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If that goal sounds familiar, it’s because public health has similar goals — and that’s what we highlight in this issue of Carolina Public Health. Ultimately, successful public health action requires a combination of policy, funding and supportive social norms.

I saw this three-part framework first-hand when I directed the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases. When the COVID-19 pandemic arrived, I became the chief architect of the vaccine implementation program and became profoundly aware of how the success of a vaccine rollout hinges on a three-pronged approach.

First, public health research must provide the evidence that informs policy. For example, once researchers prove that a vaccine is effective and safe for different groups of people, policymakers are able to craft official guidance around who should receive the vaccine and in what order.

Second, funding comes into play: Not everyone can afford vaccines, and some families will need the cost offset in order to participate. Additionally, it may take special initiatives to deliver vaccines directly into communities that don’t have easy access to health care centers — this also costs money.

Ultimately, successful public health action requires a combination of policy, funding and supportive social norms.

Third, successful public health efforts rely on supportive social norms. If public health education has been successful, the general population will be familiar with concepts like herd immunity — when enough people are vaccinated against a disease that it cannot easily spread — and want to be vaccinated in order to do their part to protect both loved ones and strangers.

Of course, vaccines are just one example of how policy contributes to public health. At the Gillings School, researchers also study challenges like gun violence, teen vaping, climate change and poor mental health.

Take gun violence: People across the United States passionately disagree on some specifics, like what kind of guns should be available for purchase, but generally agree on other concepts, like the idea of safe gun storage practices as a strategy to prevent suicides and accidental deaths among children.

We already have the research that shows safe storage is effective when it comes to these two goals, and 26 states have either Safe Storage or Child Access Prevention laws (a form of policy) in place. In some places, funding also has been considered — like in Georgia, where a proposed bill with strong bipartisan support aims to waive sales tax on purchases of gun safes.

What is still lacking, however, is more education to make people aware of these policies and initiatives in order to change social norms around what responsible gun ownership looks like. A great example of this in practice is North Carolina’s NC S.A.F.E. initiative, which promotes and educates about safe storage of firearms.

In the end, good public policy is part of a comprehensive approach to achieving better health for all. What’s more, it prepares us to be ready to respond when the next pandemic or other public health crisis arrives. That’s why I’m so heartened by the range of topics you’ll see Gillings School researchers exploring in the pages of this issue.  ‍

Dr. Nancy Messonnier
Dean and Bryson Distinguished Professor in Public Health
UNC Gillings School of Global Public Health

Public policy is an important part of the systems and structures that keep our society in good health and help us live longer, more fulfilling lives. For many citizens, the idea of policy exists in the abstract — something to be designed and managed by institutions and experts. But policy is far more than what we hear about on the news or what we learned in the Schoolhouse Rock song “I’m Just a Bill.” Each of us has a role to play in helping to achieve its goal: to improve well-being for as many people as possible.

Research has shown that policies are most effective when they are informed by evidence, inclusive of broad expertise, and designed for real-world implementation. If we want policies that truly work — that address our health concerns and help to reduce inequities — engagement from experts, advocates and the community is critical. Public policy and public health are both the work of the people, so who better to represent our interests in these areas if not ourselves?

In this issue of Carolina Public Health, we highlight the ways that our work at the Gillings School is intertwined with the facets of policy — informing its design, helping it evolve or responding to the downstream health effects it can create. We will highlight how public health and public policy are working together to support things like Medicaid transformation, tobacco and vaping cessation, better workplace health, climate solutions, public safety and injury prevention, behavioral health, and so much more.

Yet the relationship between public health and public policy goes beyond academia. Successful public health efforts can streamline communication and engagement between policymakers and citizens, which is why we also hope this issue can provide valuable resources for every citizen who wants to create change for better health.

Helping countries combat junk food, obesity‍

“About 60% of what adults eat and 80% of what kids eat is ultra-processed,” says Barry Popkin, PhD. “It’s killing us.”

Popkin, the W.R. Kenan Jr. Distinguished Professor of Nutrition, was fresh off a trip that included stops in Brazil, South Africa and Colombia — just a few of the countries that are home to global partners who work closely with Popkin and his partners in the Global Food Research Program at UNC-CH.

They conduct and share research to help countries enact policies to reduce consumption of ultra-processed, high-sugar foods and beverages that lead to obesity and health problems among their populations. They also collaborate on evaluations they fund with these global research partners. Convincing policymakers to act can take years. For instance, Popkin had been working in Mexico for eight years before that country implemented a tax on sugary beverages. But once that happened and an evaluations article was published in BMJ, about 40 other countries followed suit over the next two years.

“Sometimes it felt like we were fighting a giant,” Popkin said. “But we’ve won.”

The group’s latest big project is in India, where for the past two years, Popkin and his Global Food Research Program partners Lindsey Smith-Taillie, PhD, associate professor of nutrition, and Shu Wen Ng, PhD, professor of nutrition, worked with medical groups, academic institutions, advocates, journalists and others to increase awareness of the health impacts of junk food. It’s been a huge but worthwhile task: India is now developing new food policies that are expected to include front-of-package warning labels, joining several other countries that have enacted similar policies based on the group’s research.

