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Explaining Minnesota's public health system to policymakers

Educational strategies:
1. Before elections
2. Newly elected commissioners
3. Early-term commissioners
4. Crisis event or policy change
5. Ongoing education

Engaging local elected officials in public health is an ongoing process that involves making connections among various issues within local government. In Minnesota, state law and funding provide local governments with a framework for community health services (CHS), and local elected officials make final decisions about how programs in their area will be implemented and funded. Helping local government officials understand public health and Minnesota's system will continue to foster collaboration and support for public health issues.

"All politics is local."
— Former Speaker Tip O'Neill

SCHSAC workgroups collaborated to identify the following methods to inform and educate county commissioners about public health, based on interviews with county commissioners and staff. These strategies are intended to be useful during the different phases of a county commissioner's term of office.

Educational strategy phases

1. Before elections
2. Newly elected commissioners
3. Early-term commissioners
4. Crisis event or policy change
5. Ongoing education

1. Before elections

Building on previous local government experience: By providing introductory information on public health to a variety of local elected officials in your communities, you can increase the awareness of future county commissioners, strengthen local intergovernmental relationships, and build broader awareness and support for public health.

Key messages for other local government officials

• Very basic information about the work of the local public health department
• Basic information about public health including disease prevention and health promotion
• Information to enhance the understanding of the relationships among various levels of government
• Basic information on the local public health assessment and planning cycle
• Clarification of roles in specific situations (e.g., public health nuisances) among county public health, community health boards, boards of health, and other local government official

Possible communication methods for other local government officials

• Meet with township associations at association meetings
• Meet with individual township boards, city councils, and school boards
• Invite comments, questions, and concerns regarding public health issues

Resources for other local government officials

• An overview of Minnesota's local public health system: Structures, mandates, and funding (PDF)
  Local Public Health Association of Minnesota

2. Newly elected commissioners

Commissioners are elected in November, and take office in January. You can use this interim time as an opportunity for newly elected commissioners to get to know public health and public health staff. Newly elected commissioners are generally ready to absorb new information, but aren't yet completely overwhelmed by commissioner duties.

Related appendix: Local elected official orientation [sample]

Key messages for newly elected commissioners

• Clear and concise messages about the value of public health (introduce the broad picture of public health)
• Information from public health staff on what they can do to help commissioners
• Information on who to call in the public health agency
• Introductory information on public health governance responsibilities and the need for a solid infrastructure

Communication methods with newly elected commissioners

• Conduct face-to-face meetings with new commissioners so they get to know staff
• Invite commissioners to visit the local public health department or attend advisory committee and community meetings with a public health role
• Invite commissioners to a quarterly SCHSAC meeting
• Develop a "handbook" describing issues specific to their local public health department
• Meet one-on-one with commissioners to build relationships with, and credibility of, staff
• Ensure new commissioners have a copy of your agency's community health assessment, community health improvement plan, annual report, and/or strategic plan

Resources for newly elected commissioners

• Specific materials from your agency with organizational information, etc.
• Policy and advocacy
  NACCHO

3. Early-term commissioners

As a commissioner is sworn in and begins work in a new term, s/he will encounter tremendous information overload. This is a time for clear, concise, and thoughtful communication, but also an important time to enhance the commissioner's understanding of the value of public health.

Key messages for early-term commissioners

• Information on how public health works with other local governmental agencies (including the connection between these agencies)
• Information that reinforces and builds on the public health governance responsibilities introduced in the previous phase ("newly elected"), including a brief summary or examples of legal requirements
• Information on key public health events/issues (routine public health events that may become controversial—such as family planning, tobacco ordinances, food irradiation, immunizations)
• Increase information on the public health role in disease prevention and health promotion
• Budget/funding sources for public health
• Information on Minnesota's public health system and structure, including information on governmental public health at the local, state, and federal levels

