Introduction
In the past two decades, the field of public health has sought to identify challenges and opportunities in the U.S. public health system and build health departments’ capacity to move more “upstream” to address social determinants of health (SDOH) and center health equity.Reference e.g1 Despite growing interest in the field and academia, many still struggle to operationalize SDOH and equity frameworks — particularly in the face of ongoing structural, institutional, and socio-political challenges.2
Understanding how racism and other forms of structural discrimination — as well as the political and legal systems in which they are embedded — influence the SDOHReference Benfer3 includes recognizing how laws and policies have enabled, sustained, and exacerbated the unequal distribution of opportunities, resources, and power necessary to achieve health equity.4 This is an important competency for health departments (and public health practitioners more broadly) to develop because of their legal authority to promote public health and safety. This authority can be utilized in ways that can either exacerbate or undo health inequities. Understanding the scope of legal authority that a health department has is essential to knowing what types of actions it can (and should) take to ensure better health for all.
Yet many public health education settings — including masters of public health (MPH) programs — do not prepare students to enter the workforce with an adequate understanding of how the law can be used to improve or hinder health or how, as practitioners, they might engage in the policy process in a way that is legally feasible.5 Current accreditation standards, which strongly influence the curriculum for the courses taught in MPH programs, do not require public health law as a competency for public health students.6 Out of 190 accredited U.S. schools and programs of public health (SPPH) that offer an MPH degree, only 17% offer a course dedicated to public health law.7 This article explores some of the ongoing efforts and opportunities to systematically address this gap.
Supporting Practitioners Across the Span of their Career: The Public Health Law Academy
For the past decade, ChangeLab Solutions (ChangeLab) and the Centers for Disease Control and Prevention’s Public Health Law Program (PHLP) have partnered, under a cooperative agreement, to build the public health workforce’s capacity to use the tools of law and policy to advance health equity.8 In a 2019 Journal of Law, Medicine, and Ethics article, Ransom et al. explored one of ChangeLab and PHLP’s core projects under its cooperative agreement: the Public Health Law Academy (PHL Academy).Reference Ransom9 Now five years later, the PHL Academy has expanded its online, on-demand trainings and facilitator resources to also include fellowship opportunities, communities of practice, and a collection of resources designed to support public health practitioners at various stages in their career.
The creation and evolution of the PHL Academy has been directly shaped by needs raised by the public health community. Through multi-year environmental scans and key informant interviews, small group engagements, and in-person convenings with practitioners working in or with state, tribal, local, and territorial (STLT) health departments, non-governmental organizations, and faculty and administrators in SPPH, ChangeLab and PHLP have identified several entry points (discussed below) aimed to support practitioners across their entire career — starting before they enter the workforce.10
This training gap represents an opportunity for faculty, students, academic institutions, and accrediting bodies to integrate public health law into curricula, practicums, and other applied learning experiences.
A. Strengthening Career Pathways Into Public Health
Beginning in fall 2020, ChangeLab conducted a multi-year assessment of 190 accredited graduate SPPH.Data collected from an environmental scan and key informant interviews were then analyzed for trends and themes.11 A prominent theme was the absence of public health law concepts in MPH courses and program curricula. This training gap represents an opportunity for faculty, students, academic institutions, and accrediting bodies to integrate public health law into curricula, practicums, and other applied learning experiences.
To support such efforts, ChangeLab and PHLP are focused on the following objectives:
1. Build the capacity of schools, programs, and faculty teaching public health law.
Nearly all key informants mentioned faculty expertise to teach public health law-related courses as a limiting factor. In response, ChangeLab and PHLP have developed sample lesson plans and curricula materials that faculty are piloting in SPPHs across the country.12
2. Integrate basic public health law concepts into existing course competency models.
To increase awareness of public health law’s value and create standardization around public health law skills and competencies, ChangeLab and PHLP are developing a student competency model specific to public health law and have partnered with faculty from SPPHs across the country to build a peer network and help make the case for integrating public health law into curricula.
3. Increase educational diversity and expand access to public health law training for non-MPH students.
ChangeLab and PHLP are in the process of exploring opportunities to increase access to public health law training for non-MPH students. While SPPHs are an important training ground for future public health practitioners, only 16% of MPH graduates find their first employment in health departments — meaning many health practitioners come to the field via other educational pathways.Reference Plepys13 This is another area where accrediting bodies and academic institutions and leadership can play an important role in providing trainings, certificates, and learning opportunities in educational settings, including undergraduate programs, public policy programs, law schools, and community colleges.
