The COVID-19 pandemic has revealed the importance of trusted messengers and community outreach to ensure public health and safety. It can be challenging to effectively communicate specific health guidelines and recommendations to a diverse array of populations. Additionally, many of the historically undercounted populations in the decennial census are also among those least likely to be provided access to health care and health information. Trust in government agencies may also be low in many of these communities, particularly those experiencing disruption and trauma from deportation, eviction, over-policing, redlining, denial of medical care, and other forms of institutional discrimination.

In addition to barriers involving lack of trust in government officials, public health information may not successfully transfer from officials to communities because: (1) guidelines and recommendations may vary over time (as was true during the COVID-19 pandemic), (2) information may be filled with acronyms and unfamiliar jargon, and (3) health information may not be culturally and/or linguistically appropriate. A prime example of the necessity for trusted messengers in this space is COVID-19 vaccine hesitancy in certain communities. As of November 2020 only 58% of Americans agreed that they would take FDA-approved vaccines (Gallup Nov 2020; Kaiser Family Foundation Aug 2020) 

How is inclusive public health planning currently constituted?

At its most basic level, community engagement on health might take the form of dissemination and outreach based on plans that have already been fully developed. Agencies may hold one or two public listening sessions, soliciting feedback from the community, and making tweaks as necessary. At this level, community engagement might not go too far beyond “checking off the box,” generating frustration among community members and reducing program effectiveness and efficiency.

Beyond this basic level, some government officials and philanthropy groups might consult selectively with one or a few community organizations, as they construct the public health plan. This level engages community members through community organizations, not directly, and does so in a selective manner. 

At a more advanced level, a public health plan is designed, created, and implemented through a “whole community” approach, which works to bring stakeholders from different backgrounds and life circumstances. While this advanced level does make a significant effort to be inclusive, there still may be certain groups that are not fully engaged in the process.

Our research indicates a few potential limitations in current models

Possible disconnect between community organizations and community members.

Even at the highest level, there may still be community members who are left out of the conversation and lack a real voice, including historically undercounted populations such as LGBTQ+ and homeless members of a community.

This work may stretch community organizations beyond their capacity, especially when considering the impact of the COVID-19 pandemic on historically undercounted communities and the organizations serving them.

Engaging and investing in Census community partners would help mitigate many of these issues. Census partners can serve as trusted and credible messengers because they are deeply embedded in the communities they serve. These community experts thus can complement and reinforce the messages coming from health/medical experts as well as community health workers. Additionally, utilizing Census coalitions ensures that historically undercounted and marginalized populations are meaningfully engaged in the process of public health planning.

Important First Steps:

According to our preliminary research, current scholars in the field identify two foundational principles that should be the guidepost for the work your re-purposed Census table should conduct to achieve true  inclusive public health planning: Equitable Access and Full Participation. Equitable Access means ensuring that people have access to the services and resources necessary to achieve their full health potential. Full Participation means that the community is fully and meaningfully included in the design and implementation of health programs and services. With these two foundational principles in mind, we have outlined four necessary first steps for engaging in inclusive public health planning:

Accessibility: Create an open, accessible, and welcoming space for community members to convene on current public health planning, how it can be improved, and how it can be innovative. 

Communication: Ensuring your communications, including written and spoken language, materials, and interactions with the community are accessible, inclusive, and culturally appropriate for all community members. 

Awareness and Training: While your table will be made up of community members, be sure to take the time to acknowledge and understand each group in your community, especially marginalized groups. Include training if necessary. 

Sustainable and Intentional Inclusion: Be sure that before your group tackles any public health issues in your community, that you build in intentional and sustainable inclusion as a core value of the group. This intentionally will ensure that as you go forward, equitable access and full participation by community members remains your guidepost.