Engaging Those Served by Public Health Programs Drives Better Outcomes

The bold approach to person-centered care now contained in the Affordable Care Act is beginning to revolutionize the delivery of healthcare. Not only are providers addressing clients as people rather than cases, but also these same clients are becoming active in their own care. They are involved in plotting both the course of care and the benchmarks of its success. In fact, in behavioral healthcare, we already are beginning to move toward “self-directed care.”

Good reasons exist why active participation in one’s care can lead to better quality and outcomes. Greater engagement provides a spark for care. It can lead to a more equalitarian relationship between person and provider. It can lead to shorter duration of care and better outcomes. And it also can provide the psychic energy needed to maintain engagement over the course of care.

Let us apply the same concepts to public health. Public health interventions usually are directed toward everyone in a community or population, with special attention for those at high risk and those who already have the condition being addressed. Ultimately, public health practitioners are primarily concerned about care for these latter two groups, since they are most likely to include those who are racial or gender minorities, those who are poor, and those with other health or mental health conditions.

Clearly, planning, implementation, and assessment of public health interventions should include the participation and perspective of persons from disadvantaged groups. For planning, representatives from these groups are likely to have detailed knowledge of the community and its culture that will not be available to the public health specialists designing the intervention. They also are likely to know what approaches will or will not work in their own community. Both types of knowledge will be critical for the success of the intervention. For example, imagine how we might have changed the COVID-19 vaccination rates for these disadvantaged groups if such knowledge had been available to us early in the process.

The success of the implementation phase of a public health intervention will be contingent upon the planning, as described above, and upon the willingness and engagement of community members to participate in the intervention. For example, with appropriate preparation and prior discussion with members of disadvantaged groups in a community, resistance to COVID-19 vaccination likely could have been mitigated.

Engagement of disadvantaged groups in the assessment phase also is very important. Because of their special knowledge of the community, these persons are likely to have first-hand accounts of the successes and failures of the intervention. Such information will be needed for future efforts, for example, why particular groups did not participate in the intervention.

The American Public Health Association has a central role to engage members of disadvantaged groups in public health work. The association must reduce financial barriers so that it will be possible for representatives from these groups to join and participate in the annual national meeting and in the ongoing activities of the affiliates, sections, forums, and caucuses. Additional external resources will be required to make this possible. Clearly, each APHA activity would benefit from these voices and perspectives. And finally, APHA could actually serve as a portal to introduce these disadvantaged groups to the public health service community in our states, counties, and cities. This could be a win for all.

Ron Manderscheid, PhD, is president and CEO of NACBHDD and NARMH.