B. Moving From the Classroom to Early Career Opportunities
The Public Health Law Fellowship, which ChangeLab and PHLP launched in January 2023, offers a bridge between the classroom and workforce.14 This paid opportunity provides graduate students (e.g., M.P.H., Dr.P.H., M.P.A., Ph.D.), law students, and recent alumni of these programs with on-the-job training to prepare them for careers in public health law. Fellows are matched with mentors at host sites in health departments, CDC, or other organizations that support work in public health law and policy. The goals of the fellowship are to strengthen the public health workforce by increasing diversity (of people with cultural, intersectional identities and lived experiences) within the field, providing opportunities for hands-on-experience in public health law, and training the next generation of public health law professionals to respond to critical issues.
C. Equipping the Field With Knowledge, Skillset, and Resources
As important to building the capacity of future practitioners is ensuring current practitioners have the knowledge, skillset, and resources to utilize the tools of law and policy to address health inequities. Through the PHL Academy, practitioners — at any stage of their career — have (or will soon have) access to the following opportunities and resources:
1. Peer learning and community of practice opportunities.
In response to feedback from the field calling for more practice-based resources, learning opportunities, and peer connections, PHLP has partnered with ChangeLab and The Policy Surveillance Program at Temple University to deliver training, mentorship, and technical assistance to staff from health departments and organizations who participate in 10-month learning cohorts. Participants have the opportunity to develop the skills to design and implement their own legal epidemiology projects. Through this experience, participants have increased their basic legal literacy, gained foundational skills in legal research and evaluation, worked in collaboration with community members and partners from other agencies and institutions, and advanced a range of organizational objectives — from supporting strategic planning efforts to directly informing regulatory and policy changes.15
2. A collection of resources.
Building on findings from earlier engagements with public health lawyers and health department staff16 and a longstanding body of external reports and assessments exploring challenges and opportunities in the U.S. public health system,17 ChangeLab staff conducted a 12-month qualitative assessment — starting in November 2020 — that included an environmental scan and key informant interviews focused on identifying: (1) how health departments, across a continuum of readiness, currently use law and policy to address the SDOH and health inequities and (2) what tools, resources, and opportunities would help further their efforts.
These findings informed the current development of a robust resource library (forthcoming in spring/summer 2024) that will include research briefs and guides, tailored to support health departments in leveraging law and policy to promote health equity and navigate today’s unique challenges, including rollbacks of public health authority, a growing lack of trust in health departments and government, and mis/disinformation that undermines public health efforts. To meet health departments where they are, it will also identify tangible opportunities and resources to move from SDOH and health equity frameworks to action, including a newly-developed SDOH Assessment Tool and Roadmap to help health departments get a baseline understanding of their existing activities, resources, and knowledge of SDOH and the law and identify the incremental goals and activities needed to advance their work.
Conclusion
Understanding the relationship between the law and public health is critical to eliminating structural health inequities. While this article focused on the PHL Academy’s offerings as one starting point, its broader aim is to generate ideas and momentum for collaboration, coordination, and action among public health lawyers, practitioners, students, academic faculty and leaders, accrediting organizations, and other changemakers towards building a public health community that more effectively leverages the tools of law and policy to advance ongoing efforts to achieve health equity. Faculty and school administrators can reach out to phla@changelabsolutions.org to learn more about opportunities to test out public health law teaching modules or download free materials for instructors from the PHL Academy. Public health practitioners can also connect with local schools and programs about the need for public health law training and play an important role in offering mentorship and important on-the-ground experience for students and recent graduates who may be early in their career. Accrediting bodies, such as the Council on Education for Public Health (CEPH), can integrate public health law concepts into required competencies for accredited SPPHs. And the broader health community — including health department staff, attorneys, and medical professionals — can assess their leadership and staff understanding of core public health law and health equity concepts and identify the next steps, partnerships, and resources needed to continue building legal literacy and capacity.
Acknowledgements
The authors wish to thank all the staff at ChangeLab Solutions and the Centers for Disease Control and Prevention’s Public Health Law Program who contributed to the work discussed in this article. This publication was supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $250,000 with 100 percent funded by CDC/HHS. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. Government.
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