, good afternoon. Hopefully you can hear me okay. I'm also honored to have the opportunity to join and very much appreciate Dr. Monroe and the entire team for being able to contribute. There are examples we can draw on nationally, where you have public health agencies in the US, such as the Centers for Disease Control and Prevention, where we actually are acknowledging the importance of focusing on it and putting in place steps that we all know need improvement to help build on providing that more diverse public health workforce.

Making sure that we're able to identify structural barriers within the public health system that impede diversity and inclusion efforts are certainly key examples of how we need to have attention placed on it, connect with the ability to actually execute now and really put in place steps to implement so that agencies develop specific recruitment and retention guidelines, programming, and other norms within the organizational culture to support a more diverse workforce. The successes of attention paid to it are something we can build on and certainly now need to have the focus on executing, implementing and resourcing it effectively be what we galvanize this attention to really drive us towards so that in the near term, we see immediate improvements but then also address the pipeline with things, as what Maria just shared, with community health workers and so many who have the experience at the community level that are gonna be necessary to really drive effectiveness of a public health workforce forward.

That's great. You mentioned structural barriers and I wonder if you have any examples of things that maybe you've seen done or that you've done in Rhode Island, your team in Rhode Island is doing to try to address some of those structural and systemic barriers that we face in advancing a diverse workforce. Absolutely. It certainly starts with making sure that we recognize what our communities are experiencing. The fact that we don't have a diverse workforce isn't just a passive coincidence that has occurred but being able to actively acknowledge that pipelines have been set up to go in different directions and making sure that we really invest at the community level in elevating the voice of the community, valuing their input and providing resources and solutions that they feel will be needed to overcome some of the systemic barriers in place. The example we like to talk about is our Health Equity Zones initiative in Rhode Island.

That is a place-based, community-led infrastructure intended to create an environment using public health tools, like data-driven, action-oriented plans, implementation and evaluation, to support the community and driving systems and policy changes that we know are needed to address determinants of health going upstream, and that includes supporting the individuals, not only to go on to become elected officials and other key policy or business leaders but also engaging further in the public health and other elements of health workforce where we know they have the experience and just need some of those systemic barriers regarding education, housing, transportation and all of those items overcome to help support the path of an improved pipeline for those to really positively impact our public health workforce of the future. If I could, Maria, ask you to talk a little bit about your experience on funding and supporting your team.

There's some comments in the chat and people are really interested in hearing more about community health workers, promotores, and making the case we need more funding there, so maybe you could talk about your successes and challenges in that regard. Community-based organizations have struggled or continue to struggle with funding, and most of the promotor and community health worker positions are on soft money. They're grant funded and supported by foundations or some grants in some applications, but it is difficult, and I know the discussion many years ago was the argument for a community health worker and a promotora was an ROI, but it really should not be an ROI that generates our interest in partnering with community-based organizations and promotores and community health workers.

They are the extension of who we are. They should be that partner with health departments and state departments and mental health departments. We look at a socio-ecological approach and so every department, education, prisons, everybody should look at a promotor and a community health worker and how it is that they can integrate that individual in providing the best service to the family. We say that a promotor and a community health worker have a space for preconception to death. If you think about the health continuum, there's a space for us. If that funding is, as Nicole mentioned, resourcing is really important, so how do we support that partnership? CDC funds and HRSA funds go traditionally to state offices or to large intermediaries, to academia or to counties and that's a barrier because they still hire and disperse those funds in a very traditional manner.

One of the big obstacles, for instance, is requiring a high school degree or to speak English. Let's say I speak English, but I don't have a high school degree. We have such a high illiteracy rate in our communities of color. That's a major obstacle and still civil service isn't changing that and some of the requirements for the intermediaries isn't changing that either, so that's why we're suggesting that you look at community-based organizations like ours. We've been able to design our requirements. We hire promotores off the field. We train, some of 'em come right off the fields. Some of 'em come from cleaning houses and they are smart. They know how to do things. They come in as promotores. They become lead promotores. They become coordinators, managers. We have promotores who are directors in our organization.

We have a model called integration of the promotor model, which really looks at taking a community person who has these innate skills and abilities and how do you nurture that person, that relationship, so that you have this worker who is skilled, who can analyze projects, who can do project management, who can really look at evaluation. Of course they don't have an MPH, but that's where I'll hire an MPH to do that, and if I need a DRPH, I'll hire a DRPH.

That is against the argument to give money to universities, for instance. If you want a DRPH to run a project, then give me the money as a CBO and I'll hire that DRPH. There are too many obstacles with universities and counties in terms of getting that money out the door. Sometimes it takes months before that money gets out. They take too much of it, and by the time the community gets it, it's 25 cents on the dollar. That's just not, that's just not, you can't do a program that way. Thank you. Antonia, maybe you can talk to us about any ideas, innovative solutions to hiring a diverse public health workforce well-prepared for the next pandemic or for the challenges that we face otherwise in public health.

Any thoughts or ideas there? Definitely. We have worked very hard, the last 20 months especially, in trying to, one, implement the strategies and recommendations from the Special Commission on Local and Public Health and my colleagues in the Office of Local and Regional Health have really led these efforts and have created positions within the Office of Local and Regional Health to support that workforce development. The state level also has established a workforce development director, which we have not had. Additionally, in the course of the last 20 months and this new program that was created out of our Academic Health Department, the Academic Public Health Corps. What started as eight schools and programs of public health really evolved and it became almost every single level of higher education, two programs that are certified by our state to provide community health worker training at the community college level, our schools and programs of public health, our undergraduate programs of public health, and what we found in reaching out to these academic partners is that, one, people really wanted to help, which was really important, but two, they really wanted to gain practical experience that would be able to translate to a better opportunity to work in public health, and that's exactly what this new pipeline has created and we are working towards transitioning from, and we are already supporting non-COVID-related activities, everything from contact tracing, to data analysis, to communications, infographics and other translation of materials to really support the needs in local communities.

Thank you. You've really gotten us to start to think now about academic institutions. I'm at an academic institution, and Dr. Alexander-Scott, I wonder if in Rhode Island you have had the opportunity to work with academic partners there and what roles do you see for academic partners in this effort? Absolutely. To accompany our Health Equity Institute that focuses on the Health Equity Zones and all aspects of addressing root causes and determinants of health, we've also created a Rhode Island Department of Health Academic Institute that focuses on partnering intentionally with our academic partners so that they can better support the work at a public health level that we need for addressing our workforce concerns, for answering questions at the community level that we have, and for getting to some of the outcomes using data and evaluation of the work that we're doing in more definitive ways.

Specific to our workforce piece we have a Community Health Worker Association that we have re-established in Rhode Island and did it as a partnership with our colleagues at Rhode Island College who have joined with us in this vision such that we can create a pipeline for people who may not have some form of healthcare license but absolutely have the experience and the interest needed, and in partnership with Rhode Island College, can be brought through our Community Health Worker statewide certification program, but then also be set up in an apprenticeship-like program to be connected to community-based organizations, hospital or other healthcare facilities or our Health Equity Zones, ways to really jump in.

We're also combining it with our behavioral health recovery specialists, who are also a type of community health worker, our family home visiting staff, who are also types of community health worker, so really professionalizing that massive public health workforce in a way that allows our colleges and universities to also support the work that they're doing, setting the stage for further advancements in their own education, whether some form of educational certification or qualifications for some other type of healthcare licensing educational path, an LPN, RN or any other path, MD, that folks would like to. We're really working on, through our Community Health Worker Association, and I see Sarah Lawrence is on and so many others, being able to have that serve as a pipeline for going from that real-time experience and significant value to our public health workforce at the community level and equipping them with what's needed to contribute there and go beyond from an educational standpoint.

