Leadership Conversation with ChangeLab Solutions Founder and CEO Marice Ashe

November 29, 2018 | ASTHO Staff

ASTHO recently launched the 2019 President’s Challenge: Building Healthy and Resilient Communities, focused on community-led, place-based approaches to community resilience. How can states build healthier and more resilient communities through policy development?

States have unique and powerful roles in building healthier and more resilient communities. They have broad “police power” authority granted by the U.S. Constitution to protect the health, safety, and well-being of residents. This gives state policymakers substantial authority with tremendous flexibility and discretion to adopt legal and policy strategies that maximize health outcomes. While the federal government exerts significant fiscal influence over what states can do, at the end of the day, it is state governments that hold the primary responsibility for ensuring community health outcomes. In addition, states are the proverbial “laboratories of democracy.” They are expected to test, tailor, and innovate legal and policy strategies to find the very best approaches to serve statewide and local needs. This can be particularly powerful when states delegate their legal and policy authority to local governments, which have served as experimental grounds for a variety of policy innovations since the beginning of our republic. Partnering with local governments—and making sure not to preempt them on issues concerning health and equity—allows local health agencies to experiment on a relatively small scale and ensure states have data and practical know-how before bringing new ideas statewide.

How has ChangeLab Solutions supported this type of work?

Our reason for existing is to provide innovative legal and policy tools and resources to help state and local governments advance health equity. We offer the largest library in the nation of model laws and policies, toolkits, and how-to guides. Everything is free for download and can be tailored to meet the unique needs of states and localities.

What types of actionable, upstream policies at the state level have the potential to foster authentic community engagement and make an immediate impact?

Policies that directly address income security by preserving, protecting, and expanding affordable housing, as well as ensuring quality, affordable childcare make an impact. In addition, those that provide livable wages and paid family leave and offer earned income tax credits to low-income families have the most immediate and powerful impact on health. Smaller policies can be powerful, too. For example, restorative justice policies that keep children in school, or policies that ensure well maintained parks in every community and expand access to smoke-free public places and housing can maximize health and equity in our daily lives.

What policies can communities embrace to address the root causes of poor health outcomes within their own communities?

If state constitutions delegate “police power” authority to local governments, cities and counties can have concurrent authority with the state to protect and promote community health. This means that all the powerful poverty-alleviation policies listed above can be adapted to local needs. For example, local governments can be given the authority to ensure zoning and land use plans further fair housing, to adopt livable wages based on local economic conditions, or to exceed baseline quality standards for local childcare providers.

What leadership advice would you give public health officials looking to advance health equity?

State health officials can spearhead efforts to build the capacity of local public health leaders to work in multi-sector coalitions and then delegate policymaking authority and responsibility to those local officials. This may seem counterintuitive, but until strong local partnerships based on trust and tested credibility are established, health equity strategies cannot flourish or be scaled for statewide success. This is slow and deliberate work that relies on success at the local level, then quickly spreading and scaling successful strategies so they can be adopted and implemented statewide.

You have emphasized the importance of leaders embracing fearless learning. Why is this important for leaders trying to apply an equity-first lens to their organization?

We need “fearless learning” because we cannot be daunted or intimidated by the work ahead. Ultimately, we will need to restructure the laws and policies in our states and local communities to ensure that all families and children have the opportunity to be healthy. We know a lot about which policy levers are the most powerful. However, we don’t yet know how to reverse generations of concentrated poverty, permanently desegregate low-income housing and schools, or ensure that all families and children are sufficiently resilient and have self-determination. Maybe our biggest challenge is to know enough about how to build the political will for success. We need to be fearless in our pursuits of these goals, otherwise we could be relegated to living with status quo health outcomes or worsening inequities.

What has been your biggest achievement and greatest challenge since founding ChangeLab Solutions twenty-five years ago?

Our single biggest achievement has been developing the largest library in the nation of model laws and policies to improve health outcomes and equity. These resources provide roadmaps for success and are free to every state and local government. Our greatest challenge is providing in-depth technical assistance everywhere we’re needed. We hope to begin a series of train-the-trainer sessions to spread our knowledge more broadly, so that state and local agencies can move more quickly to act.

Looking to the future, how do you define progress over the next 10-25 years?

Success is when we prevent health inequalities based on race or income, when state and local governments embrace health in all policies so thoroughly that we are always thinking and acting in multi-dimensional systems, when playing in a safe place is as common as wearing a seat belt, when a livable wage is as common as a vaccination, and when junk food in schools is as rare as ashtrays in workplaces.