Opportunity Is Knocking at Public Health’s Door

The US public health system continues to experience the challenges of unstable funding, workforce shortages, and politicization of the language of diversity and inclusion, which are central to the pursuit of health equity. As such, this seems an inopportune time to open the door and take on new work. Public health has a long history of stepping up and responding to public health emergencies, including natural disasters, bioterrorism threats, outbreaks, and pandemics, none of which are correlated to the strength of the public health ecosystem. What follows may first sound like it is new work. It is not. It is work we have done every time we identify need; every time we identify disparity in health status, risk, access, and outcome. It only feels like new work because we have not yet recognized the millions of Americans with intellectual and developmental disabilities (IDD) as an inclusion priority. Doing so now is not new work. It is not different work. It is not segregated or parallel work. It is work that should be entirely embedded in existing health equity plans, emergency preparedness plans, communications, and health education plans. It is part of our collective continuous quality improvement. It is not new work. It is missing work.

LOCAL, STATE, AND TERRITORIAL HEALTH DEPARTMENTS

People with IDD experience unique barriers to the pursuit of their own optimal health and access to health care.¹ However, as a population that experiences significant health disparities, they are not represented in planning documents that are standard across US local health departments.² These disparities can and should be named, measured, and addressed. People with IDD experience poorer health outcomes not because of their disabilities but because of exclusion—from data systems, from workforce training, from emergency preparedness planning, and from health promotion strategies. It is hard to fathom a plan to pursue health equity that is not very intentional in addressing these gaps.

Special Olympics International’s North American Region (SOI-SONA) health team has been working with local health departments to explore strategies they can use to ensure their Community Health Assessments are intentionally and meaningfully inclusive of people with IDD. The Public Health Accreditation Board (PHAB) calls for these documents to be inclusive of underrepresented populations and populations that experience health disparities.³

Although still in its nascent stages, focusing primarily on Community Health Assessments, this work has expanded to explore opportunities across the full spectrum of health department work as described in the PHAB’s standards and measures. As is the case with any population of interest, the first strategic step is to assess the problem and understand the issue. Public health professionals do not plan for people; they plan with people. To do that, we engage the population. Special Olympics International can help with that. To those readers who work in local and state health departments, I offer an open invitation to engage with the SOI-SONA team in this work. We can help connect you with individuals with IDD to serve in Community Health Assessment focus groups, in community coalitions that address social determinants of health, and on Community Health Improvement Plan teams.

For those who might not know, SOI is no stranger to the work of public health. SOI has spent decades demonstrating what inclusion looks like in practice. Through both internal programming like comprehensive health screenings and community-based partnerships for health education, we have generated robust evidence on the health status and needs of people with IDD. SOI has trained clinical health professionals, engaged families, and elevated the voices of athletes as leaders and health advocates. We do all of this with the help and guidance of our athletes, people with IDD.

INCLUSIVE PUBLIC HEALTH SYSTEMS

While the majority of my time as a public health professional was spent working in local health departments, I have gained additional perspective from state and national leadership roles, including serving as the president and longtime executive board member of the American Public Health Association (APHA), as a member of the boards of the Council on Education for Public Health (CEPH) and the National Board of Public Health Examiners (NBPHE), and as a member of the Accreditation Committee of PHAB and the Health and Disabilities working group of the National Association of County and City Health Officials (NACCHO). These experiences taught me that there are many levers that can be used to move a system toward health equity. These partners and others, including the Association of State and Territorial Health Officials (ASTHO), the Association of Schools and Programs of Public Health (ASPPH), the National Network of Public Health Institutes (NNPHI), and the National Association of Local Boards of Health (NALBOH), along with the many foundations that have long supported public health capacity and workforce development, can support the evolution of a US public health system that is more intentionally inclusive of people with IDD. Health equity depends on it. No single organization can transform the public health system to become more inclusive of people with IDD. Systemic change requires alignment across the entire public health ecosystem—practice, accreditation, education, leadership, governance, and credentialing.

• APHA, NACCHO, and ASTHO can elevate IDD inclusion within policy statements and annual meetings. This demonstrates that IDD inclusion is a core equity issue.

• PHAB accreditation shapes what health departments value and measure. Explicitly integrating IDD inclusion into guidance around standards and measures can drive change, supporting health departments to systematically address inclusive engagement.

• NALBOH leadership can help ensure that IDD inclusion is reflected in governance decisions and oversight of health department performance.

• ASPPH and CEPH shape the future of public health as they support the educators who prepare the future workforce. While diversity, equity, and inclusion is a politicized target, including teaching examples of people with IDD and the barriers they experience to accessing health offers a uniquely nonprovocative opportunity to teach and build skills that assure a diverse, equitable, and inclusive workforce. Graduates who enter the workforce prepared to serve people with IDD are prepared to serve everyone.

• NBPHE credentialing defines what it means to be a public health professional. Integrating IDD-related knowledge into certification expectations reinforces that inclusive practice is a fundamental competency, not an optional add-on. SOI has subject matter expertise to share.

• NNPHI can support the piloting, evaluating, and scaling of inclusive models to accelerate the integration of IDD considerations into public health policy and practice. SOI can help with content that can be shared via existing training opportunities.

Whether you are leading one of the associations listed here or one of the rank-and-file public health heroes who are on the front lines of public health departments creating and executing your next Community Health Improvement Plan, SOI is your public health partner, standing ready to codevelop tools, support training, and amplify lived experience. Together, we can ensure that people with IDD are no longer invisible in public health but fully included—by design, by policy, and by practice.