Our university partners there are invaluable in helping us advance, and there's much more to do as well. Sounds like a real theme, just listening to our panel here, is that there is an opportunity regardless of whether the individual has formal education or not. Community members, regardless of background, have a lot of value to bring in helping us advance our goals and objectives around public health and it's incumbent on us to determine the right ways to train, engage and support them in bringing about health in their own communities, so thanks for those ideas. Maria, is there anything that you wanna add to the conversation on working with community colleges or universities? I think that that's an important opportunity for our community, for all communities. I used to teach at a community college. I think it's a wonderful avenue, and of course, universities, et cetera, but there's so many of us. If you just look at Latinos, there's so many Latinos in the United States and we're so diverse, both in the countries of origin, the language, the second generation, third generation, in graduating, our high dropout rate, illness, that we really need to, I think, expand the way that we integrate employment opportunities as part of our nomenclature.

At the community level with CBOs, we're out there all the time. CBOs are out there already. We've developed informal systems of care. We've developed exercise programs, nutrition programs because we wanted to support our community where support has not come from other avenues. There is an informal system in place at the community level. What I would encourage is to partner with community-based organizations, to really bring them in as that warm handoff so that they can be recognized as a partner, they can be resourced and then continue to train community members so that we can, hopefully they'll go from us and they'll go into community colleges or they'll go into universities.

That's a pathway, or if they don't, their children might. I think expanding that opportunity, we are right now training 31 high schoolers in the Central Valley and they're excited. We're training them as promotores and they are excited and most of 'em are the children of promotores already, and so the opportunity is there if we look beyond the system. I think academia's great, but the number of people that are gonna go to academia just based on the data is gonna be exponentially less than if we focus on community and bring that group forward. Antonia, to ask you to add to what Maria has said here, are there other partners or intermediaries that we haven't really discussed that may have a role to play here in facilitating the advancement of diversity in the workforce? Whether business or public health institutes, are there other groups that we need to think about as part of this effort? Definitely.

We need to also be thinking about, to Maria's point, those community-based organizations that are often trying to live, they don't want to live grant to grant, but that ends up what it takes, so trying to find avenues to support community-based organizations in fulfilling our mission. One of the things that our state health department did was to partner with community-based organizations, faith-based organizations and tribal-serving and indigenous-serving organizations to really make sure that during this pandemic that we're providing information in a way that is meaningful and is coming from community members who are trusted gatekeepers in those communities and recognizing that there's a lotta great resources that the state health department is providing and we provide it in at least seven languages, eight if you include English, and recognizing that it is that community connection that often makes the difference, especially as we're working with communities who are very skeptical about public health and government.

Another way that's been really helpful over the course of the last 20 months is our partnership with the Massachusetts Health Officers Association. Having another statewide organization to partner with, especially when it comes to supporting local public health, and having another set of experiences to share what the experience is on the local level and really trying to better connect local public health with the culture, the traditions, the languages that are needed in their own communities and connecting to our academic pipeline to also be able to support that, so I guess kinda coming full circle there, but lots of different organizations are important to partner with moving forward to diversify our workforce.

Nicole, to think a bit more internally, one of the things that I've seen in the chat here is people were asking about succession planning, and as we think about leadership, diversity, capacity, have you seen anything in that space around succession planning that we should be lifting up in public health departments and in other organizations to ensure that there's adequate mentoring, guidance, and a plan, because we wanna have great retention, but where we're not retaining, we need people ready to step up. Any thoughts on that? Yeah, it's a great question and it's so important for us to start focusing on that now, being early on in the process. One piece that comes to mind there is really ensuring the stability that's needed for the workforce and sustaining the resourcing of this expanded workforce, the notion of partnering with Medicaid, for example, to ensure that community health worker reimbursement is in place, or with other state agencies, particularly across our health and human services portfolio, to see where current funding that's already in place could help support an ongoing workforce pipeline where we may have alignments, such as a family home visitor that works in both our realm, in our child welfare realm or in behavioral health, where we have our certified peer recovery specialist who also aligns closely with our public health community health worker, but thinking intentionally about how to strengthen those alignments and to get the training process and the initiation of that role to be in sync such that we can also have the ongoing retention and resources to sustain the roles also be in sync and have it not be a one-off in terms of being able to build from community engagement and expertise into the public health workforce and long-term other educational opportunities, and then certainly being able to leverage our current workforce once we make clear the intention of expanding with diversity and making sure that that's an understood necessity that must be embraced, that's where the mentorship can then be used to help ensure that with an out-of-the-box approach, it doesn't have to be the typical, rigid public health-only way to make it through the ranks as a governmental employee, but thinking about more creative ways to bring people in.

Our Community Health Worker certification, for example, doesn't necessarily require a high school degree or other potential barriers but values the life experience and community involvement that they can bring and then uses hours of applied work to help advance what's needed. Perhaps we can bring that to the governmental public health and other state agency positions framework and approach and then use the mentoring to be able to establish that kind of pipeline in a way that is sustained and resourced over the long term.

Those would be a few suggestions. Great. No, it's great. I think we have time for one more question for maybe each of you to respond to, and maybe we just ask each of you to share your thoughts about something that has been effective for you. A lotta the things that we're talking about are things that require resources, require advocacy. Are there things that you have experienced, successfully advocated for that you would like to see scaled up and that you would point to as a real success story in the work that you've done and might be something that could be scaled up elsewhere? Antonia, I'll start with you, and then Maria and we'll go from there.

Thank you. Yes. I do think that the Academic Public Health Corps could be scaled up, out, across, not just a novelty in Massachusetts. We all have a commitment to diversifying the workforce and I can definitely say that the folks I've had the opportunity to work with, whether they be community college students, whether they be undergraduate or graduate students or postdoctoral, they all come from a place of passion and wanting to ensure there is more equity in the efforts in public health, and so by centering equity in our conversations from the very beginning has been personally rewarding to hear people's journeys, experience, and how we are tackling and dismantling systems that continue to perpetuate racism.

It is a difficult area to focus on and one that we heard from program areas that wanted to address some of the inequities in their programs and not necessarily knowing how to do that and so created the Racial Equity Data Road Map that has been implemented and continues to be implemented throughout our department and is available on our website, which I'll post in the chat box in a moment, but being able to center equity, I was thrilled whenever the new and improved 10 Essential Public Health Services were released because we were already starting to have this language, and so now nationally, there's some common language for us to continue to draw upon and to really recognize that until we're talking about social determinants of health in a way that really helps to educate our vendors, educate our community members and help them find their voice in making improvements in health outcomes, that is the way that we're going to need to work in this new future of public health.

Great. We have two or three minutes left. Maria, maybe I'll ask you to add to Antonia's comments. We have a saying in our organization, (Maria speaking in Spanish) "With or without money," because social change does not happen because you have a grant. Social change happens because you have leadership and you have people who want to better their community and better their situation. The promotores and community health workers have been doing this for hundreds of years. What we're asking is that the system look at us as experts in our community and integrate us as part of that. One example is the Medicaid money that's coming down for community health workers.

That's primarily for those who have systems, for hospitals, clinics and plans. The community-based organizations won't have access to that, and so that little change in the policy would make a big difference in resourcing community-based organizations. Ask us. I encourage all of you here, look to your community-based organizations, your longstanding experts in your states, in your counties, your local groups that have been doing this work for a long time. See how you can partner. See how you can help them. See how you can resource them. Ask them what is it that they need or ask us. We're happy to refer you to local experts or we're happy to share our papers, but I encourage you to talk to community and integrate community as part of the systems change. Great, great. Nicole, any final thought? Yeah, what was stated was excellent and powerful and just reinforcing that in our ability to have the expanded understanding of community health workers be a professional workforce that is acknowledged, is supported in terms of education and the pipeline, and is resourced effectively, and lifting up approaches such as what, I correct to mention that we eliminate barriers for education by starting with a high school degree but not testing and requiring community-based experience in a flexible portfolio for an application to become a community health worker and use those type of creative ways to start the pipeline, but then think broadly about how to make it a profession that is needed not only in the healthcare setting but in the broader understanding of public health setting, governmental, non-governmental and beyond and make sure we have the things in place to resource it across the board so it can be sustained for the long term.

