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In the late nineties, Dr. Cynthia Harris, Director of the Institute of Public Health at Florida A&M University, found herself thinking about what health equity might look like in Florida. She saw urgency in addressing equity in the public health and health care fields—in her state and across the nation. But “health equity” wasn’t yet part of the everyday vocabulary of public health practice. There was work to be done.

Harris, who through her current role administers a local performance site (LPS) of the Region IV – Public Health Training Center, decided that diversifying the public health and health care professions was a critical place to start. She decided to seek out partners to work together on developing this vision.

Around the same time, Dr. Penny Ralston, Dean of the College of Human Sciences at Florida State University, was starting Mentoring Multicultural Students for the Health Professions (MEMS), a mentoring program for diverse students interested in a health-related career. The two women began hearing about each other, and Dr. Ralston eventually invited Dr. Harris to speak to her MEMS class about public health.

The students, Dr. Ralston recalls, fell in love with Dr. Harris and her message immediately. “They come to MEMS because they want to be a physician, dentist, physical therapist—fields they may have had a direct experience with growing up,” Dr. Ralston explains. But seeing Dr. Harris’s eyes light up and listening to her speak compellingly about public health’s role in understanding, preventing, and responding to the health conditions that medical professions treat, some students who had been envisioning medical careers began considering careers in public health.

Dr. Harris’s message resonated with Dr. Ralston too, and a partnership was born that has continued for almost two decades.

As Dr. Ralston gravitated toward collaborating with Dr. Harris and other health experts, her career focus was also changing. She had served as a university dean for 14 years, had worked as both an administrator and a scholar. Now, she stepped down from her role to establish a Florida State University center with a focus on public health and health equity: the Center on Better Health and Life for Underserved Populations. But how, she and Dr. Harris wondered, could they have an impact statewide?

Then, in 2006, at a national meeting, Dr. Ralston heard Dr. Louis Sullivan, former U.S. Secretary of Health and Human Services, speak about the urgency of increasing diversity in health fields. The national Sullivan Commission on Diversity in the Healthcare Workforce had released its report in 2004, highlighting the need to establish state-based efforts to increase the number of diverse students in the health professions. Dr. Ralston approached him about starting a Florida affiliate to the national Sullivan Alliance, and he was enthusiastic about assisting with this effort. Dr. Ralston and Dr. Harris established a statewide committee to begin the planning, with Dr. Harris chairing the committee.

Building an Alliance for Diversity in Health Professions

In June 2007, the planning committee organized a conference focused on collaborating to strengthen health workforce diversity in the state. Over 100 people attended, and the momentum sparked the establishment of the Florida Alliance for Health Professions Diversity, with the goal to “increase the number of minority health professionals and researchers to mirror the ethnic/racial composition of the state’s population and to reduce disparities in access to quality health care for Floridians.”

Achieving this goal would require a focus on training. Conference participants identified a critical strategy: engaging talented students in professional development activities that would strengthen their opportunities for placements in graduate or professional school. As a result, in 2008, the Florida Alliance developed two signature programs that continue to this day: the Student Symposium, which brings students together in seminars around the state on health professions, and the Florida Alliance Scholars, which provides immersive experiences in research for high school, undergraduate, and master’s-level students. Alumni of the inaugural Florida Alliance Scholars cohort have gone on to achieve, among other accomplishments, doctorate degrees in public health and post-doctoral residencies in medicine.

With momentum from the Florida Alliance, these leaders began asking broader questions: How could they increase the scale of this work? Does real systems-level change require working in multiple sectors? What role could universities and practice-focused regional training centers play? What could other regions in the nation learn from Florida’s work?

Setting a Collaborative Statewide Research Agenda

Florida is one of the most diverse states in the United States, with systemic inequities including racism contributing to a high disease burden among communities of color, rural residents, and other medically underserved populations. To strengthen health equity in Florida, leaders determined, the state would need an agenda for action. To that end, the Florida Department of Health—including the Biomedical Research Advisory Council (BRAC) and the Office of Minority Health—led an effort to engage researchers and community stakeholders in identifying key research needs. Drs. Ralston and Harris were involved in this effort. In 2011, the resulting Health Disparities Research Advisory Committee, made up of researchers and community stakeholders, developed the Health Disparities Research Agenda for Florida.

The Agenda focused on health promotion and disease intervention, health outcomes, cancer, and genetics. It prioritized ways to improve equity and disparities across the lifespan, programs and information dissemination, quality of life, infrastructure, data and health informatics systems, community involvement, academic–community partnerships, translational research, access to technologies, sharing evidence-based best practices, and training and mentoring new health disparities researchers.

