Three women sit in a half circle. The woman in the middle is speaking. There is an easel with sticky notes behind her. For the first time in New York State history, the Commissioner of Health in late 2022 declared 3 co-occurring statewide imminent threats to public health, with COVID-19 virus, monkeypox virus, and wild poliovirus circulating in our communities.

As this confluence of emergencies further strains our public health system, the New York State Association of County Health Officials’ (NYSACHO’s) experience advocating on behalf of the workforce serves as a blueprint for responding to these current challenges.

From Data to Action

In 2021, the de Beaumont Foundation and the Public Health National Center for Innovations released Staffing Up: Workforce Levels Needed to Provide Basic Public Health Services for All Americans. Estimates from the research brief found that across the country, state and local health departments require a minimum of 80 000 more full-time equivalent positions to carry out basic community services.1

These findings resonated with NYSACHO. With Staffing Up as a model, we used estimates from the New York State Department of Health to assess our own workforce needs. When applying the national model to our state figures, we determined that 90% of the health departments in New York do not have enough staff to provide foundational public health services and an additional 1000 full-time equivalent staff are needed to fulfill basic services statewide.2

We developed a campaign that placed our budget asks under what we termed the “Public Health Reinvestment and Emergency Pandemic Adaptability, Readiness and Efficiency Act” (PREPARE) Act. NYSACHO focused our advocacy primarily on Article 6 of New York State’s public health law, which provides state funding for core public health services—a methodology for reimbursement, which had not been increased in more than 8 years.

Through the efforts of NYSACHO and its partners, we secured an additional $54 million in Article 6 funding, including an eligibility component for fringe benefit expenses that are essential for hiring public health workers.

Advocacy: A Team Effort

As a 501(c)3 nonprofit membership association, NYSACHO’s advocacy and lobbying capabilities exceed those of state and local health departments. However, governmental public health agencies can replicate certain activities and forms of outreach that NYSACHO used in its campaign to educate members of their communities about the value of public health. (Public health agencies should seek legal guidance before participating in any activities that could be construed as lobbying.)

By leveraging their resources and knowledge in partnership with state and local public health associations, public health departments can promote sustained investments in the field without jeopardizing their status as nonpartisan entities.

Pull in partners

Securing increased Article 6 funding would not have been possible without the support of diverse partners from public and private sectors including education, health care, and business. Public health departments can make introductions between their partners and state and local public health associations to pursue common goals. Being open to facilitating conversations with new partners is also important; the more organizations that sign on to a letter of support, for example, the more likely that measure is to succeed.

Use effective messaging and targeting

People are more apt to support public health legislation if they understand how public health affects their own lives. Our campaign demonstrated how public health touches people every day, with examples ranging from protecting air quality to ensuring food safety. We also illustrated the role of the public health workforce in advancing health equity, pointing to inequities compounded by the pandemic.

Advocacy messages then need to be targeted to priority audiences. For NYSACHO, that meant state policy makers, the public, reporters, and our membership. We selected the best channels and tactics for reaching each of these audiences and used a targeted digital advertising campaign to specific geographic locations.

Connect with policy makers

NYSACHO held both virtual and in-person meetings with policy makers to discuss the importance and urgency of investing in the public health workforce. These meetings were made more engaging and persuasive with the inclusion of our members on the ground, and hearing from the people most affected by budget shortfalls helped instill empathy among policy makers. Health departments may be able to lend staff to share testimony or provide anecdotes highlighting the people behind the data.

Develop calls to action

Public health advocacy occurs in a range of settings among people of all levels, backgrounds, and skill sets. Besides meeting with policy makers, community members and partners may be interested in writing op-eds for local news outlets, holding brown-bag lunch sessions on public health priorities in their communities, or posting on social media and tagging key lawmakers. Public health departments and associations can collaborate on calls to action that appeal to variety of advocates.

Strength in Solidarity

NYSACHO and its partners advocated for years before securing the 2022 increase in state funding for public health agencies. Keeping this momentum will be essential to ensuring that the workforce continues to be adequately funded and that its members can fulfill basic public health services as well as respond to emerging threats.

Public health agencies have a wealth of knowledge and talents that can be translated into action on behalf of the larger public health system. Even within the boundaries of governmental public health, it is possible to advocate for meaningful change when working alongside vocal champions.

Together, associations representing public health, health officials, and multisector partners can use their respective capabilities to raise the visibility of public health and, in effect, help sustain critical funding for the workforce.

To learn more about Staffing Up and to calculate the number of staff that local health departments need to fulfill foundational public health services, visit

For more information about the PREPARE Act, visit


1. de Beaumont Foundation/National Center for Public Health Innovations. Staffing Up: workforce levels needed to provide basic public health services for all Americans. Published 2021. Accessed October 4, 2022.

2. Ravenhall S; New York State Association of County Health Officials. The PREPARE Act: public health reinvestment and emergency pandemic adaptability, readiness and efficiency. Published 2022. Accessed October 4, 2022.

This column first appeared in the January/February 2023 issue of the Journal of Public Health Management & Practice. See the final authenticated version.

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