Medicolegal death investigations (MDIs), conducted by medical examiner and coroner offices, are crucial to understanding causes of deaths, monitoring evolving health challenges and ultimately saving lives. Funding and resources increase the ability for MDI offices to collaborate with internal and external data sharing partners to send and receive this integral information. 

To transform the MDI data landscape and reduce the resources needed by an MDI office to collaborate with data sharing partners, CDC is prioritizing data modernization. Fast Healthcare Interoperability Resources (FHIR®) is a standard created for healthcare data exchange. This standard can be used to achieve bi-directional exchange of data between MDI systems and data sharing partners. FHIR® improves data exchange while simultaneously reducing the burden of data entry.

During this initiative, selected MDI offices work collaboratively with other MDI offices, data sharing partners, vendors and FHIR® subject matter experts to use FHIR®-based data exchange to improve the efficiency of data transmission between MDI offices and data sharing partners.

Modernizing MDI data practices improves MDI office’s ability to investigate deaths, improves public health’s ability to monitor evolving health trends and creates data driven interventions to save lives without increasing burden on these offices. 

Our collaborating sites: 

• Alabama: Jefferson County Coroner/Medical Examiner’s Office 
• Alaska: Alaska State Medical Examiner’s Office  
• Georgia: DeKalb County Medical Examiner’s Office 
• Illinois: Cook County Medical Examiner’s Office 
• Michigan: Sparrow Office of Medical Examiner 
• Minnesota: Midwest Medical Examiner’s Office
• South Carolina: Charleston County Coroner’s Office

This program is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,469,915 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. Government.

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

Apply for STRETCH 2.0

The Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative is now accepting applications. Please apply by October 6 at 11:59 PM EST. View the RFA to learn more. For questions or access concerns, please contact Erin Salvaggio at esalvaggio@cdcfoundation.org.

We all want to live in a community where everyone has the opportunity to reach their best health and wellbeing, no matter their race, ethnicity or class. Communities, including state health agencies and community-based organizations, have been working toward everyone having opportunities to access health care, clean air, parks, childcare, transportation options and the many other aspects of our lives that impact our overall health. The Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative works to strengthen the foundational relationships imperative to ensuring all members of the community can thrive and improve the structures and processes needed to consistently move this work forward.

State governmental public health currently has an influx of funding to address health inequities and to strengthen the public health workforce and infrastructure. Strengthening partnerships with community-based organizations and community leaders is key to sustainably building change.

The STRETCH initiative offers capacity-building activities to build and strengthen trust and accountability among state public health agencies and community organizations, develop approaches to power sharing, identify community priorities and build a shared set of actions to achieve common goals of advancing opportunities for all community members to live their healthiest lives.

The CDC Foundation, Association of State and Territorial Health Officials (ASTHO) and Michigan Public Health Institute (MPHI) partnered on STRETCH 1.0 to bring together 10 SPHAs and their community partners to build and expand equitable public health practices and strategies.

Building upon the experiences in the first round of the STRETCH initiative, STRETCH 2.0 aims to promote necessary skills, core competencies, power sharing and authentic relationships among state team members and community partners to advance and sustain health equity through systems change.

The STRETCH initiative champions a systems change approach by analyzing the underlying policies, practices, resource allocations, power dynamics, relationships and mental models—our beliefs or assumptions that influence our perceptions—that have created barriers to everyone having the opportunity to live their healthiest life. CDC Foundation, ASTHO and MPHI will provide specialized technical assistance to state public health agencies and their communities to address these underlying root causes of health inequities.

Community-based organizations and state public health agencies are working in partnership to ensure a better future for all. STRETCH is providing additional support to strengthen these relationships with a focus on community needs for long-term changes.

The STRETCH Framework

The STRETCH Initiative synthesized different perspectives into an action-oriented framework that emphasizes addressing root causes to achieve health equity.

The STRETCH Framework is a tool for public health practitioners—including state public health agencies, local health departments and community-based organizations—to understand the shifts needed to achieve true systems change. The framework aims to re-imagine standard public health practice by centering equity as a through line throughout all public health domains and deploys a systems change approach.

A systems change approach focuses on the structures that create our health opportunities, such as the policies and procedures, resource allocations and partner dynamics. By focusing on the systems impacting the barriers to everyone having the opportunity to live their healthiest life, sustainable, long-term change can occur in our communities.

The STRETCH Framework guides teams through the three levels of systems change and focuses on five domains of interconnected and necessary functions: community-led approaches, place-based initiatives, workforce development, data-driven management and finance systems.

Learn More about the STRETCH Framework

STRETCH 2.0

The goal of STRETCH 2.0 is to promote necessary skills, core competencies, power sharing and authentic relationships among state team members and their community partners to advance and sustain opportunities for everyone to live their healthiest life. Governmental public health is currently receiving an influx of funding to strengthen the public health workforce and infrastructure. STRETCH is helping to ensure that the community is at the forefront of these decisions and that state public health agencies are investing in their community partnerships.

STRETCH 2.0 will have three levels of engagement: national, cohort and collaborative. The national tier provides technical assistance resources pertinent to challenges and needs across public health and is open for all public health practitioners to participate, regardless of their participation in STRETCH. The cohort and the collaborative are only available to those accepted to participate through the RFA. The up to seven collaboratives will move through capacity-building activities to develop and achieve their common priorities and goals. Prior participation in STRETCH 1.0 is not required.

Initiative Updates

• Strengthening Community Relationships as the Foundation for Change
• Repairing Equity and Transforming Community Health
• Nothing For Us Without Us: How Connecticut is Rethinking Their Funding Systems
• Building a Culture of Health Equity: New Initiative Launches with 10 State Health Agencies
• Building Systems Change for Equitable Public Health Systems

STRETCH 1.0 Participating States

The participating state public health agencies in STRETCH 1.0 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 centered on building collaborative partnerships to take action to address health equity. Some states adopted a statewide approach, while others will take a place-based approach, focused on specific 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

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