The group’s international work — and their proven results — are gaining traction here in the United States. “We’re involved in all sides of trying to cut unhealthy food consumption and reduce inequities,” Popkin said. “We are really at the forefront of the globe in providing research support for people trying to do healthy food policy.”

Pushing for equitable outcomes

Early in her public health career, Lindsey Yates, PhD, MPH, found herself working in Tarrant County, Texas, where infant mortality rates are especially high among Black pregnant women living in certain ZIP codes in the county.

“It was so discouraging to see that for Black women, even if they were educated, had good incomes and family support … their babies were still dying,” said Yates, an assistant professor of maternal and child health. “Something was happening at a broader policy and systemic level. It’s rooted in structural racism.”

As a health equity researcher focused on reproductive health services, maternal and child health, and implementation science, Yates works to improve outcomes through systemic change. She’s involved in a North Carolina initiative aiming to improve birth outcomes, reduce infant mortality, and improve health outcomes for children aged 0-5.

She also studies postpartum contraception, specifically when an IUD or birth control implant is inserted after a patient gives birth but before they are discharged. N.C. now covers this under Medicaid, but Yates found that patients had vastly different experiences in their contraception and counseling services — meaning there’s still work to do to improve systems and structures so they work for everyone.

N.C’s recent expansion of Medicaid services was a big win, Yates said. But she’s keeping a wary eye on how different states are reacting to the Supreme Court’s Dobbs decision and the concerning trend of rural hospitals closing their maternity care units. Such systemic and policy changes are especially important for historically marginalized populations, Yates said: “When bodies and minds encounter a system that’s not designed with their lived experiences in mind, that leads to harm, even death.”

It’s also important for policymakers to be mindful of “vital conditions” — factors like whether water is safe to drink, whether a community is walkable, and residents’ access to fresh foods or a local hospital. “These are all things out of any one individual’s control, but they are all things we need to be healthy — and a lot of that is set by policy,” Yates said. “If we want to have all our citizens thriving in strong communities, we need to pay attention to the equity implications of every policy.”

A passion project with policy results

One in four women are exposed to violence from their partners during pregnancy. Abigail Hatcher, PhD, associate professor of health behavior, has been trying to change that for years. Her studies of community and health interventions to prevent violence have been used to inform national law and policies in South Africa, as well as the World Health Organization’s care guidelines for maternal and child health care providers.

In South Africa, Hatcher worked on a study pairing gender training with microfinance — providing women with access to small loans that are secured through social relationships rather than high interest rates — and the team found it significantly reduced partner violence. A later clinical trial found that having nurses spend 30 to 45 minutes with women to talk about safety in relationships reduced partner violence by 48%. In her spare time, she got to know people and organizations who shared her interests in women’s safety.

“I’m curious about all the different ingredients, but I ultimately care about safer bodies and sounder minds for women,” she said. “For me, this was a passion project that happened to align with a policy window.”

A couple years later, South Africa saw a wave of student-led activism calling for more protections for women. Together with activists and civil society, Hatcher formed the Prevention Task Team to translate the evidence-base into outputs for policymakers. The team participated in multiple consensus-building events, writing parts of a declaration from a violence prevention summit that ended up being adopted by legislators. Two parts of that law harken back to Hatcher and others longstanding work — the central role of economic strengthening and health sector actors in ensuring women’s safety.

Once the law was in place, the health sector needed clear policies to put it into action with patients. Hatcher co-wrote South Africa’s national maternal health policy chapter on violence. Her team’s innovations around health worker training and patient assessment in pregnancy have now been incorporated into World Health Organization guidance.

In the coming years, Hatcher plans to translate these policy and programming insights into local settings. Approaches from elsewhere hold promise for the U.S. setting, where maternal mortality is higher than peer countries, in part due to violence in pregnancy.

“It’s fun as an academic to stretch my wings in an action-oriented way and feel like the work I’m putting in could impact daily lives,” Hatcher said.

Driving health behavior through policy

Lindsey Haynes-Maslow, PhD, MHA, is an expert on the intersection between public health and nutrition, and the impact government policies and programs have on health behaviors. Her work focuses mainly on lower-income families’ access to federal food assistance programs, a subject that first caught her interest over 15 years ago. The Affordable Care Act had not yet passed, and roughly 48 million U.S. adults lacked health insurance.

“I was looking for ways to prevent people from having to access the health care system if they couldn’t afford it. When I started examining the reasons people were going to the hospital, a common theme was that their visits were tied to complications from diet-related chronic disease like diabetes and hypertension,” said Haynes-Maslow, an associate professor of health policy and management and adjunct assistant professor of nutrition.

Knowing that a better diet could improve people’s health and reduce the cost of care inspired Haynes-Maslow to promote policies that would enhance access to healthier foods. For six years she led N.C. State University’s SNAP-Education program, managing a statewide nutrition education and obesity prevention program. She has also worked for UNC Health, the N.C. Institute of Medicine, the state’s Division of Public Health, and a nonprofit advocating for federal food and nutrition policies.

