Good Health is Good Governance

Strengthening relationships between public health professionals and elected officials is essential to translating scientific evidence into policies that protect and promote community well-being. Collaborative relationships are a cornerstone of improvements in a community’s health.

The National Commission designed this toolkit to make relationship-building more concrete by providing “starter” topics for discussion. Its goal is to advance the vision set forth in Public Health Forward by equipping elected officials and local public health leaders with shared language and actionable strategies to build and sustain strong connections.

It supports public health practitioners, elected officials, and community partners in building trust, aligning around evidence, and advancing policies that reflect both scientific knowledge and constituent priorities. By working across perspectives and focusing on common purpose, leaders can improve decision-making and build systems that endure beyond political cycles.

The priority actions highlighted in this toolkit — mutually identifying local priorities, strengthening localized data, and ensuring reliable access to PPE and other emergency supplies — were intentionally selected.

These topics are:

• Widely agreed upon. They are practical, nonpartisan issues that both elected officials and public health leaders can readily support.
• Fundamental to community health. Each directly affects a community’s ability to prevent harm, respond to crises, and promote long-term well-being.
• Shared responsibilities. None of these issues can be effectively addressed by one sector alone. They require coordination, clarity of roles, and ongoing communication between public health and elected leadership.
• Concrete and actionable. They move partnership from abstract goodwill to tangible collaboration with visible decisions, investments, and accountability.

By focusing on these areas, elected and public health officials build relationships around real work that matters to constituents. These topics create structured opportunities to clarify expectations, strengthen trust, and demonstrate a mutual commitment to protecting and improving community health.

This roadmap provides a visual overview of how this toolkit is organized and how the different sections build upon one another. Public health and policymaking are both complex, relationship-driven fields, and readers may engage with this toolkit from different starting points depending on their role, priorities, or community needs.

The roadmap is intended to help elected officials, public health leaders, and partners quickly understand the structure of the toolkit, navigate to the most relevant sections, and see how foundational concepts — such as public health orientation, collaborative discussions, data use, and preparedness planning — connect to broader action and decision-making. By illustrating the flow of the toolkit, this section helps create a shared understanding of the journey from conversation to coordinated community action.

The de Beaumont Foundation and the Kasich Company would like to recognize and thank the members of the National Commission on Local Public Health Leadership for their guidance and support, as well as Dr. Anand Parekh for serving as Special Advisor to the Commission.

In short, local health departments work both behind the scenes and on the front lines to keep communities safe, informed, and healthy.

There are approximately 2,800 local health departments across the United States. In addition, there are 59 state and territorial health agencies (including all 50 states, D.C., and U.S. territories) and numerous Tribal health departments.

Some public health departments serve a single city or county, while others serve regional areas. They vary significantly in terms of staffing and services offered.

Local and state health departments are structured based on governance models:

Centralized

Operated and staffed by the state health department

Decentralized

Operated independently and governed by local authorities

Shared or Mixed

Joint oversight by local and state governments

Health department reporting depends on governance:

• Local health departments report to boards of health, county commissioners, or city councils.
• State-run units report to state health agencies and ultimately to governors or state leaders.
• Tribal health departments report to sovereign Tribal councils.

Public health practice and research are supported by a multi-sector network of partners, including:

These collaborators form a comprehensive public health system, addressing community health needs and promoting community resilience.

As a result of engaging these multi-sector partners, local public health leadership can be defined as the interdependent relationship among public health practitioners, elected officials, and cross-sector leaders, and the entities they represent, that are responsible for guiding, managing, and advocating for public health efforts within a specific community, city, or region.

Collectively, these leaders play a critical role in protecting and improving the health of communities through decision-making, strategic planning, and collaboration with stakeholders to promote optimal health for all and respond effectively to local public health needs.