Possible communication methods for early-term commissioners

• Interview new commissioners to get to know their interests and information needs. New commissioners may not yet be able to indicate positions on issues, but you may be able to identify what they think is important
• Develop a list of frequently asked questions from citizens
• Develop a list of frequently asked questions from commissioners
• Develop a time line or calendar of important public health events
• Incorporate public health information into the Association of Minnesota Counties' "New Commissioner School"
• Encourage participation in MDH orientation to local public health video conference for newly elected officials
• Continue to meet one-on-one with commissioners to develop relationships and credibility

Resources for early-term commissioners

• An overview of Minnesota's local public health system: Structures, mandates, and funding (PDF)
  Minnesota Local Public Health Association
• Disease prevention and control common activities framework
• Local Public Health Grant funding
• Public health leader orientation and resource guide

4. Crisis event or policy change

Times of crisis or policy change have been identified as "teachable moments," when public health will potentially be most visible and valued—and often when commissioners need additional information on public health. Examples of changes or emergencies might include funding changes or budget decisions, policy or program changes that may be seen as controversial by the community, disease outbreaks, and/or disasters and emergencies (natural or technological).

Key messages for crisis event / policy change

• Governance responsibilities (e.g., crises and policy change will require a thorough understanding of public health statutory requirements)
• Public health aspects of disaster and emergency preparedness materials (e.g., are they ready for a crisis, how would they handle a certain situation, if involved in a previous disaster/crisis, ask what worked, what did not)
• Changing policies, practices, and scope of public health
• Information on the need for a solid public health infrastructure to assure a foundation for dealing with a crisis event or major policy change
• Understanding of the local jurisdictions, staff roles, agency roles, and available resources Possible

Communication methods for crisis event / policy change

• Use policy changes or crises as leadership opportunities for commissioners (e.g., commissioner as spokes-person for an event)
• Use public health events taking place in other parts of the state or the nation as teachable moments (e.g., ask, "How would we deal with that here?")
• Localize statewide press releases (how does this affect my community, my commissioners?) See: MDH news releases
• Conduct strategic planning exercises to prepare for crises and policy change
• Develop relationships or informal ties with county commissioners, to prepare for political/funding changes
• Consult with the MDH as necessary on legal and governance issues as well as a public health crises and communication issues

Resources for crisis event / policy change

• Local Public Health Act: Minn. Stat. § 145A
• Emergency preparedness and response
• BeReadyMN
  State of Minnesota

5. Ongoing education

When there isn't an emergency or a pressing need, sometimes it can be hard to get and keep the interest of commissioners in public health. It can be a challenging time, but is a great opportunity to increase commissioners' under-standing of the value of public health, or find commissioners with a special interest in public health who can be nurtured into becoming public health advocates.

Key messages for ongoing education

• Reiterate and strengthen messaging from each of the previous "phases."
• Work to strengthen the commissioner's relationship with, and the credibility of, local public health staff.

Possible communication methods for ongoing education

• Increase the understanding of public health governance responsibilities
• Reinforce and build on information about their governance responsibilities
• Remind the county board of the statutory requirement that the board of health meet two times per year
• Encourage frequent inclusion of public health issues on county board agendas
• Increase understanding of public health programs
• Begin to introduce more specific program issues
• Reinforce and build on previous general public health messages (support the public health basics)
• Involve commissioners in public health program or issues discussions and decisions (work with the county board to solve problems)
• Conduct "get to know your public health agency" tours, presentations or open houses
• Develop and deliver public health quality reports (present the "results" of public health programs, policy decisions, and public health goals to the county board)

Building relationships

• Build the credibility of staff and allow for the development of interpersonal relationships by allowing frequent interaction between public health staff and commissioners.

Ongoing education

• Keep commissioners aware of key public health events/issues
• Identify the "hot buttons" of resistant commissioners and connect those issues to public health
• Maintain ongoing, clear, concise communication with county commissioners
• Include public health issues workshops at the Association of Minnesota Counties (AMC) legislative conference
• Encourage participation by county commissioners at the annual MDH Community Health Conference

Other audiences

• Develop a public health education plan for the county coordinator/administrator.

Next: Health plan collaboration plans