Today Haynes-Maslow teaches students, researchers and other scholars how to communicate with policymakers and the media. She advises them to know their topic and their audience and explain their work simply in a way that’s relatable.

“It’s easy to get frustrated by politics, but for those that are interested in policy, stay engaged and focus on playing the long game,” she said.

Breaking new ground in air quality policy

Barbara Turpin, PhD, professor in the Department of Environmental Sciences and Engineering, has co-authored a major new report outlining critical tools that could drive changes to air quality policies and practices across the country.

The Clean Air Act only authorizes regulation of outdoor air quality, even though the indoor environment is where people are primarily exposed to contaminants and toxic agents — both those of indoor and outdoor origin. But as outdoor air regulations are successfully reducing pollutants, unregulated indoor air pollution is becoming more and more of a problem. So in 2022, the American Thoracic Society invited Turpin and other experts to a major workshop to investigate how indoor pollution affects outdoor air quality.

They found that building operation and indoor activities also result in emission of pollutants like methane into the atmosphere, contributing to outdoor air quality problems and climate change. The experts concluded that using filtration and controlling indoor pollution at its source can effectively reduce outdoor air pollution and identified mitigation strategies like switching from natural gas stoves to electric ones and using scent-free consumer products.

“When you burn natural gas, methane leaks out. That’s a potent greenhouse gas and is really bad for the climate and contributes to ground level ozone regionally,” Turpin said. “There are health benefits to not burning things in your house — especially natural gas — and there are also climate benefits.”

States are required to comply with the federal Clean Air Act’s health-based standard for ozone. The FDA offers states a variety of compliance options they can implement to meet the standard. Now that scientists have shown how indoor-generated air pollution contributes to ozone, indoor pollution strategies can be added to the states’ options for compliance.

“Our department does a lot of policy-relevant work,” Turpin said. “I’m an engineer and I do public health, and for both those fields the point is to make a difference in practice.”

Policy prescription that makes a difference

The U.S. drug overdose crisis continues to be a major challenge. As providers and policymakers keep looking for solutions, it’s important to evaluate the steps that have already been taken.

Juan Hincapie-Castillo, PharmD, PhD, assistant professor of epidemiology, uses real-world data to evaluate and promote evidence-based policymaking. His focus is on improving prescribing policies so patients can safely access the medication they need to help manage their pain. “You can’t do pain management without thinking about opioids,” he said. “And you can’t address the opioid problem with a one-size-fits-all policy solution.”

Hincapie-Castillo was in pharmacy school in Florida when opioid prescribing began to peak. Wanting to make sure patients had access to safe, effective medication, he decided to pursue pharmacoepidemiology, which uses population-level research to examine medication use, safety, and effectiveness. Hincapie-Castillo did about a dozen studies analyzing Florida’s new opioid restrictions. He found that the laws, while well-intended, negatively impacted certain patients needing relief from chronic pain.

When similar legislation was introduced at the federal level, patient advocates cited his Florida studies as a cautionary tale in their meetings with legislators and staff members. The provision in question was removed from the legislation.

“I don’t want my papers to just sit in journals; I want them to be used to empower patient advocacy,” he said.

Today, Hincapie-Castillo is president of the board of directors for the National Pain Advocacy Center, a nonprofit working to advance the health and human rights of people living with pain.

At the Gillings School, he launched a class this semester on legal epidemiology, or how to evaluate the law’s effects on health behaviors and outcomes. He hopes to give students tools to identify important issues, evaluate policies, and interpret evidence to inform and persuade policymakers to support public health.

“We cannot do public health purely for academic purposes,” he said. “If our ultimate goal is to improve public health, we need to be honest — it happens through policy, though political leverage.”

Advancing methodologies that inform regulation, policy

Government agencies recognize the value that academic researchers bring to the policy and regulatory process. In some cases, they put academic consulting arrangements in place so the researchers — and their expertise — are close at hand.

Lisa LaVange, PhD, professor and chair emerita of biostatistics, has seen that relationship work from both vantage points. As former director of the Office of Biostatistics in the Center for Drug Evaluation and Research (CDER), which regulates over-the-counter and prescription drugs, she established one of the center’s earliest consulting arrangements (Interagency Personnel Act agreements, or IPAs) with a university researcher. Once LaVange returned to Gillings in 2018, she became an IPA consultant herself.

As a statistical advisor to the Office of the CDER Director, LaVange did not participate in individual drug approval decisions. She advised on statistical methods for drug testing and leveraged her academic expertise to identify ways in which those innovative methodologies could impact future drug development and regulatory oversight. She also worked with the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH), a group of regulatory bodies from countries around the world that works with industry to make new treatments available to consumers more quickly while maintaining scientific rigor and patient safety.

“I was there to advise as an academic, but I was also able to draw on my experience working inside FDA,” LaVange said.

The Food and Drug Administration relies on academic experts from both public and private universities to provide continuing education opportunities for agency reviewers and keep government officials abreast of cutting-edge research methods in academia. A programmatic example where such methods can have an impact is FDA’s Complex Innovative Trial Design (CID) Paired Meeting Program, which facilitates the use of complex clinical trial designs in drug development. LaVange was instrumental in launching this program while at FDA and continued to advise on its implementation after returning to academia.