Through the combined efforts of elected officials and public health leaders to enact codes and establish health standards, significant improvements in public health outcomes have been achieved. The United States saw its first local health boards in the late 1700s, and by 1900, they were commonplace.¹ During the 20th century, life expectancy in the United States increased by more than 30 years, with approximately 25 of those years attributed to advances in public health. Rather than resulting from medical treatment alone, these gains were largely driven by prevention, systems change, and policy interventions that reduced exposure to risk and improved living conditions for entire populations.^2,3

The impact of these efforts can be seen in:

Control of Infectious Diseases

Improved access to vaccines dramatically reduced deaths from infectious diseases such as tuberculosis, typhoid, and cholera. Public health surveillance, outbreak response systems, and the development of antibiotics further reduced deaths from infectious threats.

Water, Sanitation, and Hygiene

The U.S. began focusing on water, sanitation, and hygiene in the 1700s and 1800s. Environmental sanitation through the creation of sewers, refuse removal, and proper ventilation, for example, helped prevent typhoid, cholera, and other infectious diseases of the time. These elements of environmental sanitation remain pillars of effective disease prevention.

Motor-Vehicle Safety

In the early 1900s, motor-vehicle crashes were a growing cause of death. Over time, coordinated efforts — including safer vehicle design, traffic laws, driver education, licensing requirements, and roadway engineering — significantly reduced traffic-related fatalities and injuries.

Safer Workplaces

At the start of the century, workplace injuries and deaths were common, particularly in mining, manufacturing, and construction. Safety regulations, labor protections, engineering controls, and monitoring systems led to substantial reductions in occupational injuries and fatalities.

Decline in Deaths from Coronary Heart Disease and Stroke

Beginning in the mid-20th century, deaths from heart disease and stroke declined significantly. This shift was driven by increased awareness of risk factors (such as high blood pressure and cholesterol), improvements in emergency response and treatment, and population-level changes in diet, physical activity, and smoking rates.

Safer and Healthier Foods

Food safety systems were strengthened through inspections, pasteurization, refrigeration, and improved food-handling practices. These efforts reduced food-borne illnesses and nutritional deficiencies and improved overall population health.

Recognition of Tobacco Use as a Health Hazard

The identification of smoking as a cause of lung cancer and other chronic diseases marked a turning point in public health. Public education campaigns, warning labels, policy restrictions, and community interventions helped significantly reduce smoking prevalence and related deaths.

Overall Impact

These achievements show how prevention and population-wide interventions can effectively complement individual medical care. Improvements in sanitation, safety standards, surveillance systems, education, and policy infrastructure transformed everyday environments, making homes, workplaces, roads, and food systems safer.

Collectively, these efforts have reshaped the health landscape of the United States and contributed substantially to longer, healthier lives.

When leaders engage in creating and building partnerships, they should keep these research-backed principles in mind:

• Shared purpose: Emphasize that elected officials and public health leaders are on the same team, serving the same community.
• Local expertise: Leverage local expertise and locally rooted knowledge to discuss what is feasible for the community.²
• Practicality: Focus on what’s realistic, relevant, and useful in each community’s specific context.
• Curiosity: Approach conversations with warmth and see them as opportunities to learn. Maintain a “culture of learning,” not a “culture of knowledge.”²
• Humility and respect: Value the expertise and perspectives of the other person and use meetings efficiently to honor their time.
• Presence: Showing up matters, and repeated interactions build trust. Have in-person conversations, attend community events, and follow up after meetings.

Given these key principles, public health leaders wishing to engage local elected officials can use the prompting language below to initiate conversations.

The goal is not to test knowledge or drive immediate decisions, but to create space for curiosity, clarity, and shared understanding.

The following tips, based on the “Communicating About Public Health with Policymakers” toolkit, ³ share three principles that resonate well when engaging policymakers in public health. These approaches increase trust-building and motivate stakeholders to champion public health by focusing on what is possible.

• Show aspirational impact: Position public health as a force that strengthens both local well-being and economic vitality, rather than something that inherently requires a tough tradeoff.
• Emphasize a local, listening-based approach: Show that public health recommendations are based on listening to communities about their needs, not on an ideological agenda.
• Highlight how community health leads to individual control: Demonstrate that community health and individual control are complementary. When communities are healthier, people can make healthier choices for themselves and their families.

