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Ashley Wegner
Section Chief of Health Planning and Policy, Clay County Public Health Center
Background, mentorship and transition from research-based science to public health
In high school, I knew working with infectious diseases was something I wanted to pursue, but growing up in South Dakota I didn’t have any exposure to public health and didn’t know what all the options and opportunities were. When I was in undergrad, I met a food microbiologist who worked at Cornell University. I interned with her for a few weeks in New York and Colorado. She said, "I know you’re really interested in infectious diseases and you like learning about lab techniques, but you might thrive more in a public health setting." And she was right. I’m a much better fit working with people and not just Petri dishes.
After working in a lab and graduating with a microbiology degree, the turning point for me was having access to great mentors who had experience in scientific research and public health. I went on to get my master’s in public health. And I bridged my interest in infectious disease with the world of epidemiology so that when I entered the workforce, that was the field I entered through. The first seven years of my public health career was infectious diseases and epidemiology related. As I advanced into managerial and supervisory positions, that morphed into a wider range of roles. Now I’m at the Clay County Public Health Center overseeing five of our programs: epidemiology, emergency preparedness, community development, internships and volunteers, and continuous improvement.
Lessons learned in the workforce
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When I entered the workforce, I thought, "My education is going to speak for itself." I had this entitled view that education was probably more important than direct work experience. And I learned very quickly that if I wanted to be successful, I needed to lean into developing the experience side more. Education may get you the skills and knowledge to be successful. But once you get into the workforce, it’s not what you do, it’s how you do it that matters. You have to have communication and leadership skills. And leadership doesn’t just mean you’re a
supervisor but that you lead by example and are willing to work through conflict.
My first big kid job was working with a team of highly motivated, high-performing women under 30 on professional development. We’d do things like StrengthsFinder 2.0 and 360-degree evaluations, push each other to have constructive conversations, and give feedback even if it wasn’t the most desirable to get. It was great being a part of that kind of environment where you know the people you’re working with have your back and want you to succeed. I have friends who entered the workforce in a hospital, and it can be quite the opposite. It’s competitive, people are constantly trying to one-up each other, and I’d think it’s more difficult to develop in that kind of environment unless your personality thrives there.
Impact of COVID on the public's perception of health departments
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In the past, our organization has been well supported by the community. Prior to the pandemic, we had great partnerships, we had a whole lot of credibility, we were a reliable and trusted source. Then COVID hit. This is kind of where things are across the country, but we’re seeing the same issues with people trying to discredit health departments and staff or poke holes in what our authority should be in terms of mandates and masking. Depending on the political climate, there’s a difference in the reaction we get from the community. Missouri is a conservative-thinking state. We like our liberties. So we’ve had a pretty significant drop in the support we used to have pre-pandemic. But there is not one time that we haven’t followed CDC guidance. That is a value we have absolutely stuck to. We’re following the science.
Intersection of public health and policy
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In terms of being a catalyst for policy and decision-making change, public health in general has opportunities to grow. Policy analysts are new positions within the public health field, which help us understand long-term impacts of local and state policies and then create a strategic plan to see how we can make more of an influence. Policy gets hairy for us. As government workers, we’re not allowed to advocate for any policies. We cannot go to the decision-makers and ask, "Can you vote for X, Y, and Z?" We can show up, educate, and provide information on impact or about the current state
of affairs. We can share interventions and how they’ve been evaluated in other jurisdictions. Or, we can say, "All of the other communities in our county have adopted these measures except for you, zip code X," which can create pressure for communities to adopt ordinances that may be beneficial to public health.
Equity work as the future of public health
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The future of public health is equity work. The analogy I use to describe it is, "Rising tides lift all ships." We work with communities that are basically underwater or sinking to raise their ships. And if their ships are rising, the rest of our communities are rising. That means working on policies so there aren’t unintended consequences or negative impacts on populations already experiencing disparities. It also requires resources and a different way of doing business. Some public health agencies don’t have the capacity to focus on getting upstream to things like equity work, but there’s an understanding in high-performing health departments that that is where the focus needs to go.
The future of public health is also working on social determinants of health — things like access to housing, education, and healthcare, or access to income. Raising the minimum wage may not seem like something related to public health. But, for example, if you don’t have income, you may not have access to healthy food, which can lead to a multitude of poorer health outcomes.
In the State of Missouri, high performing local health departments aim to bring along everyone else who has been doing status quo work so we can move the needle together. There are early adopters, agencies that haven’t been thinking much about it, and some that don’t want to change at all. Some of our local health departments do have more resources than others, so we’re able to take over that role a little bit more. Still, bringing this process of change management to organizations which are already highly under-resourced, is a huge challenge.
Challenges in moving toward equity work
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Equity work is going to require a huge shift of dynamics and take quite a while before it becomes the status quo. It’s hard work. And sometimes it’s less gratifying because you don’t see the benefits as quickly. Public health has to prove that where we’re spending public dollars is the best bang for our buck. And when you start working on social determinants of health and equity work, you may not see outcomes for 30 years. So when you have elected officials trying to get results within their term, it’s a difficult sell. With our current healthcare system and the way our country views health — or
doesn’t view health — it’s a tricky terrain to navigate. So many in the U.S. believe health is all about individual choice: ‘If I just choose to eat fruit and not fast food every day, I’m not going to have diabetes.’
The deeper issue is that many populations don’t have the option to make healthier choices. So shifting the narrative and finding common ground will be crucial. We’ve been educating governments for years, saying, "Spending money on prevention will save money on the back end." But policymakers vested in for-profit health businesses say, "If the government is going to pay for this prevention, who’s going to be saving the money?"
Americans' individualistic mindset towards COVID and health in general
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America is like, "Everyone just take care of yourselves and we’ll be fine." But when it comes to things like a pandemic, that’s a very flawed stance, because your decisions impact me. The individualistic mindset of this country has been one of our biggest obstacles within COVID. We have community members coming to us and saying, "We just want choice. We don’t want to be told, ‘This is your only option, or don’t participate.’" When you look at the way other countries have responded to universal mitigation measures, there isn’t the same level of backlash, because the sense of community is different.
We got such hard resistance to folks getting vaccinated because it goes against America’s set of values. So one thing I attempt to do when delivering messages is to find common ground with people. Whether or not you believe COVID is real or if it’s causing you problems economically or if you’re concerned about health problems it can or has caused, regardless of what your problem is with it, we can agree that COVID is causing a problem. So I’ve had a little success trying to reach people in that headspace.
The way I’ve started framing my messages is, "Hey, if you want to re-enter society and you want this to stop causing you problems, whatever they are, there are two options. We can either wear masks and get vaccinated, or you can not be part of the solution, and these issues are going to be prolonged." So we’re trying to tailor to that individualistic mindset by reminding people, "If you don’t want to be affected by things like quarantine, because that’s an issue for your kid at school or your employer isn’t supportive of paid quarantine, then get vaccinated. You’ll be less likely to get sick, and so many of those issues will go away." We haven't fully evaluated this approach, but it’s a tidbit of a success story I’ve been seeing as I go about every day.
Ashley Wegner
Section Chief of Health Planning and Policy
Clay County Public Health Center
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