This is the moment definitely to do that and helps us achieve our ultimate goal of addressing determinants of health by having that community-informed workforce really lead the way. Wonderful. Thanks so much, Nicole, Maria, Antonia for your comments. This has been a rich discussion. I wish we had more time and I'll also point you to the chat. Some really wonderful resources and comments in the chat as well. Many thanks for taking time to share your thoughts and experiences with us. I wanna thank all of those that joined us for this session, and at this time, I'll return the floor to you, Dr. Monroe. Thank you, Dr. Lyn, and the entire panel. This was an excellent discussion. We're going to take a moment and sneak in another poll question here, and the question is, to what extent is your local or state public health department employing community health workers or promotores? We'll give you a few minutes.

We're already gonna make an improvement. By the next Lights, Camera, Action summit, we're gonna have music for these for sure. You can answer your question and we'll get an answer here in a moment, and while you all are answering, I do wanna just remind everybody that we are collecting the chat, so please continue to put your thoughts, your questions, your ideas, your challenges in the chat and that'll be included in a summary report, and then also I would encourage you if you have done things that are showing improvements, if you're a bright spot, if you're one of the lights, as an example, governmental public health hiring, if you've overcome barriers or you've seen improvements, you've got ideas and have activated improved governmental hiring, please let us know.

Okay, with that, let's see what our poll question shows. The answer is, again, pretty equally distributed, a lot of these. Some are not using community health workers at all. Some are fully integrated full-time employees, only 16%. 21% are partnering with other organizations, community-based organizations, and 26% is more on an intermittent basis. Thank you for that information, and to keep things moving, now we're going to go to our next panel. This is an incredibly important topic. This discussion's going to focus on how we can improve governmental hiring practices, which we know can be quite challenging. To lead the panel for this discussion, I'm very pleased to welcome Dr. David Fleming, who is clinical associate professor at the University of Washington School of Public Health, distinguished visiting fellow at the Trust for America's Health, and chair of the Advisory Committee to the Director of the Centers for Disease Control and Prevention. David, you have floor. Hey, thanks so much, Dr. Monroe, and thanks to the CDC Foundation for hosting this important summit today. I'm really enjoying being here listening to these sessions.

It's great to hear about the vision that people have and the common need that we're articulating for change in our public health workforce, and so now we're gonna talk about governmental hiring practices, and speaking for me, and maybe some of you, I didn't get into public health because of my love or knowledge of hiring practices or the systems that recruit and retain us. In fact, for me, the truth is pretty far from that, but this actually may be one of the most important issues that we discuss today and that's because our current workforce is the product of our current systems. As we all know, every system is perfectly designed to get the results it gets. If we think our current workforce and how we've hired and retained them is sufficient to meet our future challenges, we don't have to worry, but if we think that we need to head in a different direction with our workforce, to change, to even transform, and I kinda all think we are beginning to believe that, then we need to look carefully at our HR systems and we need to think about the necessary change and the transformation in them as well, and that's why this change may be among the most important things that we need to do to be successful in our charge today, thinking about how we get from where we are to where we need to be, and in part, we need to think about the HR system that each of us exists in in our own institutions, and in part, more solutions need to take into account this collective crazy reality that we all are in, in which our workforce hiring is determined not only by our needs but by the needs of our funders and the larger federal, state, local public health and political system that we all live in.

Luckily these are the issues our panel is here today to talk about, and we have a great panel, so let's get to it. Because this topic is broad, we've asked each of them to start with two minutes or so to speak to one or two top issues in mind, and with that, I'd like to start with Lisa Macon Harrison from the Granville Vance District Health Department and the current president of NACCHO. Lisa. Hi, it's so good to be with you all again this afternoon. We've had a wonderful series of panels, and so I'm looking forward to this one on Improving Governmental Hiring Practices and continuing this great discussion line, but you are exactly right, David.

Collective crazy workforce environment is one that we are all in. We're sort of at a new point in hiring practices, not just in government, but across all industries right now. We've heard of the Great Resignation. We know that people are making different choices during the pandemic to work more flexibly and differently than in times past, and that includes governmental positions as well, so we've gotta continue to come up with creative, flexible and really generous practices that honor what I call, and am learning more about, this human-centered notion of hiring and retaining people who work with other humans. We like to talk about building the public health infrastructure as improving data systems as well as workforce, but we can't ever forget that it takes the humans doing the work on the ground to enter data, to analyze data, to make decisions based on data, and that's why these decisions and these new hiring practices are really critical. We also have to honor the now as we think about the future. What we're called to do anytime we're looking across our agencies and figuring out what we need to do our best work, we have to continue to evaluate future needs, but that doesn't mean we ignore the needs of those who are with us right now and retaining the excellent, well-experienced, skilled workforce we already have.

I'm reminded of that song, "Make new friends, but keep the old. One is silver, the other gold." We've gotta do both of those things at the same time, so to me that also means we have to say, "Yes, and," a lot, and then I loved hearing some thoughts about that Academic Health Department model from Massachusetts, and I'm gonna add a little bit more today on our Rural Academic Health Department model. In Granville and Vance, there's some ideas on the ground about new governmental hiring practices and look forward to hearing from others on this one. I'll stop there for now. Thanks so much, Lisa, and thanks for reminding us that not only do we serve people in our work, but we are people as well and so we need to attend to that in our hiring and retention practices. Next I'd like to ask Mindy Waldron, who's the department administrator at the Fort Wayne-Allen County Health Department, to weigh in on this issue.

Mindy. It's been so encouraging to hear what everybody's had to share today, and I sit here thinking, "How do we approach this as a local health department?" Sorta the boots on the ground and sometimes the lowest on the totem pole sometimes of hearing what's going on nationally, and so some of this is just, this is my passion and been very encouraging to hear. I think one of the struggles as a local health department, especially in a state like Indiana, who's really working to better the public health system but does have some of the lowest funding and sometimes the lowest outcomes, usually dependent on funding, is that for local health departments, we're stuck within a local government structure.

We don't have a lotta say over what those hiring practices or policies are, and I think what we can do though is be the example, and so a lot of us have tried to have policies or procedures or targeted hiring practices that go above and beyond what the minimal government structure is in local government, not to be offensive, but to try and target certain experiences, and so some of our changes over the last few years have really been to look at who it is we're serving and what service are we talking to them about, because I heard it also mentioned that trust is a really big factor, and it is.

In public health, boots-on-the-ground folks, you're talking directly to the public. They need to see people that look like them, see people that speak like them and have had similar experiences. We got really creative a few years ago being a community that has the largest Burmese resettlement site outside of Burma itself, in that we couldn't just have interpretation going over the phone or translated documents. We needed to have folks on staff who were Burmese and who not only could speak the speak and say what we needed to say and educate, but they needed to educate us so that we knew why certain cultural things were the way they were, why they were important, and I think, I guess I'll end for this first comment here of being, to really break things down by tasks that we need to do and the population we're serving and think about ways to get around the minimalists.

What are you required to do? What are your limits at local government? But can you be, like it's been said today, that light and just have slightly a little bit better so that you're the example in that, and when it comes to hiring, we really do need to build trust, we do need to diversify and get into high schools and do some of this grassroots education so we could see what it's like to be in public health and that that be a wanted career and not just a job.