The toolkit includes additional resources such as messaging do’s and don’ts, exercises to implement these tips, and sample language, drawn from focus groups and in-depth research with policymakers.

A 2025 poll from the de Beaumont Foundation and the Harvard Opinion Research Program (HORP) challenges common media narratives that the U.S. is hopelessly divided, revealing bipartisan support for key public health priorities.⁴ In particular, broad swaths of the public across political parties share many top priority issues for state public health agencies to address in the next four years, including: 

• Preventing chronic diseases (85% of Republicans, 86% of Democrats)
• Protecting against new viruses that could become pandemics (69% of Republicans, 92% of Democrats), and
• Addressing opioid and other substance addiction (76% of Republicans, 83% of Democrats).

There are also commonalities that might not be expected within specific public health policy areas, such as support across parties of routine childhood vaccination requirements for children to attend school: 79% of Americans — including 90% of Democrats, 68% of Republicans, and 66% of Make America Great Again (MAGA) supporters — support requiring routine childhood vaccines.

The National Commission recommends that public health officials meet with local elected officials and use these prompts in one-on-one meetings, small-group discussions, retreats, or joint planning sessions. Some questions focus on clarifying roles and responsibilities. Others explore values, tradeoffs, and opportunities for alignment. All are intended to help participants:

• Build a shared vocabulary
• Identify areas of mutual interest or concern
• Surface potential misunderstandings early
• Lay the groundwork for collaborative action

There are no right or wrong answers. The value lies in the dialogue itself. By discussing these questions openly and thoughtfully, partners can move from assumptions to understanding, and from understanding to coordinated, forward-looking leadership in service of community health.

These questions are meant to seed public health-focused conversations and uncover elected officials’ priorities.

The tables below include lists of commonly used data sources to address public health issues. While these lists are not exhaustive, they provide starting points for examining what population-level data is readily available.

*These organizations or services operate nationwide and provide location-specific data, and are separate from federally provided (e.g., CDC, HHS) data.

The National Commission provides some discussion questions to foster shared understanding, clarify expectations, and strengthen collaboration before urgent decisions must be made. These questions can inform ongoing meetings among elected officials, public health workers, and their partners and naturally lead to tangible next steps.

1. What essential supplies are most critical based on our community’s risks and past experiences?

Potential barriers to access

Where do we see potential vulnerabilities in the supply chain we can access?

Consider supplies needed across sectors, including:

• Personal Protective Equipment (PPE)
• Medications and vaccines
• Testing materials
• Sanitation and cleaning supplies
• Equipment for first responders
• Supplies to support community members

2. How does our community currently access essential supplies during normal operations — and how does that process change during an emergency?

This includes:

• Purchasing systems
• Emergency procurement
• Vendor relationships
• Distribution during emergencies or times of increased demand

3. What local, state, or federal stockpiles are available to us, and what steps are required to request or receive those resources?

This includes:

• Existing resources
• Eligibility requirements for specific partnerships or access points
• How to submit requests for supplies
• Timelines for receiving supplies
• Potential barriers to access

4. Where do we see potential vulnerabilities in the supply chain we can access?

This can include:

• Dependence on a single vendor
• Local storage capacities
• Transportation issues
• Staffing issues
• Competition for supplies during emergencies

5. What roles and authorities do elected officials and public health leaders each hold during emergencies?

Clarify:

• Who authorizes purchases
• How emergencies are declared, and by whom
• Mutual aid agreements
• Communication responsibilities

6. What lessons did we learn from recent public health emergencies about access to supplies, and how have those lessons informed current policy or practice?

Consider:

• What went well
• What created confusion and delays
• Which partnerships were valuable
• What operational or policy changes have been made since then

7. How can we communicate clearly with residents about supply availability and preparedness efforts in ways that build confidence rather than alarm?

Discuss:

• Potential trusted messengers
• How to have clear and consistent communication
• Managing false narratives
• Maintaining transparency during challenges
• Public expectations during emergencies

The following action steps can help communities operationalize the ideas discussed in this section by translating conversations into concrete practices, formal agreements, and ongoing collaboration. These actions are intended to improve readiness before emergencies occur, reduce confusion during high-pressure situations, and create lasting systems that support faster, more coordinated responses over time.