Now retired, LaVange no longer consults with CDER, but she does stay engaged through FDA public meeting participation and other activities, and the FDA continues to lean on the department’s scientific experts for research and guidance through other research agreements. “Although biostatisticians tend to focus on methodological research,” said LaVange, “applications of those methods to real-world problems are just as important. Drug development and regulatory oversight are examples where those applications impact policymaking and, ultimately, public health.”  

‘Pracademic’ leadership to help meet crime victims’ needs

After a crime, victims may need help in a variety of ways, from short-term financial aid to long-term counseling and health care for conditions resulting from the crime. The Governor’s Crime Commission, which funds victim assistance programs, decided that a statewide assessment of victims’ needs would help the Commission optimize its resources.

Dana Rice, DrPH, assistant professor in the department of public health leadership and practice, and colleagues from the UNC School of Social Work led the assessment. Key to their work was creating a community advisory board to examine how victims’ needs, and their access to services, varied across populations.

“We really integrated the community advisory board as partners in the process,” Rice said. “They informed every phase of the needs assessment, from design to the interpretation of results and the final recommendations.”

The team undertook a comprehensive effort to better understand the scope of victims’ needs, making recommendations the Commission is now using to guide its funding decisions. But one of the most significant outcomes was that the Commission invited community advisory board members to be part of their new advisory board. “For the Commission to continue the relationships we’d built is a testament to the value of the community,” Rice said.

She also highlighted the role Gillings School students — including a capstone team from the health behavior and health equity and social justice concentrations and multiple practicum students from the Leadership in Practice concentration — played in the project. “From beginning to end, they were in it — they did all of it,” she said.

Rice, who uses the term “pracademic” to describe her academic and practice work, said impactful community engagement requires knowledge of the work and the ability to build relationships. “Without both the science and the art of public health work, policy change can’t happen,” she said.

Better outcomes for all

These are just a few of the outstanding leaders who exemplify that at the Gillings School, we strive to excel in both the art and the science of public health — working toward policy changes that improve equity and outcomes for families and communities in N.C. and across the world.

Now, thanks to recent state legislation, N.C. has become one of the first states in the southeast to expand Medicaid coverage to thousands more. The N.C. Department of Health and Human Services (NC DHHS) has embarked on a multifaceted effort to transform how providers receive payment for that care, and they tapped the UNC Gillings School of Global Public Health to serve as the project’s official independent evaluator.

The project is one of many that have developed thanks to years of partnership and data-sharing between UNC-Chapel Hill and NC DHHS, according to Mark Holmes, PhD, professor of health policy and management at the Gillings School and director of the Cecil G. Sheps Center for Health Services Research.

“The partnership is a strategic benefit for everyone,” he said, “and it allows us to weigh in on the things that matter to the people of N.C. The Gillings School is providing expertise to DHHS that enables the evaluation, with involvement from other UNC partners in the Schools of Medicine, Social Work and Pharmacy.”

"This partnership with the state exemplifies the commitment of the Gillings School to improve public health by bridging research and real-world application. Faculty are using their expertise to help drive positive change for the people of N.C. through evidence-informed policy decisions."

Enacted based on policy from the N.C. General Assembly (NCGA) in 2015, the overall aim was to move health care providers participating in Medicaid from a model where they are paid per office visit (called “fee-for-service”) to one where providers are paid based on the improved health outcomes of their patients. Called “managed care,” this approach incentivizes the increased use of health-improvement measures, screenings and tools to keep patients well.

As part of this process, N.C. Medicaid has contracted with third-party insurance providers, such as AmeriHealth Caritas, Blue Cross and Blue Shield, and UnitedHealthcare, who will offer pre-paid managed care health plans to Medicaid participants. These participants will then receive care through a network of doctors contracted to provide services through these managed care organizations (MCOs).

Under the guidance of federal rules, each state has control over the administration of its own Medicaid program, and nearly all of them have adopted some form of MCO system. N.C. was one of the last states to adopt the Medicaid MCO model, and according to a 2023 report from KFF, Alaska and Wyoming remain the only states without one.

The Centers for Medicare & Medicaid Services (CMS) require an external evaluator to ensure the transformation is accomplishing the goals it set out, and so the UNC-led evaluation is examining the process through four workstreams. The first is through evaluating administrative data to see what kind of trends reflect the impact of the transformation. The second is through provider surveys that seek to understand the experiences of health care professionals during the process, and the third is through a series of interviews with providers, plan leaders and participants.

The final is a pilot program called Healthy Opportunities, which is a strategic initiative to address the social determinants that play as much of a role in our health outcomes as medical factors. A portion of the funding for Medicaid transformation will be used to address transportation, nutrition, housing and interpersonal violence with the goal of reducing visits to hospitals and emergency rooms in pilot counties across the state. Based on results of the evaluation, the program has the potential to expand across all counties in N.C.

The Gillings School evaluation team includes a host of Gillings School faculty from the Department of Health Policy and Management, including Holmes, Sandra Greene, PhD, Christopher Shea, PhD, Valerie Lewis, PhD, and Justin Trogdon, PhD, as well as affiliated faculty across the country, including adjunct faculty Marisa Domino, PhD, at Arizona State University College of Health Solutions and Paula Song, PhD, at the Virginia Commonwealth University College of Health Professions.