Thanks so much, Mindy, for that frontline perspective, and also for reminding us that we all exist within a larger public health system, and that is reflected in our next two speakers. Next I'd like to ask Tahra Johnson, who's the program director at the National Conference of State Legislatures, to talk with us a little bit about their perspective on this issue and her perspective. Tahra. Thank you, David. Good morning from chilly Colorado. I'm glad to be here today speaking with you all. NCSL is the national bipartisan organization that works with state legislators and legislative staff across the country.

We educate and inform our members on state policy, but we do not advocate for any specific policies. I spend a lot of my time working with state policymakers on public health and maternal and child health policy, and again, a big part of my job is educating and informing them on public health policy. State legislators have several different roles to play when it comes to the public health workforce and thinking through the future of the public health workforce.

The biggest one that you all are aware of probably is budget and financing, so budget and funding allocations primarily with state dollars, though the flow of and allocation of some federal dollars also may go through them. During the pandemic, we saw state legislatures look at specific public health functions and areas for investment, especially when urgent. For example, several state legislatures, such as Georgia, Massachusetts and South Carolina, allocated funding from the general fund for contact tracers and vaccine programs, and other states, such as Arkansas, Florida, Illinois and Massachusetts, enacted laws around ensuring data and information is clearly communicated to the public, whether it's urging transparency, or culturally and linguistically diverse public education, or prohibiting dissemination of knowingly false or misleading information. We've seen several types of legislation enacted this year around supporting the public health workforce, such as in Colorado and California, adding protections from harassment for public health workers and those working at vaccination sites, and we've seen some mental health programs instituted for healthcare and public health workers. While these are immediate reactions and responses to urgent priorities this year, I think it's safe to say that state legislators are learning quite a lot about public health this year and it is really a ripe time to have discussions with them about the future of the public health workforce.

We receive a lot of questions at NCSL from policymakers about the best way to invest money into public health, whether that's workforce or just certain programs, and we're getting a lot more of those questions, I would say, in the last year, year and a half. Many of them are interested in how to address this pandemic, but also how to be better prepared for the next one. I think it's important for all of you as public health leaders on this call to know that we're getting these questions from across the political spectrum across the United States.

We're hearing it from chairs of health and human services committees. We're hearing it from our Health Innovations Task Force, and then just a lot of legislators that are hearing different things from their constituents. When they ask me what is important to invest in, I am often saying the answer truly lies within your state and your local communities. I really encourage all of you to be working with your state legislators as partners in this endeavor. Really good point, Tahra. Thanks so much, and then to close off this introductory section, I'd like to ask Blaire Bryant, who's the associative legislative director at the National Association for Counties, to give us a few thoughts from that perspective. Blaire. Thank you so much, David, and first, thank you to the CDC Foundation for having us here and to my esteemed panelists for engaging in one of many transformative discussions taking place during today's summit.

I'm here today on behalf of NACo, who represents the nation's 3,069 counties, who support the majority of America's approximately 2,800 local health departments, which are traditionally seen as the hubs of local public health, but we know that public health and prevention services certainly extends beyond the walls of just local health departments, particularly counties as the administrators of key healthcare safety net programs, and really, this is the cornerstone of my thoughts on enhancing governmental hiring practices in this field. It really starts with an understanding of where public health and prevention services are rendered at the local level and is reinforced through both private and public partnerships, such as community-based organizations and academia, as was mentioned in the previous panel, as well as intergovernmental partnerships between counties, states and the federal government that ensures a sustainable and diverse pipeline for the public health workforce, and with that, I look forward to speaking more about this in today's discussion and getting into some of the how-tos of these ideas.

Now I'll turn it back over to David. Thanks so much, Blaire, and thanks for that lead-in, because the CDC Foundation has told us they really want these summits to be about how. We kind of know where we want to go, but how is it that we get there? I'd like to ask each of you a couple of questions. We'll see how far we can get in this session, but let's start with one of the most important issues that's confronting us. We've talked about it a bit already, but it's certainly worth talking about again, and that's simply how can we better assure that our public health workforce and our public health leadership is reflective of the communities that we serve, particularly communities of color.

This is something that we have within our grasp, within our hiring practices to either be successful at it or not. I'd like to ask each of you, from where you sit, what are some of the most important steps that we need to take within our hiring practice systems to continue our journey down this path towards diversity? And let's stick with the same order that we've been in, but Lisa, could I ask you to go first? Sure. Yeah, happy to. I think someone on the last panel mentioned the importance of leadership and this notion of how we change our practices and we definitely have to have leader commitment.

I have an entire leadership team of a dozen people who, we've had to just talk about this for a number of years now as a value and a priority for our health department and our own hiring practices. One of the other things that I see we need to do a better job, with the partners here on this call being able to potentially influence this, is the hiring practices often at state government levels and state office of human resources rules are a bit antiquated with what their expectations are around having experience in public health already by the time you're hired, and so I think having some type of entry point or pipeline for those who don't already have public health experience in a local, state or federal position, that we can get them in at a more honorable salary rate than a dollar less than hiring (indistinct) that exist currently. I think that's, when I say we need to be creative about these approaches, that's one creative notion, where we have to come in with some more flexible ideas about how people get started in public health so that we can bring people on board who might be new to our field more easily.

That's one specific thing that we're trying to do in our health department. A great point, making sure the qualifications that we're establishing match the workforce that we want to bring on. Mindy. I build exactly on that. I would ditto that for sure, and then when you get to some of the grassroots interviewing, interviewing is a skill. It's not something that's easily learned and sometimes you look for with the paperwork, you look for the degrees they have, the experiences they have, but we really need to look for fit. Who has had the experiences that we know this position is gonna have? Ask them to apply those. Not just, "What skill do you bring to the job?" but get into the, "And how have you utilized that to be successful in X, Y and Z?" And so learning interviewing, if you are one to be the interviewer, is a key role in getting to the appropriate people, and then again, on job descriptions, which I have seen a lotta comments on in the chat, being sure that we are not writing them to people but writing them to the skillsets that we need for the job, being very specific of some of the experiences that we're looking for so that we aren't, again, just looking at the paperwork but looking at the skillsets people bring to the job, and also realizing that people are nervous in interviews, so getting beyond that and looking for them to complete other activities and so forth to back up what it is that they say they can do, and then also having appropriate training available.

That's one of the things we probably lack, is to have some of the soft skills, assertiveness and those sorts of things, so really talking about what they bring to the table and being better at our assertive interviewing skills, I guess, ourselves. That's how I'd start with that. Yeah, thanks, Mindy. Again good points. Tahra, we've heard a little bit already that sometimes those of us in the public health world feel like we're somewhat trapped by the systems in which we find ourselves. Do you have a perspective on this issue from the standpoint of NCSL? Sure, and I agree with everything that's been said, and historically, state legislatures have not legislated around the demographics of the public health workforce. However, we've seen more of this since the pandemic has showed significant disparities between communities, and there are several examples of state legislatures who have legislated on this.

We saw the District of Columbia, for example, require at least 50% of their contact tracers to be hired through D.C., so they have to be D.C. residents serving the community. We saw something similar in New York, that they have to represent culturally and linguistic diversity of the communities, and again in South Carolina, hiring those who are best suited to interact with their population. That's more of that 500-foot level.

There are these structures in place. I'm not saying that legislation is necessarily the best way to address this issue, but it is one option to help provide some more guidelines. Then lastly I would say state legislators, they're representatives of their communities and they know a lot about the community organizations and the educational pipelines in their state, in their towns and cities. They can be excellent informal partners to discuss different ways of improving and promoting jobs in those communities that they represent. Yeah, it's a good point to remember that we're all on the same side in this. Thanks for making that, and then Blaire, we'd appreciate your perspective on this.

