A Century of Service: How Jackson County Public Health in Missouri is Leading a New Approach to a Healthy Community

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A Century of Service: How Jackson County Public Health in Missouri is Leading a New Approach to a Healthy Community

An interview with MaryAnna Henggeler, M.P.H., Division Director of Strategy and Operations at Jackson County Public Health

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For decades, local public health departments have navigated a cycle of uncertain and fluctuating funding, often stretching limited resources to continue protecting and serving the communities they are charged with supporting. Jackson County Public Health (JCPH), located in Lee's Summit, Missouri, is no stranger to this. In the 100 years of its existence, the health department has experienced periods of low funding and periods of intensely high funding with short grant timelines and deliverables.

In Missouri, per capita public health funding has been historically low; in 2023, Missouri spent $7 per person in state public health funding, the lowest rate in the United States. (In comparison, Kansas spent $32 per person in state public health funding in 2023, the 15th lowest.) How has JCPH learned to adjust to this funding instability? A conversation with MaryAnna Henggeler, division director of strategy and operations, highlighted the innovative work the agency has done to integrate systems-level thinking into how it approaches public health. As it marks its 100th anniversary, JCPH has worked to remain at the forefront of public health practice and innovation and, in the last decade, has strengthened its capacity to create lasting change on public health issues in Jackson County.

Building a Public Health Foundation

During the first 90 years of its history, funding and effort focused on traditional public health department work, such as investigating disease outbreaks and providing direct services to prevent the spread of emerging diseases.

In the 1920s, the health department focused on improving children's health and led efforts to provide physical examinations for school-aged children. That work expanded in the 1940s to include free medical services and immunizations for children from infancy through kindergarten, followed in the 1950s by polio vaccinations and in the 1990s by research partnerships with hospitals and federal agencies to address emerging diseases such as multiple sclerosis.

Throughout the 20th century, the department remained at the forefront of outbreak investigations, vaccination efforts and public education to prevent communicable diseases, as documented in its 100 Years of Health magazine.

Systems-Level Thinking in Community Health Improvement Planning

In the mid-2010s, JCPH began exploring systems-level thinking and intentionally shaping staff roles around the Foundational Public Health Services framework to meet Public Health Accreditation Board standards and build a department able to withstand fluctuations in funding tied to specific public health issues.

In the spring of 2020, JCPH quickly doubled its staff to address emerging COVID-19 pandemic needs. After receiving a small portion of federal CARES Act (Coronavirus Aid, Relief, and Economic Security Act) funding designated for Jackson County, JCPH leveraged those dollars to build capacity.

In addition to expanding staff and equipment to respond to the pandemic and protect the community, JCPH broadened its community-based programming and internal departments to strengthen community engagement, improve internal and external communications, and foster a culture of health equity and quality improvement.

After the height of the COVID-19 pandemic, JCPH revisited systems-level thinking, recognizing that lasting progress in health would require changes in how the department worked. As JCPH collaborated with partners to develop its Community Health Improvement Plan (CHIP), it designed a new, more collaborative process to help partners connect, align and take action together.

"We tested a systems-level approach for our CHIP, which was led largely by our Community Initiatives Team, using a number of different techniques and systems tools to develop the approach," Henggeler said.

Over three years, JCPH used NACCHO's MAPP 2.0 framework as a foundation for its CHIP. Partners from a wide range of sectors worked with JCPH to develop a network, InCoLab (Innovation + Collaboration + Laboratory), that analyzed data, compared experiences and identified the community's largest health challenges.

After identifying the health challenges, JCPH hosted monthly meetings that convened the InCoLab network to examine the root causes of disparities experienced by Jackson County residents. Network partners identified threats and opportunities across priority areas, leading to the creation of systems maps that illustrated the complexity of these systems in Jackson County.

The maps showed how factors interacted to influence economic stability and behavioral health, and how changes in one area could affect the whole system. Partners then identified key leverage points - places in the systems map where the InCoLab network and JCPH could intervene to have the greatest impact for each priority area.

JCPH now hosts monthly tactic action groups made up of network partners to address those leverage points. Through collaboration and the mobilization of partners across the county to participate in and lead the department's new approach to its CHIP, a plan for collective action to address the root causes of those challenges was developed.

Integrating Systems-Level Thinking into Strategic Planning

JCPH used the lessons learned from this systems-level approach to reflect on efforts across the department, especially during development of its new strategic plan. Like many health departments, JCPH experienced a temporary increase in funding during the COVID-19 pandemic that has since declined.

As a result, JCPH has focused on targeting limited resources to integrate systems thinking and collective impact into its public health work to achieve the greatest effect countywide.

The strategic plan measures collective impact in two ways: externally, through the CHIP and supporting partner efforts, and internally, through collaboration across divisions. Key activities to integrate systems-level thinking into the department's work include:

• Aligning resources across community programs and internal divisions to reduce duplication and increase efficiency. For example, last summer JCPH partnered with school districts to offer vaccine clinics at enrollment and registration events, providing more convenient options for families unable to schedule appointments with the health department or their primary care providers. Those off-site clinics vaccinated 366 students and strengthened partnerships with school districts and families.
• Mapping internal systems by assessing which teams are involved in each initiative, identifying overlaps or gaps, and ensuring coordination around shared goals.
• Communicating health issues in the county internally and externally, with an emphasis on the department's work to address community needs. JCPH's public information officer focuses on both community-facing health communications and internal staff communication to strengthen collaboration across divisions.
• Evaluating efforts using performance data and community outcomes to ensure resources support the most effective systems-level strategies. JCPH's Strategic Initiatives Division has worked with each division in the health department to establish performance goals and systems to track progress toward those goals, and will continue building internal capacity for systems-thinking approaches.

What lies ahead for JPCH over the next 100 years?

"We can still expect to encounter the same systems-level challenges and issues," Henggeler states. "Although factors like funding, public trust, service continuity and emerging diseases will continue to shape our work, the department is well equipped to stay proactive and maintain its leadership in serving the public."

JCPH has strengthened its capacity in foundational public health skills and systems-level thinking, enabling the department to work with the community to better understand needs, identify problems and develop solutions. By integrating systems-level thinking into external public health efforts, such as the Community Health Improvement Plan, and internal efforts, such as the strategic plan, JCPH has built public health leadership skills among its staff and the community it serves. Together, they are better equipped to navigate complex public health challenges for the next 100 years.