“This partnership with the state exemplifies the commitment of the Gillings School to improve public health by bridging research and real-world application,” said Kristin Reiter, PhD, professor and chair of health policy and management. “Faculty are using their expertise to help drive positive change for the people of N.C. through evidence-informed policy decisions.”    

In fall of 2023, the NCGA voted to expand Medicaid eligibility based on the provisions of the Affordable Care Act, meaning more North Carolinians are now eligible to access health care coverage through Medicaid. The expansion provides much needed stability to people who have struggled to find health care coverage or lost the temporary Medicaid benefits that were enacted under the COVID-19 public health emergency.

“Anytime you have turbulence in coverage, that can be disruptive to maintaining quality health,” Holmes explained. “Part of our evaluation is also looking at how that access to coverage affects people’s health outcomes.”

As a whole, Holmes says the evaluation is an opportunity to understand the methods and metrics that the state is using to reshape a system that impacts the health of millions of N.C. citizens.

“This is an enormous transformation that’s made up of multiple small levers, and each one has an impact,” he said. “This project helps us to evaluate how changes to each lever affect participants as they navigate the health care system and then identify opportunities that improve health outcomes and keep people out of the hospital more effectively.”

The UNC-led evaluation is projected to run through 2027, and the results will be released to the public after review by CMS.

Moracco was involved with women’s health issues as an undergraduate student, and then she worked with the Peace Corps in the Democratic Republic of Congo. It was through her work in Congo that she first witnessed the burden that gender-based violence places on individuals and communities. She also saw firsthand that many of these issues are preventable.

After completing her Master of Public Health and doctoral degrees in health behavior, Moracco joined the faculty at the Gillings School in 2008.

Moracco’s research is very applied. She has a strong interest in identifying which interventions and policies will be most effective at reducing gender-based violence. Throughout her career, Moracco has engaged with policymakers and state agencies in many capacities.

She has worked extensively with the North Carolina Administrative Office of the Courts, advising on best practices for processes in civil domestic violence cases and on how to bring trauma-informed processes into the court system.

“Engaging with public policy is vitally important, because the more public health research informs policy, the more effective policies will be at addressing these important issues.”

She is also a member of the N.C. Violent Death Reporting System advisory board, providing guidance on how the statewide surveillance system can be implemented and how the state can use these data to reduce the number of violent deaths.

She is also on the advisory board of the N.C. Office of Violence Prevention within the Department of Public Safety.

“Public health practitioners have both empirical and practice-based evidence that can inform effective policy,” said Moracco. “Engaging with public policy is vitally important, because the more public health research informs policy, the more effective policies will be at addressing these important issues.”

Moracco was involved with the push to have questions about intimate partner violence incorporated into routine primary care visits in N.C. While this has now become standard practice, particularly in prenatal care and emergency department settings, when it was first initiated more than 30 years ago, there were significant barriers.

“Many health care providers felt that they would know if a patient was being abused; they didn’t feel equipped to counsel patients who were suffering abuse, and many were concerned that their patients would be offended by the questions,” said Moracco. “Our role was to show providers that domestic violence doesn’t fit a stereotype, has far-reaching health implications for their patients and that they as providers aren’t expected to do it all. They are just the first line of defense in providing the screening and, ideally, information about community-based resources.”

Moracco worked with the N.C. Coalition Against Domestic Violence to develop a standard screening tool that providers would use with patients and a process for how to connect patients with resources and counseling if they were experiencing violence at home.

More recently, Moracco’s research has focused on the intersection of gun violence and gender-based violence, with a focus on the prevention of gun sales and possession among people subject to a domestic violence protective order. Policies restricting gun access to domestic abusers are included in N.C. state statutes and have broad bipartisan support, but questions remain around the implementation and enforcement of these policies. Moracco is studying the gaps in how these laws are implemented and which policy changes could reduce gun deaths in intimate partner violence settings.

“The Gillings School is a leader in collaborative research that informs policy,” said Moracco. “We have a very collaborative relationship with the state in ways that benefit everyone. I’m honored to be a part of it and excited to see more and more of our students recognizing the importance of engaging with public policy and conducting research that can inform policy.”

In July 2023, Moracco became chair of the faculty at UNC-Chapel Hill, where she represents all faculty at the University.

“It’s an honor to be in this position, and I hope that I can bring the tools from my work as a researcher to inform the position and best advocate for the University and its faculty,” said Moracco.

Looking back now, Staley pinpoints three pivotal moments that brought him to this work. First was realizing as a young child that he wanted to have a job that would help people. Second was having his family home destroyed by a fire when he was a teenager and, as a result, forming relationships with firefighters and learning about the hazards and health risks inherent in their work. Finally, an accident occurred at an organization where Staley was working as an environmental scientist early in his career.

The accident happened when a teenage intern was working with a hazardous chemical and almost died from inhalation of the substance. The intern hadn’t been trained on how to handle the chemical and was not under supervision at the time of the accident.