Absolutely, and also agree with everything that's been said, particularly Tahra's points on looking at this from a national local government perspective. At NACo, we're always looking at issues from the perspective of county systems and the issue of diversity, equity and inclusion in our local workforces is no different. The value of a diverse workforce starts with local government that values diversity and is taking practical steps towards systemic inclusion. Since May of 2019, before the pandemic, we've seen a number of counties in at least 22 states publicly recognize racism as a public health crisis through declarations and resolutions in which they've committed to assessing internal policy and procedures that will promote equity, increase diversity across the county workforce and leadership, and advocate for policies that would improve health in communities of colors as well as other actions. I believe that this is really the catalyst to diversifying the county workforce broadly and the leadership structure to include the local public health workforce as well. Yeah, thanks, Blaire.

I would just add from my personal experience that one of the places we need to be especially vigilant is at the very beginning of the process. Sometimes we trust the system to generate that pool of applicants that then we then interview, but I found it's critical to look at a pool that is presented at the beginning, and if it doesn't contain the diversity, the types of skills that you want, to actually stop at that point and tell your recruiters to go back and continue to work until you've got a pool of applicants that reflects what it is that you are really looking for. Lots of future opportunity to do better on this front, but I wanted to switch gears a little bit to talk about another aspect of the transformation of our public health workforce and that's, as we have been hearing all morning, building the future, not only rebuilding the past.

Our future workforce will continue to need the skills in health and in public health, but those skills increasingly are gonna need to be integrated with skills and social determinants and community organizing, lived experience, and to be effective, we need our categorical programs resting on that bedrock of foundational capabilities, just the opposite of what we have today, where arguably our meeker foundational capabilities sit on top of time-limited categorical programs. This is a transformation. It involves both the old and the new, as we've been talking about, the gold friends and the silver friends, but what are the most important changes that you are seeing we need to be thinking about in our recruiting system to meet this challenge of building for the future? Lisa. When we talk about foundational capabilities, I'm thinking so often during these last 22 months, we have really needed to lean on the skills of others outside of our agency to help with communications and informatics in particular.

Our rural public health academic health department model, that's what we've had to leverage in our academic partners, was some of those skillsets that we just haven't, frankly, paid for in public health to date or valued the same way in governmental systems that private systems understand are needed. I've seen a lotta that in the chat already today but would just agree that we've gotta level up our skillsets in communications and in informatics to make our data-driven decision-making as strong as possible and to withstand all of the attacks that we frankly need to do a better job at communicating back against some of the chaos that is coming at us in social media to poke holes in our public health expertise.

We've gotta be really good at getting back and saying, "Well, no, this is what the science says and here's what we're gonna stand by." Those are the two from our foundational capabilities that I really, as a local health director, need to have more skillsets within my health department to do better. Yes, and to think about the job descriptions and the salary ranges that we're gonna need to bring those new skills on, I think, is an important part of the equation. Yeah, thanks very much for that. Mindy, how about from you? I agree with what she just said as well and there's gonna take a lot of education for the folks in the political sectors to see the importance of public health and be able to put blinders onto some of the things that have created their opinions over this last year and she's exactly right and two things I would add would be to develop that pool of candidates in that hopper, if you will, we all have to get better at the local level, and it's very difficult if they're not paid, but we need to be able to take interns so we can show them what the real life is in public health, and as I said earlier, getting into high schools and other areas or other venues where you can promote public health and what it does.

For example, I presented several times at some of our schools of public health in a class, in a public health class, and I would see that some of the things that they're being taught are so global and not so local, where you explain what local public health does and relate that to some of the topics they're learning, and so I've learned to hone in on that to promote how important we need that kind of development of the pool of candidates ready to come in, and then we try to foray that into internships where we can show them and apply some things so they become advocates and that really is they can also be educators of what true public health is.

We work on those daily, and then it really is a bit of a domino effect to when you talk about the bedrock of some of those foundational services that we need to know and provide. It's a domino effect of more money to get more staff to do better training to be able to accept interns and all of those programs where we can educate and get out and talk about public health to build that trust that gets people to wanna come in.

Yeah, thanks, Mindy. Again, really excellent points. Tahra, in my career when I've gone as a public health person in front of the state legislature, oftentimes, although people have been polite, I sense a desire to, of rolling eyes. "What are you back here for again now and what new request?" Can you talk a little about, from your perspective, how the public health system might best approach the state legislature in this time and speak to some of these new needs that we've been talking about today? Yeah, that's a great question, and I know that politics and working with state legislators and policymakers has come up several times throughout the day and the significant challenges with one-time funding.

State legislators, there is a desire to be working with public health. I, again, would really encourage you all to work with them. It's very mixed in terms of what we hear about changing or increasing government workforce, as I'm sure many of you are very aware of. There are significant hesitancies in some states of increasing FTEs, but at the same time, we're getting that and questions about how can we be more efficient or effective. I think going and talking with them with several ideas is important and understanding the budgetary constraints. States do need to balance their budgets. They are very aware of that and state legislators are, that is a big, if not the biggest, part of their job. In terms of thinking about this from a funding piece and working with state legislators, we've seen success with outsourcing and contracting, not necessarily the maybe best option for long-term sustainability, but it is an option, and then thinking outside of the box a bit.

One thing I've been thinking about a lot is how many new partners public health has had over the last year and a half. Almost every state has worked with their National Guard and has worked with other hospital systems or their systems to do testing and the vaccine rollout and have built all of these partners, and I think there are opportunities for us to train and partner with those entities so that the entire public health workforce and folks that we don't always think of as public health can be trained to respond in emergencies.

If you're working with your state legislator and you're interested in asking for more sustainable funding, get to know them. Relationships are hugely, hugely important. If you're going, they're used to people and agencies asking for money, asking for policies, but it's really essential that you get to know them before you have your ask. Get to know the folks who are on the health committees. Get to know the folks who are on the appropriations committees. Make sure they know you're credible, and then when you do have those conversations, some of it may be very difficult, they already know who you are and are interested in talking with you about this. There are a lot of champions in the legislature who are interested in building the public health workforce. We're thinking creatively about how to support the public health workforce.

I know there's been a lot in the media. There's a lot of things going on with public health authority and some things that may make it a little bit more challenging to be working with state legislators, but they are interested, and again, this is across the political spectrum and the country from what I've been hearing and seeing working with our members. I'm happy to go, I can, whole presentation on working with state legislators. I won't do that right now, but I'm more than happy to talk with folks offline a little bit more about that. We may need to invite you back 'cause that would be great, and I've had the privilege of working at the local level as well where it's sometime easier to get to know your county commissioners, but this issue is still an issue at the local level.

Blaire, I'm wondering if you could quickly weigh in on this point as well. Absolutely, and I wanted to circle back on something Tahra just said that I actually wrote in my notes, so we're reading off the same page here, about partnerships with other healthcare settings, so not working in a public health silo, but working with hospitals, working with clinics, working in other health settings to come together and advocate for better hiring, more funding for local public health. Together united, you'll have a greater voice, particularly with county commissioners who oversee the large majority of local healthcare safety nets, which includes local health departments as well as hospitals and clinics.

In terms of interfacing with county commissioners, as you said, David, they have much more of a closer proximity to local residents as well as county workers, so it's easier to get to know your county commissioner than it is your state legislator, but wanting to make sure that the decision makers are appointing people in positions of authority that are representative of the community and have an understanding of the needs of the community, and I say this specifically for counties and county governments. This means ensuring that the individuals appointed to local boards of health reflect the population that they will be serving, which means they're diverse in both racial and ethnic background as well as in their lived experience and skillset so we know that there's at least one county commissioner or county elected official that sits on the local board of health and then they appoint the rest of the people that are on that board, so ensuring that you're talking with your commissioners, making sure that the people that are appointed to that board are reflective of the community.

