RWJF: How Public Health Sector, CDC Can Focus on Health Equity

The nation’s public health sector is at a crossroads after two years of a pandemic that illuminated infrastructure shortcomings. And amid work to improve efficiency, governance, and clarity, there also needs to be an emphasis on health equity, according to a new report from the Robert Wood Johnson Foundation (RWJF).

The US public health sphere, spearheaded by the Centers for Disease Control and Prevention (CDC), deserves praise for its ongoing efforts to stem COVID-19, RWJF asserted. The agency had to manage not just the virus spread but also the spread of misinformation and vitriol that culminated in attacks on the CDC’s independence and integrity, RWJF said.

Even still, as the CDC leads its own self-reflections on its response to the COVID-19 pandemic, RWJF asserted there is room to center health equity.

“When institutions prioritize equity, they are more likely to cultivate systems that benefit all people and communities,” RWJF wrote in a report, Centering Equity in the Nation’s Public Health System. “As follows, fostering a national public health system that values people who are overlooked and underresourced and that effectively meets their communities’ needs will lead to a model that improves our collective wellbeing.”

CDC has already acknowledged the place health equity has in its future post-pandemic, the RWJF report authors pointed out, and in response, RWJF has set out a number of strategic areas CDC can embrace to fulfill its intentions.

Foremost, CDC should build out leadership and governance for its future health equity work, starting with the health equity office it has already promised to build. That office should be a part of CDC’s director office, leaving the CDC director to be the agency’s chief champion for health equity.

From there, the agency should foster a sense of collaboration among other staffers, encouraging all to bring their unique experiences and skill sets to the table, RWJF recommended.

“CDC should also consider forming an equity leadership council composed of staff from across the organization who work collaboratively with positional leaders to shape, refine, and assess the agency’s equity strategies,” the RWJF report stated. “These equity leads should be given the requisite time, support, and compensation to fulfill their roles effectively.”

That collaboration should extend to sister agencies under the HHS, CMS, and NIH umbrellas.

Second, CDC should prioritize community relationships, including with state and local public health entities. This will help create more just public health systems that include all, RWJF said.

Third, the agency should consider the data and accountability that will support its health equity efforts. RWJF suggested that CDC look at the experiences of those affected by structural discrimination to understand the best outcomes measures. And through collaboration with other public health agencies, CDC should work on standardizing data collection to ensure all entities can contribute the experiences of traditionally marginalized groups.

After that, the CDC should re-examine its public health messaging efforts, with a particular emphasis on inclusion. Messages should be accessible to all audiences, meaning they should be available in multiple languages, including American Sign Language, or include closed captioning or meta descriptions when applicable.

CDC should consider not just the message, RWJF added, but also the messenger.

“These messages and narratives are best communicated by trusted messengers,” the report authors advised. “Here again, the national community health infrastructure described above will be critical, allowing not just dissemination of information from public health “experts” to the public but two-way dialogue that values the expertise of all.”

And finally, RWJF urged CDC to prioritize workforce diversity as it moves forward with its health equity missions. This will ensure that current and future plans to bolster health equity are informed by individuals impacted by structural discrimination and therefore are most impactful.

Those efforts should be supplemented by public health worker training.

“CDC should develop a set of health equity competencies, spanning public health sciences, program and policy development and evaluation, communications, partnerships and advocacy, and leadership,” RWJF said. “In both the internal and external work, bidirectional learning is essential as staff and state and local partners have their own experiences and expertise that can enrich CDC’s efforts.”

RWJF acknowledged that CDC is facing headwinds, particularly in the current sociopolitical climate.

“Equity can be marginalized when institutions go through strategic resets, particularly those driven by crises,” the organization said. “This marginalization is even more likely when powerful sociopolitical actors paint equity as divisive, un-American, and unlawful and as critics call for institutions with broad mandates, like CDC, to focus on ‘core’ issues (i.e., not the needs of people experiencing structural discrimination). Adding to the challenge, structural inequities persist even with intentional efforts toward reform.”

However, as CDC continues to look inward and reevaluate its mission post-pandemic, it should center health equity as a part of all of its initiatives, something RWJF president and CEO Richard Besser, MD, said will improve public health for all.

“The COVID-19 pandemic revealed important opportunities for us to repair trust and strengthen our public health system,” Besser, who also served as acting CDC director in 2009, said in a press release. “A fragile public health system puts everyone at risk. If we build a public health system focused on equity, all people will have the opportunity to thrive regardless of who they are, where they live, or how much money they have.”