The Becoming Better Ancestors™ Fund was inspired by the writings of Dr. William “Bill” Foege, a renowned American physician and epidemiologist. During his expansive career, Dr. Foege was one of the key architects of the successful smallpox eradication effort in the 1970s. He also guided Bill Gates and Melinda French Gates to make global public health impact their top priority, championed the science and management behind vaccines and vaccination and co-founded the Task Force for Child Survival, now the Task Force for Global Health. From May 1977 to 1983, Dr. Foege served as the Director of the Centers for Disease Control and Prevention (CDC) where his legacy continues to inspire multiple generations working to protect the public’s health.

The fund was created to support best in class, future-forward thinking and strategic opportunities for improving public health. The fund was inspired by lessons learned from transformational public health impact throughout the history of CDC—including Smallpox eradication, the HIV epidemic, SARS, Ebola, Zika virus and the COVID-19 pandemic, in addition to non-communicable disease work such as reducing tobacco use and pioneering a public health approach to violence and injury prevention. The fund aims to explore how we might apply these lessons to address evolving and complex public health issues, like inequity, climate change and its impact on health and the preparedness of our communities. Learning from our public health history can empower us to become better ancestors—to leave the world better than we found it. Inaugural support for the fund was provided by Dr. Craig White (EIS, Class of '83), a long-time friend of Dr. Foege.

Photo credit: Billy Howard for The Task Force for Global Health

Strategies to Repair Equity and Transform Community Health (STRETCH) engages intermediary organizations, such as local health providers, philanthropy, academia and others, to support governmental state public health agencies to achieve health equity.

While state public health agencies (SPHAs) are integral to establishing a culture of health equity, they face challenges in creating the lasting systems change needed to achieve the vision of healthy and resilient communities. These challenges range from a disinvestment in public health to a workforce deeply impacted by the global pandemic to the public health crisis of racism and oppression. As the challenges facing public health become more complex, the role of partnerships and strategic alignment with communities, state and local organizations, intermediary organizations and others becomes more critical.

There are three primary objectives of STRETCH, which include supporting SPHAs in:

1. Designing meaningful, lasting systems change to create inclusive, equitable public health systems. 
2. Embedding equity into priorities, programs, policies and practices. 
3. Leveraging new funding through financing strategies to drive impact.

Ten SPHAs have been selected to participate in the STRETCH initiative, and each of them will develop a core project aligned with their agency's priorities. Tailored technical assistance and capacity building will help these agencies reach their specific goals and strengthen their community partnerships.

The past two years have been extremely difficult for our colleagues in public health. They have been completing transformative work in their communities while also confronting the challenges of responding to a pandemic. The STRETCH Initiative aims to be an extension of their team, helping them build and expand equitable health systems.

Initiative Updates

• Building a Culture of Health Equity: New Initiative Launches with 10 State Health Agencies
• Building Systems Change for Equitable Public Health Systems

Resources

• The Future of Public Health: A Synthesis Report for the Field, National Network of Public Health Institutes Nov 2021
• Rhode Island Health Equity Zone Initiatives
• Lights, Camera, Action: The Future of Public Health National Summit Series

Participating States

The participating SHPAs have created teams composed of cross-sector members bringing together key players such as their health equity officer, finance team members, local and county health departments health director or deputy, intermediaries and community members. The SPHA teams each have a core project, developed to align with and address their unique state priorities. These projects center on building collaborative partnerships to take action to address health equity. Some states will adopt a statewide approach, while others will take a place-based approach, focused on particular communities or regions.

• Connecticut State Department of Public Health and the Office of Health Strategy
• Kansas Department of Health and Environment
• Maryland Department of Health
• Minnesota State Department of Health
• Mississippi State Department of Health
• Nevada Division of Public and Behavioral Health
• Tennessee Department of Health
• Vermont Department of Health
• Virginia Office of Health Equity
• Wisconsin Department of Health Services

STRETCH Framework: A Health Equity Approach

The STRETCH Framework is designed to guide efforts to create meaningful systems change to achieve health equity. By addressing root causes through a systems change approach, the STRETCH Framework is meant to re-frame and re-imagine current public health models necessary to achieve more equitable outcomes. This framework emphasizes partnering with communities and intermediaries to stretch the impact public health agencies can achieve.

Learn More about the STRETCH Framework

Environmental Scan: Preliminary Findings

To begin to anticipate how this learning community could be useful to participating SPHA teams, 12 subject matter experts and individuals with experience in state public health agencies were consulted for their perspectives and experiences about how states might take advantage of current federal funding to turn successfully reduce, and even eliminate, health inequities.

Conversations with the subject matter experts focused on: federal funding, workforce strategies, state health agencies' roles in place-based work and technical assistance needs. In thinking about key opportunities to (re-)invest in public health, those interviewed identified several areas that would enable critical change:

• data collection and reporting,
• information flow between sectors, department levels and geographic areas,
• strengthening staff capacity to effectively and consistently apply health equity principles in all aspects of their work,
• working to change historically oppressive systems,
• embedding equity in all policies,
• funding sustainability and
• community partnerships practices.

The views expressed here do not necessarily reflect the views of the Robert Wood Johnson Foundation.

The PLACES Project is a collaboration between the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation and the CDC Foundation. PLACES will allow counties, places, and local health departments regardless of population size and urban-rural status to better understand the burden and geographic distribution of health-related outcomes in their jurisdictions and assist them in planning public health interventions.

PLACES is an extension of the original 500 Cities Project that provided city and census tract estimates for chronic disease risk factors, health outcomes, and clinical preventive services use for the 500 largest US cities. The PLACES Project provides model-based population-level analysis and community estimates to all counties, places (incorporated and census designated places), census tracts, and ZIP Code Tabulation Areas (ZCTAs) across the United States. Learn more about the PLACES Project.