Wow, excellent, excellent points, and I can't believe it, but we're coming close to the end of the session already. In the last just couple of minutes, I wanna ask you a question if you could do just a quick lightning round, and in some ways this is a tough question because it recognizes that we're in a system and we don't control all parts of that system. As you think about it, what might be the most important thing that you would ask from some other part of our system in terms of flexibility or guidance or understanding across that local, state, federal public health political environment in which we work that would help you best be able to do the things that you need to do for your part in this.

A lightning round, so I'm turning first then to Lisa. My answer is we've gotta use both and more clearly and often when it comes to the fact that we need to both respect, decentralize decision-making and opportunities to connect with local resources and local needs in public health and we need state and federal-level policies to help administer the kind of changes we're talking about and I do think we can do both. Perfect. Mindy. Mine would be local health departments and state health departments are seeing a lot of their power stripped away, as we even talk right now, following the pandemic and we need to stem that a little bit so that we can build some flexibility, develop some trust, and I look forward maybe to talking to Tahra about how we might be better in speaking with our local legislators on some of those issues. That's the key. That opens funding. That opens trust. That opens the ability to have flexibility in hiring practices. I look forward to all of those things and those would be the key things for me to build that foundation as locals.

Thanks, Mindy. Very wise. Tahra. I agree with what's been said, and something a bit more concrete perhaps, I think that understanding and education of policymakers in public health is absolutely essential. It is a huge part of my job and what my organization does, but it is essential that they're also getting that from the state and local level. State legislatures have term limits. There are elections and the turnover can be pretty high, so it is really essential that they're getting that education and learning about public health from a variety of credible sources. A great point about learning from public health from the people who are actually doing it in their jurisdiction.

Blaire. Ditto to everything that has been said, particularly what Tahra said about the education piece. You'd be surprised the levels of government that don't have an adequate understanding of the role of local public health, even amongst county officials, so making sure that your county officials understand the role of local public health, what you're doing in the local health department, the various things that local health departments do in terms of prevention and public health services, because then they can be your advocates with the state legislator and the state can be your advocates with the federal government, so making sure we're continuously educating up.

Thanks, Blaire, and thanks, everybody. I'm kinda blown away by the wisdom on this panel. I wish we had more time, but we don't. There will be some breakout sessions and I'm really looking forward to working with the CDC Foundation on the report after this session because this really is the place where if we're gonna be successful, we need to figure out how to move forward in our hiring practices. With that, back to you, Judy. Yeah, thank you, David, and to the panelists. This was a really great discussion. You all could've used a lot more time, and I will tell ya, in the chat, I think folks really resonated with the getting to know your legislators, building the relationship, but I loved one recommendation was maybe more of us need to run for office and actually be the folks in those positions, in those elected positions.

With that, I'm going to, I think, move to a poll question. This is our fourth poll question. What is the top structural barrier for building the public health workforce in your jurisdiction? And you have a few things to choose from. This one is a single choice. You have to narrow it down to the single highest barrier, structural barrier. And honestly, if I was a musician, I would have music for ya, but you don't want anything close to that coming from me. With that, are we getting close to our poll? Salaries, yeah. I've personally heard from a lot of folks about salaries being a real issue, and it's one, an area that I personally feel strongly that we need to be advocating for, improve pay, and then there are hiring practices.

You can see there are number of things. Hiring freezes is a little less than I would've expected. I'm glad to see that's not as high, but you can see, again, some of the barriers, and again, we'll be collecting everything and doing a report on this, and this is a great national conversation and meant to be really a stimulus for all the work ahead 'cause there's much to be done.

With that, what we're going to do now is move to our final panel, and this panel is Pushing the Boundaries with Innovation. This final panel will explore how we can push boundaries on innovation to enhance and improve and fill gaps in our public health workforce. Again, feel free to keep the comments coming in the chat function, and this panel will be led by Dr. Brian Castrucci, who's president and CEO of the de Beaumont Foundation, a foundation that has done a lot of work in workforce and has been behind a lot of the reports. Brian, I'm gonna turn to you to lead the discussion and get your panel introduced. Thank you, Dr. Monroe. Good morning, good afternoon or good evening, depending on where you're joining us today.

We've heard some just excellent conversation throughout the day and the chat is totally off the hook and I'm glad someone is capturing that, but we've really been focused on where we are in public health, and for this session, we're gonna wanna really think about where do we wanna go. What boundaries need to be pushed and what innovations are needed? And so joining me today is a great panel and I'm just totally humbled to be here with them.

Starting off is Scott Becker from the Association of Public Health Laboratories, Renee Canady from the Michigan Public Health Institute, and Loren Hopkins from the Houston Department of Health. We don't have as much time as we need for this conversation, so we're gonna dive right in, and I wanna start by really talking about innovation and what innovation is, and for us, we're gonna define innovation as the development of an idea to solve a problem for which no other solution exists and then executing on that idea. Taking that definition, and for our panelists, and Scott, I'm gonna start with you, in what ways have you and your organizations been innovating and what is really the number one problem in public health that is most in need of innovation? Scott, I'd ask you to start us off.

Thanks very much. Thank you to Dr. Monroe and to you, Dr. Castrucci. This is a terrific group that we have together. It's been, you're right, the chat has been amazing. It's been hard to follow all of it. For our organization, a couple of things. I wanna talk about innovation in something that's critically important today, and I mean today, and that is sequencing, the ability for us to sequence the virus and look for new variants, et cetera. This didn't begin today. This began a number of years ago with the very modest amount of support from the federal government, from Congress, $30 million a year for advanced molecular detection for both CDC and the states. 30 million for our country. What did we do with that? We did learn and grow over time, but what did we need to do really quickly? We needed to, I hate the word pivot, but I'll use it, we had to pivot very quickly to actually build this system for daily use, if you will, for genomic surveillance, and we were able to do that.

One area that I think has been struggling a little bit was workforce, and part of that is because they're just not, we just don't have the number of bioinformaticians that we need for our fields. We need to really think about that. What did we do? We took a look at two things. One, we needed data scientists in public health laboratories. We needed that quickly and that's something that we stood up. We stood up that opportunity. The other thing that we did is we enumerated what the workforce need was for public health laboratories and we took advantage of the fact that we had our members' attention. They said, "Okay, in an ideal world, this is what I need to do all the things for public health lab science in practice." They gave us that information and we advocated to Congress, we advocated to the administration, and as was mentioned earlier sessions, the American Rescue Plan now allows for us to have funding for a public health laboratory pipeline initiative.

What's innovative about that? It's the first time that a large amount of money is being put towards that, and we're gonna have a goal of 40% of the participants to come from underrepresented minority communities, from other areas of public health that are not represented in our community right now. We're gonna do the best effort we can for outreach and to also institute a new internship program. Those are just a couple of the things. To your second point, which is what do we really need to do, what is the innovation, nevermind the lab science sector? I want to follow on the last session. We've gotta innovate in our salaries. We need to innovate in civil service. We need to innovate in our hiring practices. If governmental public health is to succeed, we can't be operating with systems that are 80 years old. We absolutely have to look at the future. Thanks, Brian. No, thank you, Scott now. Yeah, that last point's really an important one. Mike Fraser is often to say, "Is this a public health problem or is it a government problem?" and at first, I pushed against that idea.

Now I've really thought, "Well, maybe he's right," but don't tell him I said that. No, I won't. Renee, what have you been doing at the Michigan Public Health Institute to innovate and what is that one thing that we really need to solve in public health? Oh, thank you, Brian, and thank you to Judy, to Dr. Monroe, for convening what I'm calling a public health family meeting, like she just called us all into the living room and we're sitting here having this really transparent, authentic discussion. Innovation, I think, lives within systems, lives within organizations, but also lives within people. We are the purveyors that are carrying out the new policies, the new practices, and so in very, very clear ways, I think we've been effective at innovating in this space of equity, and really, more importantly, I'm pushing people to think about inequities.

