An association of public health leaders is continuing and expanding a partnership designed to make access to healthcare more equitable.

Last week, the CDC Foundation announced the creation of STRETCH 2.0, an initiative designed to provide “specialized technical assistance to state public health agencies and their communities to address the underlying policies, practices, resource allocations, power dynamics, relationships and mindsets that have allowed health inequities to persist,” according to a release. The CDC Foundation developed the program, which is funded by the Robert Wood Johnson Foundation, in partnership with the Michigan Public Health Institute and the Association of State and Territorial Health Officials (ASTHO).

STRETCH (Strategies to Repair Equity and Transform Community Health) was launched in late 2021 as part of an effort to encourage and increase community-level involvement in public-health initiatives like COVID-19 vaccinations. “We were looking at the capacity of [community groups] to respond, looking at vaccine availability and vaccine uptake,” said Alicia Justice, senior director, programmatic health equity initiatives and strategy, at ASTHO. “We were trying to understand what needed to be done to strengthen the relationship between public health and the community.”

We had a lot of what would be called uncomfortable conversations.

Alicia Justice, ASTHO

The first iteration of STRETCH also developed a framework for funding and support of community health groups. It did so by engaging with the public health departments in 10 states to test ideas. As an association representing those departments, ASTHO was well-positioned to provide support, Justice said. But because STRETCH is intended to explore biases and inequities, preparing participants for some tension was critical.

“We had a lot of what would be called uncomfortable conversations,” she said. “We had to talk about possible past harms that maybe the community had experienced from public health, whether that was intentional or not. What we wanted to be able to do is to have those conversations in safe spaces.”

STRETCH was initially designed to last for a year, necessitating the creation of STRETCH 2.0. The overall mission of the program is the same, but this time it’s moving beyond studying root causes of inequities and testing solutions. STRETCH 2.0 will create up to seven “collaboratives” that pair public-health agencies and community-level groups to develop health initiatives unique to that area. One element of the new initiative is that community groups that are approved will receive direct funding, to speed up capacity building and avoid red tape. 

“Some of our state public health agencies are still challenged by procurement systems that create delays in actually getting the money to the community-based partnership,” Justice said. “It just increases their capacity to immediately participate.”

The participants in the collaborations will be announced in November, Justice said, and the programs will run through spring 2025. Through that time, the partnership will be monitoring both how health inequities are handled at the community level, and how public-health groups can operate more effectively.

“We’ll be asking, ‘What new partners or new ways of engagement were implemented as a result of you participating in the STRETCH initiative?’” she said. “What policy changes were made within your agency as a result of anything that you’ve done in STRETCH?… We’ll be doing a combination of quantitative and qualitative assessments to find out, what revelations did you have as you were executing the technical assistance?”

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