Public Health Stewardship

It will take all of us working together to realize our shared vision for health, well-being, and equity. Public Health often facilitates cross-organization and cross-sector work to steward vital community conditions. Through partnership and collaboration, Public Health Stewards work with purpose, in partnership, and across sectors and settings to advance thriving.

The practice of stewardship can guide our work on the Essential Public Health Services, as well as efforts to expand, improve, and modernize public health systems.

Defining Stewardship

Stewards are people or organizations who take responsibility for working with others to create conditions that all people need to thrive, beginning with those who are struggling and suffering. Stewards may be affiliated with organizations, like public health departments, or may act on their own agency, such as community residents. Stewards have (or are interested in developing) an equity orientation with regard to purpose, power, and wealth.

    Purpose must be larger than oneself and one’s organization.

    Power must be built and distributed with others, not consolidated.

    Wealth must be invested, not withheld, to create long-term value as well as address short-term urgent needs.

    Stewardship Practices

    Stewardship practices rely on age-old concepts used by communities and cultures around the world. Stewardship practices emphasize our interconnectedness and shared humanity. They invite discovery, experimentation, and learning to uncover the solutions our communities need. Stewardship requires new postures, new practices, and new ways of learning and working together that extend beyond job descriptions, institutions, and formal roles.

    Stewardship practices are patterned on three themes: 1) Connecting across differences, 2) Creating opportunities, and 3) Learning and adapting. They demonstrate unique power to create meaningful, lasting change in any setting. Examples of how Public Health Stewards are working to connect across differences, create opportunities, and learn and adapt are given.

    Stewardship Themes
    Public Health Stewardship in Action
    Connecting Across Differences
    Stewardship is not a solo act. It becomes increasingly powerful as more people and organizations are drawn into the work together, connecting across geographies, roles, departments, sectors, or cultural divides because they are informed by place-based, interdisciplinary, multisector, multiracial, and multicultural perspectives.
  • Partner with community for more effective, equitable, and sustainable solutions See: Equity
  • Partner across organizations and sectors to do more by acting together See: Partnership
  • Communicate across differences to reach diverse audiences See: Communication
  • Creating Opportunities
    Progress depends on actively breaking from the status quo by continually creating opportunities for a different future to take hold. This can only happen if we transform systems that were never designed for all community members to thrive.
  • Create and champion interventions with co-benefits to multiple health outcome areas See: Implementation
  • Leverage legal and regulatory actions to secure vital community conditions See: Authority
  • Improve organizational infrastructure for public health See: Infrastructure
  • Learning and Adapting
    Our world is constantly changing; adaptive approaches will help us to move forward together, especially in the face of uncertainty. We need to be able to adapt to and navigate the future together.
  • Improve public health programs through evaluation, research, and quality improvement See: Evaluation
  • Monitor trends in population health and make data-informed decisions about matters affecting health See: Assessment
  • Develop a diverse and skilled public health workforce capable of meeting current and future needs See: Workforce
  • Stewardship and Public Health

    Stewardship is at the heart of Public Health practice. It shows up in Public Health’s commitment to improve health, well-being, and equity and vital community conditions, and provide theEssential Public Health Services. Public Health is uniquely positioned to lead and catalyze transformational change for health, well-being, and equity.

    Opportunities for Public Health

    Multiple national efforts have emerged to guide Public Health’s path forward in the wake of COVID-19 and in preparation for future challenges. Among them is Public Health Forward: Modernizing the U.S. Public Health System, which advances a vision for a robust and modern public health system; complementary efforts focus on a specific area or aim, for example developing the public health workforce, modernizing data and technology infrastructure, and strengthening public health law. These efforts provide direction to Public Health Stewards.

    Public Health has the opportunity to show up as stewards by centering community voices and solutions, collaborating to measure well-being, and committing to multisolving across community investments. These key opportunities and their role in advancing the Essential Public Health Services and our collective vision for a modernized public health system are discussed below.

    Center community voices and solutions

    Public Health can lead as stewards by centering community voices and solutions. Through Partnership with community, Public Health Stewards lift up voices of people with lived experience, co-create solutions with community, and improve Equity. This stewardship practice is well-aligned with Public Health Forward’s vision for modernizing community engagement which advocates for investing in long-term relationship-building and partnership development with residents and community-based organizations.

    Vision: Public health departments partner with community members toward the shared goal of providing a fair and just opportunity for all to achieve good health and well-being. – Public Health Forward

    Collaborate to measure well-being

    Measuring well-being has emerged as a key stewardship practice that can focus us on what people need to thrive. In some places, Public Health and partners are already collecting well-being data, and seeing its value as a meaningful and sensitive measure. Through its Assessment and Surveillance services, Public Health has the opportunity to spread and scale well-being data collection. This stewardship practice is well-aligned with Public Health Forward’s vision for modernizing data and technology, which advocates for strengthening the collection of timely and actionable public health and investing in data sharing.

    Vision: A robust, modern, interoperable, and secure public health information system delivers real-time, accurate, and actionable data. – Public Health Forward

    Collaborate to measure well-being

    Public Health is often called upon to do a lot with relatively little funding. Investing funds wisely, being a good steward of funds, and ensuring that investments add up to impact are real concerns. Multisolving—working across sectors to address multiple challenges with one policy or investment—has emerged as a key stewardship practice that extends budgets and aligns constituencies for greater impact. This stewardship practice is well-aligned with Public Health Forward’s vision for modernizing financing, which advocates for maximizing existing assets and evaluating the impact of public health programs and strategies.

    Vision: Sufficient, predictable, and flexible funding supports the public health system and enables it to sustain healthy communities across the country and act quickly to protect the public from expected and unexpected health issues. – Public Health Forward

    Reflection Questions

    • What does stewardship mean to you?
    • What are the three stewardship practices?
    • How can Public Health stewardship advance equity?
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