This article is written by Dr. Sarah Moyer, Director, Chief Health Strategist, Louisville Metro Public Health & Wellness. This article is one of the entrants in Apolitical's 2020 American public servant writing competition.

Last summer I helped my husband scratch an item off his bucket list by taking him on a surprise skydiving trip for his birthday.

People thought it was crazy for me, the mother of four small children, to jump out of a plane, but I’m a risk-taker and I don’t let worrying keep me from achieving my goals.

It took us two hours to get trained and strapped into parachutes, but soon we found ourselves each strapped to a different skydiving instructor, packed like sardines in a tiny plane with no door, and as soon as the engines started it was far too loud for any conversation. The plane climbed into a perfect blue sky until we reached 10,000 feet. I watched my husband slide out of the plane and disappear into the vast expanse of blue. Thirty seconds later it was my turn and adrenaline kicked in like nothing I’ve experienced before. I was euphoric!

The rush of the wind was thunderous in my ears and I could feel my hair being violently whipped around. I loved the freefall — it was 30 seconds of pure bliss. Then the chute opened with a jerk and I felt a little carsick as we rocked back and forth like a sailboat on the ocean.

When it was over, so many feelings washed over me. I had a sense of disbelief and shock at what I had just done and pride for what I had accomplished. I felt exhausted as the adrenaline left my system. Still, skydiving turned out to be one of the greatest experiences of my life.

The bigger picture

I had a very similar experience transitioning our health department to Public Health 3.0, a bold new era of public health practice that challenges us to go beyond traditional public health programs in order to address today’s health issues.

Many people thought that transitioning from providing screening services to advocating for changes in the root causes of health was crazy

Health is more than healthcare, and we now know that our zip code has a greater impact on our health than the medical services we receive. In Louisville, Kentucky’s largest city, people on the east, richer side of town live 13 years longer than people on the west side of town. Life expectancy also has decreased since 2015, due to rising deaths of despair like homicide, suicide, and overdoses.

From 10,000 feet above Louisville, I could see some of the root causes of the disparities in life expectancy laid out before me. I could see how lush and green the east end is, and how much more blacktop and concrete cover the west end. I could see parks, golf courses and wooded areas in the east and smokestacks, factories and a power plant in the west.

Because of historical practices like redlining, which prevented people of colour from taking out loans to buy homes, and deed restrictions which prohibited the sale of homes in white neighbourhoods to people of colour, east end properties increased in value and residents there prospered, while west end properties languished and residents there were unable to build wealth. The result is that today’s cancer mortality map of Louisville mirrors the redlining maps of Louisville’s past. While cancer screenings address the symptoms, we will never achieve health equity without addressing the root causes of health. Many people, including some of my own employees, thought that transitioning from providing screening services to advocating for changes in the root causes of health was crazy.

We must engage with community stakeholders from both the public and private sectors and we must continue to form partnerships to guide the changes that must be made to improve the health of our communities

Rewriting the organisational chart of our health department, eliminating some direct services such as cancer screenings (which our healthcare system can do instead), and hiring policy analysts, community outreach specialists, and quality improvement coordinators, was like jumping out of a plane for all of us. The urgency to create Kentucky’s first Syringe Exchange Program, a whirlwind of advocating to local legislators, educating the community and researching best practices, was a similar adrenaline rush to freefall. And like skydiving, spearheading the transition of our department to a Public Health 3.0 model was one of the best decisions I’ve ever made.

We’re not going head first

Public Health 3.0 addresses the root causes of health. All the factors into which we are born, live and die.

It works collaboratively to create healthier, more equitable conditions in which everyone and every community can thrive. Public Health 3.0 requires that public health departments to be the GPS navigation system that leads our communities toward improved population health and foster health equity. We must engage with community stakeholders from both the public and private sectors and we must continue to form partnerships to guide the changes that must be made to improve the health of our communities.

Actionable data should also drive everything we do in public health

Our Community Health Improvement Plan, called Healthy Louisville 2025, uses data and stakeholder input to address the community’s health needs in four areas: improvements to the built environment, environmental equity, increased access to healthy housing and connecting health to education. By making improvements in these four areas, we can increase health equity far more effectively and efficiently than intervening on an individual level.

Before deciding to jump out of that plane, I did research and learned that tandem skydiving is safe. According to the data, I was more likely to be struck by lightning or crash my car on the way to the airport than to die in a tandem skydiving accident.

Actionable data should also drive everything we do in public health.

Data provides the information we need to make good decisions and points the way forward in our work. It wasn’t easy to implement the first syringe exchange in a very conservative state. At every turn, legislators, religious leaders, community members and others challenged the wisdom of harm reduction. What enabled us to convince them was the data showing that harm reduction works.

Since its inception, our syringe exchange program has tested 1700 people for HIV and referred over 600 for drug treatment. In 2018, when our state experienced a hepatitis A outbreak among people who use drugs, Louisville fared better than the rest of the state thanks to the relationship we had developed with participants in our syringe exchange program.

Purpose trumps fear

I could have listened to the people who thought I was crazy to go skydiving or let anxiety overcome my resolve and refused to jump.

In Louisville, we could have listened to the people who said it would be too hard to implement Public Health 3.0 or that the city would never implement a health-in-all policies approach that puts public health at the forefront of every decision the city makes. But we’ve taken the leap and the city is better for it.

Louisville Metro Government now considers the potential health impacts of every government decision, not just those which traditionally fell under the purview of the health department.

Life is full of calculated risks like skydiving and making bold leadership decisions. If you’ve done your research and worked with stakeholders, don’t let fear or anxiety hold you back. When you find yourself at the edge of your plane, savour the view, and enjoy the exhilarating, wild ride. — Sarah Moyer

(Picture credit: Unsplash)