“This accident really opened my eyes to the importance of workplaces having safety practices and policies, and it led me to a career focused on occupational safety and health,” said Staley.

Today, Staley serves as deputy director of the North Carolina Occupational Safety and Health Education and Research Center (NC OSHERC) and co-director of the outreach core at the Carolina Center for Healthy Work Design and Worker Wellbeing.

“John Staley epitomizes the highly skilled and well-rounded occupational health and safety practitioner, educator and researcher,” said Leena Nylander-French, PhD, director of NC OSHERC and co-director of the pilot research programs at the Carolina Center, whom Staley describes as his mentor. “He has unique skills to make occupational health and, particularly, safety super interesting. He can explain complex contexts and issues in plain language to drive his message when working with student and worker populations. It has been such a pleasure to work with him these past four years, and I am looking forward to the new ideas he has enunciated coming to fruition. We are very fortunate to have John at the NC OSHERC, Carolina Center and at UNC-Chapel Hill educating our students and occupational health and safety practitioners, and protecting the population at-large.”

“This accident really opened my eyes to the importance of workplaces having safety practices and policies, and it led me to a career focused on occupational safety and health.”

The NC OSHERC team is primarily focused on educating trainees. Both masters and doctoral students in the Gillings School receive training at the center, as well as students from programs at NC State and Duke University. The center also offers continuing education to professionals.

The Carolina Center for Healthy Work Design and Worker Wellbeing is primarily focused on conducting research to identify vulnerable worker populations and develop practices, programs and policies that can help keep their workplaces healthy. Both NC OSHERC and the Carolina Center are funded by the National Institute for Occupational Safety and Health as centers for worker excellence and Total Worker Health®.

Total Worker Health® is a comprehensive approach that seeks to put practices and programs into place that improve worker health overall, and it’s been a major focus of Gillings School researchers like Laura Linnan, ScD, senior associate dean and professor of health behavior. It stands in contrast to the “do no harm” approach to occupational safety and health that merely aims to avoid injuries while at the workplace.

“Most of us are going to spend half of our lives or more in the workplace,” said Staley. “Work itself is a social determinant of health, so opportunities to both protect workers while they are at work and do things to protect workers’ overall health and well-being are a win for everyone — workers, communities and employers.”

Much of Staley’s work is focused on partnering with industry and various workplaces to see best practices implemented. He views himself as a bridge between the school’s research activities and the workers and businesses that need the information.

The Carolina PROSPER project, which sought to promote safe practices for employees returning to work during COVID-19, is an example of this partnership. Staley and team worked with 53 N.C. businesses to identify potential pathways for disease transmission in the workplace and developed recommendations for practices and policies for businesses and workplaces that could help protect employees.

The last several years have been significant for the research community focused on worker health and safety. The landscape of work changed rapidly during the pandemic, which highlighted issues like an aging workforce, the unique vulnerabilities of gig workers, and the ways that essential workers drive society and the economy.

“The future of work is a big topic right now,” said Staley. “As we strive to protect workers in the future, I hope we can continue the momentum we have experienced since 2020.”

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by Ciara Zachary, PhD, MPH, Assistant Professor of Health Policy and Management

Check out a recent Gillings School Inclusive Excellence Community Conversation on “Public Health Advocacy: Gun Violence Prevention as a Public Health Issue,” which includes Dr. Ciara Zachary (starting at 44:10)!

Step 1: Identify your capacity.

Advocacy can take many forms. Think about what skills, knowledge or experiences you can contribute — and what your capacity is to contribute them. Can you write emails or provide transportation? Are you good at organizing? Do you have a compelling story to share? Does your public health knowledge lend itself to a particular issue? Whatever your contribution may be, there is a place for it.

Step 2: Do your homework.

If you are very passionate about an issue, chances are, others are, too. Find a way to get plugged into existing groups so you can best apply your skills instead of trying to do it all or duplicating the efforts of others. Existing groups typically have defined policy goals and understand strategies that are most effective for creating change. Many are also led by those with lived experience who are most impacted by policy or lack thereof.

Step 3: Build relationships.

Relationships are key to mobilizing support. Understand the value you can provide to others, whether that be through education, skills or storytelling. Learn who is being impacted and bring diverse voices into your coalition. Partner with those who have complimentary skills, connections or influence and can establish trusting, friendly relationships with organizations or legislators.

Step 4: Set realistic expectations.

Making progress on policy can happen quickly or very slowly. Expectations that are clearly defined ensure that, when progress moves slower than anticipated, you can maintain energy in a movement, overcome challenges and address concerns of partners who provide resources.

Step 5: Determine your bright line.

A bright-line standard is your way of setting boundaries. Many aspects of policy involve compromise, so it’s important to identify areas where concessions are acceptable — and where they’re not.