There's so much that's not always about what we're doing but how we're doing it. It makes me think about, my sons are now all adults, but when they were young, we had this little game called Bop It. I don't know if Bop It still is out there. You twist it, you flick it, you do all these things, and when you mess up, Bop It would say, "Do it again but better." There's a lot of space in public health, a lot of things that we need to do better, and so this, one of the things that I would say we've been skillful in doing around our portfolio of work in health equity and social justice has really been to push us, not just in this space of talking about social determinants of health, which we need to do, but social determinants of health inequity.

How do we transform public health back to the root causes of why we all started doing the things that we're doing? If we think back to the Lillian Walds of the world, the founder of Public Health Nursing, the John Snows of the world that began to, not really doing something that was amazingly unheard of but doing what we knew to be right and pushing a system to do that, and so certainly in this space of health inequity, I believe that we're leading in that space, but I'm also trying to link arms with lots of people to talk about this. When I was recruited back into public health practice, I was tenure track at Michigan State University, thought that would be my retirement gig, but I was recruited back into public health practice because Ingham County Health Department said, "We need help doing this social justice health equity thing in a really authentic, impactful way," and so here, they drew me back, and so that point about systems innovate, but they innovate through people, and so it's not just who we're recruiting in terms of representation, but what do we mean by representation? When I first got to MPHI, we had 9% of our workforce was staff of color.

We're now at 29% staff of color. Michigan's population of color is 14%. Does that mean that I'm done trying to recruit diverse folk? No, right, 'cause it's about more than just checking that race box. It is about a whole plethora, if I can say, of identities, and so this whole issue of how do we push differently when we're leading the curve, we're leading the curve so that others will get on that curve, on that wave with us, and I'm just honored that we've been able to be a part of the dialogue around health equity, health inequity, social determinants of health inequities for the last several decades in this space.

Thank you, and Loren, what would you add? I can only give the perspective from, really, the boots-on-the-ground experience because I'm sitting in a local health department and I run various really applied programs. I think that the thing that, in terms of innovation, that we have found to be really successful is that we were able to pivot and begin a very successful wastewater epidemiology program at the beginning of COVID, and some examples of the innovation with that I think just stemmed from our partnerships. We were able to, and I suppose it's because we've been handed public health emergency one after another for the past few years. I am the chief environmental science officer for the city and we had Hurricane Harvey, we had something called the ITC fire, which other people may not remember, but it was a very big explosion with a plume of smoke that lasted for over a week and benzene concentrations in the neighborhoods, and then we had the pandemic, and so with that, with every step of that, I have become very agile at asking for help from my academic partners.

I think that it's potentially an important message to, I hear people talking about academic partners, but I don't know how well it's working for other places, but here, I actually am faculty at Rice University and I sit in the health department and I'm the only one in the City of Houston that has that role, but I know that the director of our health department has found it to be very useful because I'm able to do research to support policy and changes.

I think that type of model is something that should be considered in other places if it's possible to happen, but just again, for innovation, it was all about working outside of the health department, and I was just talking to a colleague earlier today before we got onto this call thinking about how I have not had a public health class. My background, I'm in the statistics department, but I also do environmental work. Everything that I see is bringing together facets from outside and also just programming innovation, trying to automate things that people shouldn't have to do, and just for the wastewater program, it was reaching out to public works, really working well with public works, then working with Baylor College of Medicine, virologists, environmental engineers, developing our own wastewater staff here in the health department.

We actually sample everything we do. It's a very multifaceted team. It can't just be, these people are not gonna be, and I do not believe all of them, anyway, would be in your typical undergraduate program or graduate program for public health. It's going to have to be bigger than that. Maybe not everything, but there are going to have to be pieces of that new workforce that have, public health was something they're drawn to, but their training, we need to rely on training of other disciplines. Thank you, Loren. Scott, I know you've been doing some innovative work with CDC. Can you talk a little bit about that? Yeah, in particular with the CDC Foundation. One of our scientists at the California Department of Public Health contacted us and said, "We have this opportunity to look at canines and their ability to sniff COVID-19 from socks." We said, "Hmm, this is interesting.

That's really pushing the envelope," 'cause we deal with laboratory testing. That's qualified lab testing. This is pushing the envelope, but I had a great conversation with Dr. Monroe and others and we said, "Let's go for it." Right now, there is a pilot underway in California with the use of canines to sniff out COVID. Yeah, that, even for us, was pushing the envelope. We like to think that we're innovative, but this was really something. I think that's so important, especially during a crisis like this. Take advantage of every opportunity that comes your way. This is not a time to shy away. Loren gave this great example of wastewater surveillance, which has been out there but not in the way in which it's being used now and potentially being used in the future. This is an opportunity for us to do research in the wild, and we are the wild, so let's use that opportunity.

Thanks, Brian. Yeah, I'm a cat person, so it's good to know that dogs have some use. Renee, you said something that I wanna probe a little bit and I wanna talk about for a second. You said that the CDC Foundation convened a family meeting. I really liked that idea, but are we really a family? How often are we built into our categories? We all too often have a culture of cannibalism, where we are actually fighting against each other for very limited resources, and so this idea that we have a unified public health identity is one I wanna probe a little bit with you.

Do you think that identity really exists and what can we do to strengthen it? Absolutely love that, and honestly, I think the fact that we are together in this space is the start of what I'm aspirationally calling a family meeting, because you're right. We work in, I'm not a psychologist, but as I understand it, this idea of parallel play, where we're in the sandbox together, but we're really not, and we all bring our biases. Those of us that are educated with a degree that says public health. Those of us that have, as Loren said, don't have a degree in public health but have been working the field for so long. How do we begin to, in one space, understand who we are as family members and that we all have integrated roles? The fact that MPHI exists is a demonstration of governmental public health innovation. In 1990, the first woman health commissioner, state health department director in Michigan said, "I gotta figure out how to get all this stuff done," and she began leveraging relationships with partners in the community and with the legislature so that she, it was their idea to create this thing called MPHI which would be a nonprofit entity that was a public health partner who they trusted, who they had relationship with, and she was innovative enough to get us established in legislation with unanimous approval from both sides of the aisle.

That was the '90s. That was then, this is now. I think the fact that she was not threatened by a nonprofit entity coming in to do her governmental work or and the fact that she did it in partnership with academics. The three major universities in Michigan state have two board seats on our board at Michigan Public Health Institute because she was intentional about how do we get rid of these silos so that if I need scholarship and intellectual insight, I can call a university partner and what is the hub that is the tie that binds us, and that's what she created Michigan Public Health Institute to be, and so yes, we have some schisms in our family, but I'm still optimistic that the more we learn and understand each other and the more we see what happens when we don't partner authentically, as we're seeing now, that will all be motivation for us to do more and better.

Scott, how would you respond? You are the CEO of the Association of Public Health Labs. How do you think through what money lab's getting versus maternal child health or epi? How do you see the funding? Is it complete or siloed? I think we have been siloed. There's no putting lipstick on that pig. We have been siloed. I think it's the opportunity now to think about public health in a very interdisciplinary way. We say that. We say that a lot. That's not how we're funded, so therefore the structures that are in place force us apart, not together. I have a great example of previous silos. Lab and epi have been siloed in the past and that was something very intentionally, and I love the term that Renee and others used earlier today about we have to be authentic, but we have to be very intentional, and a number of years ago, APHL and CSTE came together and said, "How can we work better together to strengthen public health surveillance?" because the definition of public health surveillance, one definition, is epi and lab working together, and we really have done that in any number of ways, supporting each other, our members supporting each other, not having lab seen as a subset.

