Feature Interview
Shelley Hearne, DrPH

This interview, conducted by by Nat Thomson, Simmons MSW Candidate, runs abridged in the March 2024 issue of the MPH Monthly.  Shelley Hearne, DrPH is director of the Lerner Center for Public Health Advocacy at Johns Hopkins Bloomberg School of Public Health.

First, Shelley, thank you so much for taking the time to talk with us here at the Simmons MPH program. I wanted to start by asking you about your role in the public health sphere as a force who is challenging the field to remind it that a tremendous part of the work is advocating for policy change. How do you tend to view the history of the field progressing to this point?

Public health had its heyday back in the 1800s, right at a moment when there was a convergence of critical social and health movements–women's suffrage, the anti-slavery movement, many pro-union developments, a desire to establish labor laws and also to improve public tenement housing. It was the moment where the public health field emerged and where the phrase “public health” itself was coined. This movement was made of health professionals who could really connect the dots and see the implications of these unhealthy, unsanitary living and working conditions, which were a huge driver in poor health outcomes. 

They took that information and directly engaged in the political and policy making processes to establish a whole new world of law and policy to address those poor health outcomes. That’s when public health emerged as a field, and it was absolutely in lock-step about the importance of relying on evidence and engaging directly with decision makers to get law and policy on the books to improve overall health and living conditions. It was that way for a long time, but that ethos has, in a sense, been abdicated in the last few decades. Public health has become great at research, identifying problems, and building knowledge, but we’re no longer as skilled in the solving of those problems and putting knowledge to action.

Right so, problem identifiers, problem researchers or problem articulators, you could say. But then, if I'm understanding correctly, at this current point it's almost as if many in the public health field are assuming, or hoping, that someone else will take up that mantle. Does that sound accurate?

We can’t do our job of protecting the public’s health unless we are part of helping to translate how that information should get put into use in the policy making process. Many in public health take an approach of  like to think that if we shout the facts really loud, that somehow it will be heard, and people will believe it and move on their own accord. That's not how it ever works. Public health is trusted to take the facts, deliver them, and actually become a part of the process to make sure that good policies are being made with the evidence.

Could you tell us a little bit about some of your initiatives or your overall initiative in building consensus around advocacy in public health education?

A few years back, the Council on Education for Public Health (CEPH) added a new very specific accreditation requirement for public health programs that reflects what the field had determined through a lot of work and research: We need to have the skills to advocate for public health as a core competency of our profession. The accreditation body took that and said  “OK, if you’re graduating with an MPH degree, you have got to be able to advocate for public health.” It’s built in now. You cannot be a school or a program unless you’re teaching advocacy in your MPH program.

New research spearheaded by Glenn Schneider in The Journal of Public Health Practice and Management, provides an analysis of every syllabus at every school and program. Many schools say that they are teaching advocacy, but the findings show that very few places are actually giving a full insight or even a full introduction to the basics of advocacy. It’s not happening out there. That’s actually how we stumbled upon Simmons, because it’s one of the exceptions, a really good exception, in that advocacy is actually being taught as a full course. Students are coming out of the Simmons MPH program with the kind of skills and knowledge that every MPH student across the country needs. 

There is a boom happening around public health advocacy. One outcome of the pandemic is the realization that our field does need to be better at advocacy. The institutions of public health have predominantly been research institutions. But in those institutions, you’re rewarded for publications, not for passing policies. So we have a little catching-up to do in that regard.

It seems to me like advocacy is an overlapping or an additional skill set and, as you are saying, it’s not the same set of skills as publishing research.

Advocacy is built into so many of the competencies that you need to have in public health. 

For example, let's say you've done great work on identifying the problem. Now you have to understand what the policy fix would be to help deal with this problem. Then, you figure out the policy process at a state, national, or local level. You have to know who the specific decision makers are and how to inform and influence them.

Understanding who the deciders are is critical, rather than more naively thinking, “if I yell my facts really loud and say, ‘this is the ethical thing to do,’ change will take place.” You’ve got to understand your audience in terms of the information they have so far, their values, and their needs. You also have to build a strategy around who you build a coalition with–whether it’s local ministers, a local Chamber of Commerce, the PTA or others. All of this is variable depending on the issue, but it will always be based on doing your homework and understanding how these individual decisions get made and how policy is put in place. 

Different scenarios require different advocacy tactics, from organizing to polling to earned media. There are a variety of things that you have to figure out and then target in order to move a specific policy forward.

I’m curious: to what degree do you feel like current folks both leading and learning in MPH programs are comfortable with seeing things from this perspective?

It takes a village. Some people are going to be out there organizing a coalition and some people are going to be taking their research and translating it so that an agency can use it. My best example [would be] the Johns Hopkins Chair of Epidemiology, Jon Samet, who was an enormous influence in tightening up EPA air pollution laws. He took his epidemiology research on the impact of particulate matter and then served on science advisory boards. He testified. He went and met with agency officials. He helped develop different models to look at the issue, with an attitude of “well, if you regulate it this way, here's the health outcomes.”

Most epidemiologists had been trained to approach things like “okay, just go publish in your journal” and leave it at that. And he instead approached things more in the manner of “yeah, I published and I am now making sure that people understood what those findings were and the implications.” He translated that research and actually worked with policymakers to ensure that good evidence was driving the decision making. That's advocacy. And that’s the kind of power that we need to return to the public health field.

For me, as a social work student, it is always interesting to compare and contrast social work and public health. It’s interesting how the roots of fields or schools of thought still have a big impact decades later. 

The reality is that the next generation coming in to get their MPH are hungry for this training. Yes, they want to be versed on technically understanding the issues, but this generation is a generation of change. They're a generation of action. It is not enough to talk; you have got to do, Our field needs this skillset. Surveys are showing this change, and it's starting to happen again. Both the old leaders and the incoming future are saying, “we have got to get this skill set back in our wheelhouse.” That's what the new initiative that we're putting together is about; to give some more structure to [advocacy training] so that we can have everyone thrive as an effective policy advocate.

Social work teachings often include or focus on the very different experiences of minoritized individuals within our society; I was wondering if you had any thoughts on this kind of orientation as it pertains to public health?

You and I started off our conversation together today discussing the 1800s and the emergence of public health as a field. It's kind of the same thing now as it was then; a convergence of critical issues such structural racism, the rights of LGBTQ individuals, transgender medical care, and women’s reproductive rights among many others. All of these critical issues have core public health implications; people are making these connections and a new recognition is emerging. What we must work on is taking the energy around these various issues and combine them into an overarching movement focused on the enormity of the health challenges out there. In the 1800s public health was what actually knit together many similar issues of the day. We have to recapture that energy.