The field of public health creates conditions to keep communities healthy. As the U.S. population has expanded, public health needs have evolved, and today’s complex issues require a skilled and engaged public health workforce to create collaborative opportunities to explore, understand, and address community needs and priorities, including the social and structural determinants of health. However, despite iterative calls to action over the last 35 years, investments in the public health workforce have not kept pace, leaving critical capacity gaps. A focus on public health workforce is particularly important in rural communities, where mortality rates due to preventable diseases are 20% higher than urban populations, and where health departments face significant challenges in staffing and staff capacity.

Public health equity can be achieved in rural communities through a capacitated workforce that applies Public Health 3.0 approaches to ensure community engaged opportunities to assess needs, identify priority issues, steward partnerships, braid resources, and support process improvement, and there are clear opportunities to build capacity: over 86% of the current public health workforce has no formal public health training and 54% report having critical skills gaps in domains that support health promotion activities (e.g., community health assessment and improvement activities). These numbers are likely higher in rural health departments due to structural barriers such as limited talent pools and limited funding.

Cornell University’s Center for Health Impacts is poised to serve as one of CDC’s national CBA partners, helping to revitalize the U.S. public health workforce. To close health equity gaps in rural communities in the U.S., we will partner with state, local, tribal, and territorial health departments, and build learning cohorts of those charged with leading community health assessment and improvement processes. We call this group “Health [Equity] Promoters.” We will build capacity using the Public Health Essentials (PHE), our evidence-based CBA approach that has helped 1,115 public health workers build the foundational knowledge, strategic skills, and confidence needed to implement equity-based public health promotion. PHE provides 75 contact hours of online public health education in an asynchronous, facilitated format that can be scaled to reach state, local, tribal, and territorial health departments across the country. The training comprises five courses that cross-cut silos: The role of public health; How public health is done; Using data for action; Influencing health behaviors; and Building community resilience. PHE as a CBA intervention has had a significant effect on closing strategic skills gaps, and 94% of PHE graduates apply their newfound skills to their work.

Through this 5-year CoAg, we will work with CDC and partners to augment the reach of PHE and its impacts with Health [Equity] Promoters, particularly those in RHD. Specifically, we will increase awareness of promising CBA practices (PHE) through outreach, engagement, and reporting; increase access to and use of CBA products (PHE) that develop and maintain a diverse workforce with cross-cutting skills and competencies through subsidized access for at least 1,000 learners; and demonstrate enhanced skill and ability among Health [Equity] Promoters to support decision-making toward applying recommended processes, policies, programs, and practices. Our team will integrate our PHE intervention and our established M+E processes to support learner success (knowledge, skills, confidence), as well as intermediate outcomes related to Workforce (e.g., PHE graduates who are skilled, retained in the workforce), and who are having impacts on Organizational Capacity + Performance Improvement, Partnership Development + Engagement, and Policy + Programs (e.g., how PHE graduates are investing in community engagement to support health equity-focused actions).