Additional considerations:

• Practice self-care. Learn when to step away and take a break before you burn out or become discouraged. Connect with friends who can encourage you, especially when setbacks happen.
• Learn the difference between advocacy and lobbying. While the two actions have overlapping goals, they are not always the same. Advocacy is a broad term that involves raising awareness, educating and supporting programs and policies. Lobbying involves directly urging a lawmaker to take a position on a specific piece of legislation. Many public health organizations encourage advocacy but may not permit lobbying.
• Use the resources you have in public health. If you’re not sure where to begin, check out resources from public health organizations like the American Public Health Association and the National Association of County & City Health Officials.
• ‍Do not undermine community-driven efforts. Advocacy involves collaboration among those who are directly impacted by policy, which means it’s important to ensure that you do not prioritize your own goals over those of the whole community.

Understanding the importance of engaging with policymakers and the public about these important issues, the Association of Schools and Programs of Public Health (ASPPH) formed a communications and marketing section, which is led by Matthew Chamberlin, associate dean for communications and marketing at the Gillings School. This group recently released a comprehensive resource guide to help public health schools and professionals raise their voices and promote greater public awareness of their work.

It all started with one email.

In the fall of 2021, as new guidelines were continually issued in response to the COVID-19 pandemic, tensions were at a fever pitch. Masking policies, school attendance protocols, travel rules were debated in full force, and information — and misinformation — was in no short supply.

“We were just trying to figure out a way to keep public health issues in front of policymakers.”

“I’ve never really felt motivated to do anything like this before,” Chamberlin said, “but I came into work that day and looked up my peers at 24 schools of public health, and I just sent them all a cold email. It basically said, ‘You don’t know me. I don’t know you. But we all have the same job, and we’re all going through the same stuff. It just seems to me that all of us together — with all of our deans, our alumni, our researchers, our students and our boards — we could do so much more together.’”

Out of the 24 people he emailed, 22 responded.

From there, this informal group of public health communicators met monthly over Zoom, with ASPPH representatives also in attendance. At first, the monthly meet-up was primarily a forum to share concerns and frustrations about what was happening in the world, but soon it became a vehicle for more. The health communicators began exchanging information and advice based on their own experiences and discussing larger issues that affected them all.

“It ended up being a really powerful network that lets us all do our jobs better,” Chamberlin said.

Over time, the group became an official section of ASPPH, with governance and subcommittees — and a rise in popularity. The section meets quarterly and now has about 100 members, representing almost every school or program of public health in the country.

One of those larger issues that kept coming up in group discussions was how to prioritize public health for legislators and policymakers. The new ASPPH section decided to create a subcommittee to develop tools that public health programs and professionals could use to increase policymakers’ and the public’s understanding of — and ultimately, support for — public health.

The ASPPH resource guide is the result of that subcommittee’s work. It contains key messaging that public health programs can use when talking about the need for ongoing investments in public health. It also includes issue briefs for policy staff, social media tags and suggested content, videos and scripts, email and newsletter copy, and other content.

The attention paid to public health can be inconsistent, partly from cyclical budget pressures and availability of funds, and partly from officeholders changing with potentially every election. The resource guide takes this variability into account.

“We made this guide so that you can take these messages and tailor them to work well for you in your community and your state,” Chamberlin said. “We were just trying to figure out a way to keep public health issues in front of policymakers.”

Interest and reception to the guide has been positive, particularly during a session at the 2023 American Public Health Association Annual Meeting, when Chamberlin presented the guide to a standing-room only audience.

Governor Tim Walz of Minnesota recently signed a law legalizing adult-use cannabis in the state. During the 2023 legislative session (Jan-May 2023), Sarah Bjorkman, the then-communications director at the University of Minnesota’s (UMN) School of Public Health, referenced the ASPPH’s guide when developing an advocacy campaign for annual appropriation from cannabis sales tax to establish a new Center for Cannabis Research at UMN.

“We were successful in this campaign and were designated with an annual $2.5M appropriation for the center,” Bjorkman said. “As defined within the bill, the specific charge of the center is to ‘investigate the effects of cannabis use on health and research other topics related to cannabis, including but not limited to prevention and treatment of substance use disorders, equity issues, education and decriminalization.’”

The group has just started talking about what this year’s big project should be and will meet for a section retreat this summer in Boston to finalize those plans. The communicators also continue to look for ways to keep raising the visibility of the important work that is public health.

“Post-COVID, I think there was a little bit more awareness in the mind of the public as to what public health really means, but where do we go from here to continue to make people really understand that public health is not just vaccines or pandemics?” Chamberlin said. “You have to remain optimistic and know that the work that we do, and that all the schools do, is moving the needle.”

Research is a core component of that mission — and while its research expertise is a key reason that the Gillings School remains the top public school of public health in the country, the School has big plans to raise the bar.

“We’re doing amazing research, and we want to build on that,” said North, who is also professor of epidemiology. One of her top priorities is putting into motion the School’s new strategic research plan, which promotes innovative, collaborative research efforts to ensure positive health outcomes both locally and globally.

North, a renowned researcher herself, knows first-hand the importance of collaboration. She leads the UNC CVD Genetic Epidemiology Computational Laboratory, a collaborative assembly of faculty members, pre- and post-doctoral fellows, and staff members spanning departments across the Carolina campus with collective expertise in both family- and population-based genetic epidemiological research.

“Building collaborative teams to do public health research is the wave of the future — and nobody does this better than Carolina,” she said. “The increasing complexity of public health problems requires a diverse team of individuals to move the needle.”

