Engaging Communities in Public Health

by Jon Scaccia July 2, 2024

The COVID-19 pandemic laid bare the critical need for a more inclusive and engaged public health system in the United States. The pandemic showed that community-based organizations (CBOs) are essential partners in public health, especially in reaching marginalized communities. This blog post explores a recent study that sheds light on barriers to effective collaboration between public health departments and CBOs and proposes policy recommendations to build stronger partnerships.

The Significance of Community Partnerships

During the pandemic, community-based organizations played a vital role in addressing public health challenges. They utilized their deep understanding of local cultures and needs to deliver effective public health messages and services. For example, the Black Boston COVID-19 Coalition advocated for a mass vaccination site in a predominantly Black neighborhood, ensuring community members were employed to support the effort. Similarly, the Arkansas Coalition of Marshallese focused on reaching mothers in their community, understanding the matriarchal structure of Marshallese society.

These examples highlight the importance of CBOs in public health efforts. They combine scientific knowledge with culturally resonant messages, personal relationships, and a deep understanding of their communities’ needs. However, as the pandemic recedes, there is a risk of losing these valuable partnerships and the progress made.

Identifying Barriers to Effective Collaboration

The study conducted online surveys with both public health departments and CBOs to identify barriers to effective collaboration. Three main barriers were identified: mistrust, siloed work and funding, and insufficient shared decision-making.

1. Mistrust: Mistrust between communities and public health departments is a significant barrier. Only 18% of CBO respondents and 11% of public health departments reported a high level of trust between their organizations. This mistrust is rooted in structural inequities and historical disparities in health status and social determinants of health. Building trust requires addressing these factors and fostering authentic community collaboration.

2. Siloed Work and Funding: Public health is often seen as the sole responsibility of public health departments, leading to siloed work and funding. The pandemic highlighted the interconnectedness of health, education, work, and well-being. New linkages between public health and other sectors, including CBOs, are crucial. However, underfunded local public health departments often lack the staff needed for community relationship building. Furthermore, disease-specific public funding does not match the needs of CBOs, which require flexibility to address local priorities.

3. Insufficient Shared Decision-Making: Communities often have insufficient decision-making roles in public health planning and funding. While 91% of CBO respondents reported being asked for input, only 29% were formally engaged in deciding priorities and policies. Smaller CBOs were less likely to receive funding from health departments, further marginalizing their voices in public health leadership.

Policy Recommendations for Stronger Partnerships

The study offers several policy recommendations to address these barriers and build stronger partnerships between public health departments and CBOs:

1. Establish Community Councils: Federal agencies should require state and local public health agencies to establish community councils with a formal role in public health decision-making. These councils should be involved in all stages of public health projects, from selection to assessment. They should represent underfunded and marginalized communities and promote shared power over resource allocation.

2. Dedicated Funding for CBOs: Congress and federal agencies should dedicate funding specifically for CBOs. This funding could be direct or through subcontracts with larger organizations. By ensuring funding is not tied to specific diseases or conditions, CBOs can address local priorities more effectively.

3. Simplified Procurement and Reporting: Simplified procurement and reporting processes are essential to lower barriers for small CBOs. Many small organizations struggle with eligibility requirements and extensive reporting. Simplified processes, upfront funding, and technical assistance can help CBOs access and manage funding more effectively.

4. Technical Assistance and Training: A centralized technical assistance program should be established to support community capacity building and best practices for public health partnerships. This program should offer foundational training for CBOs and community health workers, as well as financial management support for smaller organizations.

5. Bolster Community Health Workers: Increasing diversity in the public health workforce, including sustained funding for community health workers, is crucial. Community health workers should be integrated into the public health and healthcare workforce through long-term funding and career advancement opportunities.

Why This Matters

Strengthening community partnerships in public health is not just about improving health outcomes; it’s about fostering trust, equity, and resilience in our communities. By implementing these policy recommendations, public health agencies can harness the creativity, resourcefulness, and wisdom of communities to address health disparities and improve overall health. Public health practitioners should prioritize building these partnerships to create a more just and effective public health system.

What is your experience? Let us know in the comments!

1. What experiences have you had with community-based organizations in your area, and how have they impacted public health efforts?
2. How can public health departments better engage with and support marginalized communities in your region?

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About the Author

Dr. Jonathan P. Scaccia, PhD, is a clinical-community psychologist with expertise in public health science and practice. He has led evaluation and research initiatives focusing on health equity, vaccine distribution, and organizational readiness. Dr. Scaccia has contributed to federal suicide prevention programs and vaccine equity strategies. He has been recognized for his impactful work and is a leading voice in advancing public health practices.