Conduct a Joint Supply Readiness Briefing

Schedule a standing briefing with local public health leadership, key elected officials, healthcare leaders, and other partners to review how essential supplies are obtained, stored, and distributed for essential health workers (healthcare, public health, environmental services/sanitation, first responders, etc.). This should include an overview of current stockpiles, purchasing contracts, approval authorities, and the process for accessing state or federal resources. The goal is to ensure shared understanding before an emergency occurs.

Engage with Hospitals and Healthcare Systems

Healthcare systems often have mechanisms for bulk purchasing supplies. Elected officials and public health leaders should partner with these systems to gain familiarity with how critical supplies are purchased, stored, or accessed, and seek partnerships with pre-existing mechanisms to obtain such supplies.

Clarify Partners, Roles, and Decision Pathways in Writing

Document who has authority to declare an emergency, approve emergency expenditures, request access to state or federal stockpiles, and communicate with the public. Confirm that both elected officials and public health leaders understand these roles. Clear documentation reduces confusion and speeds response when time is limited.

Identify and Address One Supply Vulnerability

Using recent experience or discussion, identify one realistic gap in your community’s supply readiness, such as limited local PPE reserves, unclear procurement timelines, or reliance on a single vendor. Develop a practical plan to address that vulnerability, whether through updated contracts, participation in a purchasing cooperative, or modest local stockpiling. Taking one concrete step builds momentum and strengthens preparedness over time.

The Strategic National Stockpile (SNS) is a national supply of medicines and medical equipment that can be sent anywhere in the United States during a major emergency.

How the SNS Started

In 1998, Congress gave funding to the CDC to build a stockpile of medicines and vaccines to protect the public from biological or chemical threats and large disease outbreaks. The program was first called the National Pharmaceutical Stockpile (NPS).

In 2003, it became the Strategic National Stockpile (SNS) and was managed jointly by DHS and HHS. After the BioShield law was signed, oversight returned to HHS. In 2018, responsibility moved within HHS from the CDC to the Assistant Secretary for Preparedness and Response (ASPR).

The SNS is meant to support and resupply state and local public health agencies during national emergencies anywhere in the U.S. or its territories.

What is in the SNS?

The SNS contains large quantities of:

• Antibiotics
• Vaccines
• Antitoxins and chemical antidotes
• Antiviral drugs
• Life-support medications
• IV fluids and administration supplies
• Airway equipment
• Bandages
• Ventilators
• Other medical and surgical supplies

Some supplies are packaged as “12-Hour Push Packages,” which are ready to ship quickly. These make up less than 5% of the total inventory and include broad-use medicines and supplies for emergency care. The rest of the stockpile is managed inventory that can be tailored to a specific threat.

Who manages and requests the SNS?

HHS/ASPR is responsible for maintaining and delivering SNS supplies, and state and local health authorities are responsible for planning how they will receive, store, and distribute the supplies upon arrival.

State health departments, usually through their governor, can request SNS assets. National agencies like FEMA or the FBI may also request assets in certain situations. All requests are then reviewed by HHS/ASPR.

While these assets are available at the federal level, they may be difficult to access during times of emergency. Therefore, it is critical that local elected officials and public health officials understand where they can access supplies *locally* while waiting for federal assistance.

During the COVID-19 pandemic, when PPE was scarce, states created ways to supplement local stockpiles through policies and strategic partnerships.

The State of Iowa spent $45 million in purchase orders for masks, gowns, face shields, goggles, and other equipment from a variety of sources, including businesses that typically produce campaign signs and other promotional goods. Supplies were also brought in from the National Guard.

In Ohio, the governor engaged Ohio hospitals to compile and store PPE throughout the state. Establishing the stockpile was a joint effort between the Ohio Hospital Association, hospitals, and state agencies.

States also created regional supply chains to supplement federal aid during the pandemic. By consolidating multiple states’ PPE needs, they reduced costs and improved regional coordination of supplies.