In its emphasis on education and training, the Agenda set an objective to increase professional development on topics like best practices for testing interventions, community-based participatory research, and developing partnerships between academia, health care, and communities.

To achieve the document’s goals, it was clear that universities, government, training centers, researchers, and other institutions would all have to play a role. It was also clear that Florida needed a new central entity focused on health equity research.

Establishing the Florida Health Equity Research Institute

The multi-disciplinary Florida Health Equity Research Institute (FL HERI) came about as a direct result of the Agenda. With funding from the state legislature, FL HERI, which includes 13 collaborating institutions, seeks to increase development, translation, adoption, and implementation of relevant innovations; diversify the health-related professional fields; increase funding; and establish Florida as a leader on health equity.

Dr. Ralston handles finance and operations for FL HERI, and Dr. Harris directs the education and training core—one of four core areas, along with research, community engagement, and administration. From the start, the Florida Alliance for Health Professions Diversity was the key partner in implementing this core area, which addresses “how to involve students and junior faculty in health equity research and how to bring students together across health disciplines including public health to address health equity,” says Dr. Harris.

FL HERI, she adds, also focuses on “mentoring junior faculty interested in health equity research, and making health equity research a priority across our state—and in our academic institutions in particular.” The Florida Alliance signature programs—Student Symposium and Student Scholars—are now implemented under this larger FL HERI umbrella.

FL HERI developed because of partnership and collaboration, values it continues to reflect. It sponsors an annual summit on health equity, bringing partners together to learn about new topics, share research, and network. FL HERI is governed by a 10-member statewide Steering Committee and a 15-member Community Leadership Board.

Collaborating with a Regional Public Health Training Center

A relationship with its regional public health training center and local performance sites is central to FL HERI’s unique and deeply collaborative work on professional development. The Florida Local Performance Site (LPS) of the Region IV – Public Health Training Center works with FL HERI to provide training for public health professionals and health care providers on the importance of cultural competency and health equity in the public health workforce, particularly on issues like infectious diseases, HIV/AIDS, gun violence, opiate abuse, and obesity.

In April 2016, the LPS and FL HERI hosted a webinar called Cultural Competency in the Public Health & Health Care Workforce. The audience included state officials, agencies, public health training centers, educators, and researchers interested in equity and workforce development.

The LPS is “trying to increase and put at the forefront health equity issues as they relate to research, training, and service,” says Dr. Harris. The LPS offers webinars, in-person seminars, and trainings across the state for public health professionals. The goal is to keep public health professionals current and engaged on health equity. The process, she explains, is ongoing and requires continued collaboration.

Planning for the Future

Choosing a collaborative approach has been intentional. “One of the compelling needs in a state like ours, where we have an abundance of diversity and where our partners are very spread out geographically, is to find ways that are intentional and purposeful to come together and share best practices, share new research, and just get to know each other,” says Dr. Ralston.

But to develop a cadre of culturally competent public health professionals, Dr. Ralston emphasizes, the seeds of professional development must be planted early. To that end, Dr. Harris and Dr. Ralston continue their efforts to bring youth into health professions. Their joint commitment to young people is the passion that drives them. Dr. Harris and Dr. Ralston watch smiles spread across parents’ faces when the Florida Alliance/HERI Student Scholars give their research presentations at a culminating event every summer. “When you’ve been guiding a student on a career path and you see the result actualized, it’s awesome,” says Dr. Harris.

It’s one of many satisfying moments Dr. Harris and Dr. Ralston think of when reflecting on the momentum their health equity work has sparked over the years. Their collaboration has been built on sharing a strong work ethic, an interest in community-based participatory research, and a deep friendship. “The tie that binds is that we are all working together. We really are committed and love the work that we do regarding issues of health. It’s a calling more than anything. It’s been a labor of love,” says Dr. Harris.

The commitment will be helpful for changes ahead. Public health has never seen a downturn in activity, says Dr. Harris, and that activity continues to reflect inequities. Zika, she says, is a prime example of why the work of public health training is never done. “There are things we have yet to know about that are on the horizon, as we see with climate change and other issues,” says Dr. Harris. “We know there are upcoming conditions and disease states we have yet to see. We know we have to have people trained on the frontlines who can work with diverse populations. That’s our commitment—to keep that training going.”

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Authors:

Deborah Gardner, MPH, MFA, Project Manager, Northwest Center for Public Health Practice, Region X – Northwest Public Health Training Center

Penny Ralston, PhD, Professor, Dean Emeritus; Director, Center on Better Health and Life for Underserved Populations, Florida State University

Cynthia Harris, PhD, DABT, Director and Professor, Institute of Public Health, Florida A&M University; LPS Director, Region IV – Public Health Training Cente