It is that building off in the distance where things happen, but what we really tried to do was to support and strengthen each other, and one outcome of that, quite frankly, was the advocacy campaign on data modernization, and this was something that four organizations came together to advocate prior to the pandemic and we were successful in advocating for funding for data modernization, 'cause we knew, we knew deep down how bad the system was, how disconnected the system was, so I think there's opportunity.

Our community tends to be driven by the money, when I mean our community, public health, and that means in a siloed way. We ourselves have to be intentional about breaking those barriers down. We need to support each other, not cannibalize each other. Thank you, Scott. This is always the fastest 30 minutes that you ever wanna have. As time is starting to get away from us a little bit, I do have one question for you, Loren, that I really wanna probe a little bit. When you think about what the health department was before the pandemic and the health department that we need going forward, what are the changes that we need to see inside our health departments so that we can live up to the modern public health system that we all want? I think that, I could repeat everything, we need to diversify workforce.

We need to actually be able to attract these very highly educated data scientists. We need to be able to pay them. We need to be able to retain them. We need to develop a system where we have, where they feel like they belong, that right now during the pandemic, a lot of the people that work with data, there was so much data coming in, were allowed to work from home and that stuck out, a key thing, that comfort, and you know these young generations (laughing) are really more interested in that kind of quality and we're losing them right and left to other health departments that are allowing them to work from home. We need to find ways to really look at them as whole people and integrate them as well as continue to educate them because they're gonna be driven, in our market, they're gonna be driven by really doing good and keeping learning and exciting things, which may mean that their education, this workforce development, their education, they come out, they're educated. They've taken logistic regression. They've taken some really wonderful classes, maybe database management, but they're not immediately given that opportunity.

We need to bring in those academic partners to oversee them when they're doing sophisticated analysis so that they can continue to grow and we can all feel confident that the answers are correct. I just, and again, really broadening out this public health world to include some of these expertise, and when Scott was talking about the lab, we're all working on data modernization now and it's very intimidating because of the amount of computer science, IT skills, and medical information that you need to know to be able to do this extract and electronic case reporting. These are huge milestones, wonderful stuff, but we have to be able to get that staff. I don't know if everybody experiences that. I assume they do. We don't pay as well as other industries. The medical center across the street could take any of our people at any time. We have to have a reason to keep them here. Just for our last question, we know that Public Health 3.0 had really encouraged better partnerships between public health and other sectors, and I think we all know that somewhere in this nation, a health department official was meeting with a chamber of commerce president for the very first time.

They introduced themselves and the health official had to say, "Oh, and by the way, we're gonna have a stay at home protocol," which is a bad first date no matter how you slice it. In your opinion, what is the sector that we need to reach out to immediately so that we have a better public health practice in the future? If you had to name one sector, tell me what that sector is and why, and Loren, let's start with you. I would like to reach out to the statistics and data science, if that's what you're talking about, that type of sector, and I would like to reach out to young undergraduates early and provide them, they're excited, and get them going and then provide this infrastructure to keep them and keep training them, which is obviously something that can only happen with partnerships.

Scott, what would you add? Business, business, business because public health is economic health. I think we have the tools. We have the knowledge. We need to work on the communications, but if we can get the business sector to truly understand that we are here to support them, to keep their workplaces healthy so they can continue to do what they do, that would be it.

Renee. I was gonna say communications, but Scott hit me there, but so I'm just gonna embellish that a little bit. I would dare say we should reach out to the arts. One of our biggest challenges in public health is telling our story, telling it effectively, telling it meaningfully, telling it in a way that people can understand what exactly is it that you do. The narrative that we have built for ourselves has not been effective. Things like we're the neutral convener. We're not really neutral. We do have a point of view. We have a self-interest as an organization. We might be skillful conveners, we might be excellent conveners, but not neutral, and even in our space in the public health institute and those of us that are not governmental public health referring to ourselves as intermediaries.

Well, are we? Not really, that are built upon our own strengths, and so I think in the arts, helping us establish narrative, helping us to communicate more effectively through fotonovelas, through drama, through whatever it might be might serve us well for really launching into that space of innovation. I wanna thank each of you for your ideas. Some of the takeaways for me, creativity and innovation, when you look in public health departments, if creativity and innovation are perceived to be rewarded, issues like salary are mediated. You have much better performance in that health department, and I put a link to a podcast on this in the chat. I also noticed that in the chat, which is amazing, we're all bringing new resources and information that for some reason we don't all seem to know that each other has. In some ways we're like the Tower of Babel in public health, that we have been split amongst ourselves and it's all the great information we have, we've not been able to bring it together, and that might be a necessary innovation going forward, is where do we put all of the great information that we have in one place so that we can access it and leverage it and operationalize it, and in doing so, rebuild the Tower of Babel and have great success.

I wanna thank everybody for listening. I wanna thank, the chat has been amazing. Like to thank CDC Foundation and Dr. Monroe, and with that, I turn it back to you, Dr. Monroe. Thanks, everybody, for your time and attention. Thank you, Dr. Castrucci and all the panelists. That was amazing, as has been the day. Renee, I must tell you, the family meeting, when you said we'd convene folks in the living room for the family meeting, it's the public health family, and yes, a lotta families may have some dysfunction that needs some work, but it's also the extended family when we think about public health, and that will be some of our future summits that we'll work with, and then your comment about the arts, there's a reason we named this Lights, Camera, Action: The Future of Public Health, to think about pushing the envelope, and so hopefully we'll see more in some of those recommendations.

We have a couple of final questions for you all. This is just for our feedback. The first question, if we can put that up, will be just some summit feedback, and if you could just rate your level of agreement with the following statement, I gained knowledge on solutions to build the public health workforce, and you just give us a single answer on how well you agree with that statement, and whenever you feel you have enough answers, we'll go to the second, we'll leave that. Oh, and there's a second question already on here. Please rate your level of agreement with the following statement, the format for the national summit series was conducive to increasing knowledge. We're looking for feedback. This is, again, the first of a series of summits and certainly the time did fly by. It's difficult to believe that we've already been together 2 1/2 hours this afternoon, or morning, depending on where you are. I do wanna thank everyone, thank all of our speakers and our moderators and our panelists, and many, many thanks to the United Health Foundation and Robert Wood Johnson Foundation for their support of our Lights, Camera, Action Summit Series.

I'm just really thrilled that so many of you were able to join us and stay with us throughout the entire summit. Thank you for being part of the summit and for your contributions in the chat. Again, they will definitely be captured and summarized and we'll have a report out. We certainly have real challenges in front of us, as you heard from the presentations and the discussions today, but we're all collectively in this together and we do need to break down the silos, as folks have talked about, and be a really functional family, a major functional family to take care of our fellow human beings, both across the United States and around the world.

We know how difficult this last two years are and we also need to come together as a family for the healing that needs to take place for so many. There have been so many sacrifices made by our public health leaders and public health workers, as well as in the healthcare sector and others. While the challenges behind us are great, those in front of us are very real and we have an incredible opportunity to write this new script, to be more creative, to push the envelope, and let's get our friends in the arts involved as well, as well as the master communicators in the business community. I'm very pleased that today's summit along with the great and thoughtful work that's been developed by so many individuals and organizations will help us in writing that script and preparing our nation not only for future health threats but for the ongoing health-related issues of chronic disease, infectious disease, environmental issues that we're all facing.

We will be following up with everyone that registered with summaries of the summits and other materials. We'll be posting on our Lights, Camera, Action website, which is FutureofPublicHealth.org, from the summit, and again, thanks to all of you. Believe there's a slide up on the future summits and we do have the date for the next summit, will be January 25th, 2022, so mark your calendars, and that one, we will be focusing on data modernization, modern data and technology infrastructure. Should be a robust conference. We have a final slide there for information, and with that, I'm gonna say thank you to everyone and bid you a good afternoon.

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