That’s why the strategic plan is so critical as a research roadmap. More than a year in the making, the plan was spearheaded by Elizabeth French, MA, associate dean for strategic initiatives, and was written by Andy Olshan, PhD, the Barbara Sorenson Hulka Distinguished Professor in Cancer Epidemiology who served as interim associate dean for research from 2022 to 2024, and Alexia Kelley, PhD, assistant dean for research. The plan builds on previous assessments of the School’s research strengths and is based upon several months of intensive discussions among faculty, staff and students, along with a task force representing every department at the Gillings School.

“Building collaborative teams to do public health research is the wave of the future — and nobody does this better than Carolina.”

“This plan focuses more on how we do research than what we do research on,” said Kelley, adding that making the School’s support structures more nimble will enable Gillings to be a leader at the cutting edge of new research approaches as they emerge. “We’re all in this field because we want to make an impact. Our hope is to provide an inclusive and supportive research environment for faculty and students that sets them up to be successful in the science part of the work.”

Olshan noted that the strategic research plan would complement the strategic plan for practice that the Gillings School implemented a couple of years ago, with a special focus on ensuring that the School’s community-based participatory research efforts involve public health researchers and practitioners alike. The plan also considers ways to promote innovation, entrepreneurship and translation of research into policy and action.

“We are a big school full of great people,” he said, “so we are looking for ways to create mechanisms to enhance collaboration across the entire school.”

These mechanisms include building a centralized and searchable database that researchers, students and grantees can use to find others doing similar work — again opening the door to more collaboration.  Another collaborative effort is “in-house networking” — holding events where faculty with similar interests can get together, learn about each other’s work and explore opportunities for collaboration.

Some of those networking events are already occurring: One such gathering, held in December, is helping to evolve the School’s approach to mental and behavioral health research. Kelley and Kristen Hassmiller Lich, PhD, associate professor of health policy and management, organized the networking event.

Several faculty members presented brief “flash talks” about their research interests, which included anxiety and depression among HIV-positive patients, violence or neglect in the home, substance use disorder risks, resource optimization modeling, and other issues. The wide variety of mental health topics being studied — and the variety of approaches being used to address those topics — provides a lot of runway to build strength in numbers, Lich noted at the event.

“There is such potential to cross these methods and strengths with other aspects of mental health and behavioral health, and to find opportunities to do more with the deep dives we’ve all already taken,” she said.

Two major factors are driving the School’s approach to its mental and behavioral health research, North said. One is the desire to devote more attention toward community-based interventions. The COVID-19 pandemic sparked the realization that while clinical care is important, so are the interventions that happen in the community — whether it’s through schools, churches or other community organizations.  

The other factor is the fact that Gillings School faculty are doing research on both global and local levels — and although sometimes those locations may be far away in terms of distance, their impacts might be more closely tied than one would think.

“The networking event helped bring to light that we need to think about our full umbrella of global to local, and vice versa,” North said. “For example, we’re doing international HIV research that might also have relevance right here in our community. We have all this great global research and local research going on, and they can inform each other and gain perspective from each other.”

In addition to mental and behavioral health, the School’s research office has stimulated a focus on several other urgent and emerging areas:

• Health equity, with the goal of determining how to alleviate the effects of racism and health disparities on health and disease, in N.C. and globally, through both action and research.
• ‍Climate change and air pollution and their impacts on local and global health, and how those impacts are embodied through molecular mechanisms. The hope is to increase the visibility of Gillings research on this escalating global issue.
• The use of Generative AI and other technologies as the foundation for innovative research through collaborations with UNC’s new School of Data Science and Society, with a focus of becoming a leader in the field.
• Making UNC-Chapel Hill a leader in big data science and precision public health by partnering with the schools of medicine, data science, and the College of Arts and Sciences to promote collaborative science that leverages strengths across the entire campus.

The strategic plan calls for establishing an infrastructure that can promote strategic priorities like these while supporting all of the School’s researchers. For example, to keep up with changing federal grantmaking rules, improving research grant processing and compliance through a schoolwide administrative structure would free up researchers to focus more time and energy on their actual research work, not just their paperwork.

North also wants to work closely with new investigators to help them forge a path toward earning their first round of major funding. For mid-level researchers, she envisions a seed-fund program to help get important projects off the ground. “There are a lot of great ideas out there that just need a little funding to get them going,” she said. “It’s really important to me to incentivize and reward our researchers, because they are doing amazing things.”

It’s also important to identify and leverage new funding opportunities to sustain and grow the School’s research programs, North said. Federal research funding levels can be variable year to year, and research institutions like the Gillings School are looking more and more toward private donors, foundations and other nontraditional funding sources for support.

But first, North says, she wants to listen and learn. “I have a big learning curve,” she says. She plans to spend time meeting with faculty, staff, students and department leaders in each of the School’s departments and across campus to build relationships and learn more about their activities, priorities and concerns.

“Overall, my goal is to create an environment for sustained excellence,” North said, “with the core belief that public health has the power to transform our understanding of health and disease — that’s the key to everything we do at Gillings.”