Utah policy experts discuss lessons learned during COVID pandemic and strategies for rebuilding trust in public health
The 2023 Utah State of Reform Conference in Salt Lake City last month brought together a panel of local health policy experts to discuss how to reestablish trust between Utahns and state and federal public health agencies.
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A survey published in March in the journal Health Affairs revealed that 63% of Americans said that their trust in the CDC was either limited or nonexistent, citing alleged political influence on its recommendations and policies as the main reason.
Panel members from the Utah Public Health Association (UPHA), Association for Utah Community Health (AUCH), and Get Healthy Utah (GHU) shared their thoughts on how to reframe public health to better communicate its objectives and goals.
Sarah Woolsey, AUCH’s chief medical officer, spoke to the importance of the organization’s health centers and their partnerships with the community and relationships with patients, and how they helped in the administration of vaccines.
“Of the 77,000 vaccines [that] were delivered by health centers, 70% were [administered] to racial and ethnic minorities because they felt safe to come there or they were in their local neighborhoods where they were already patients,” Woolsey said.
“That was a great opportunity. [In] the Navajo Nation, 90% of their patients were vaccinated for COVID. So there was something happening that was disproportionate to messaging in other places. There are lots of reasons for that, but who are the partners that are [part of] public health [who can] extend their ability to translate or be partners? So I think that’s an opportunity.”
In her briefings with the Utah Department of Health and Human Services on the lessons learned from the COVID response, Woolsey said she highlighted the successful mobilization of community health workers. She said the inclusion of those trusted and established partners as part of public health was something the state could consider as it works to build trust.
“That’s a significant mobilization of resources—calling up that workforce, adding that workforce, and giving them unrestricted resources to take care of people’s needs for being housed, for being fed, for having transportation,” Woolsey said, “Whatever was needed, those partners were able to do that within the community.”
Carrie Butler, UPHA executive director, said making the healthy choice the default choice is imperative to rebuilding public health trust, and that begins with officials understanding the population they are serving. Butler believes public health agencies failed to meet people where they were at and meet their needs when it came to issues like immunization, quarantine, and isolation.
“I think that we made some clear-cut mistakes,” Butler said of public health officials. “We did not address the divisiveness that we have been confronted with politically. And I think that caused us as public health professionals to create this ‘us versus them’ mentality.”
UPHA is focused on rebuilding its workforce and trust in the expertise of its members, which both took a big hit during the pandemic, according to Butler. The organization has been providing resources and access to public health students statewide and recently launched the Community Health Workers Association as an independent organization to promote professional growth.
Butler said trust in the research and guidance of its members by state policymakers is key to creating the policies and programming that help people make the safest choices, as was the need for members to understand the public they were serving.
Alysia Ducuara, GHU’s executive director, said the organization’s approach to building trust was building relationships across all sectors of the state to serve its mission of healthy living. It launched the Healthy Utah Community initiative in 2020 to work with cities and towns on implementing evidence-based strategies to improve community health.
“We already know that zip code is a better predictor of health than genetic code,” Ducuara said. “And so this helps us focus on policies, build environment, infrastructure, access to green space, access to grocery stores—all these different pieces that impact individuals’ health and ability to choose and make the healthy choice a default choice.”
GHU is engaged in conversations with city leadership, the Utah Department of Transportation, and urban planners on improving transportation, infrastructure, and building healthy communities. Ducuara said that along with relationship building, communication and messaging will be critical to reestablishing public trust.
“At GHU, I steered away from even saying ‘public health’ for the last few years when we’re working with partners, and just talk about community health and quality of life—again, knowing the terms and the language and the values of our partners and what they care about using their language,” Ducuara said. “[Conventional public health messaging] hasn’t really worked well, and [it’s important to be] packaging our messages according to what they will listen to and knowing what will turn people off.”
Butler agreed with Ducuara, saying the use of curated language that people will listen to can be more effective than traditional public health messaging. Butler believes matching the language to the audience is something public health needs to start focusing on.
While the panel acknowledged positives that emerged from the pandemic—increased access to telehealth, increased focus and identification of health inequities, and the released public funding behind it—Butler stressed institutions of public health needed to be strengthened through expanded funding, adding that the next emergency situation must not be so dependent on private sector backing to meet the challenge.
“We have seen a diminishment of funding for public health steadily and progressively since [before the pandemic]—we know that we’re underfunded,” Butler said. “We know that some of our inability to respond quickly, some of our inability to communicate well, were a direct result of underfunding the important work that public health does in this case. I think funding for those things is really, really critical.”