Re-Envisioning Community-Led Public Health Through a Case Study of Chicago's Response

In efforts to increase community leadership and equity in public health, local health departments (LHDs) partner with community-based organizations (CBOs). To improve these efforts, it is important to know what kinds of CBOs participate in public health, why some do not, and what kind of transformation is needed to create a public health system that equitably includes CBOs. This study had three aims: 1) To address the assumptions underlying CBO participation in LHD activity by examining the knowledge, attitudes and beliefs of CBO leadership who chose not to participate in the initiative; 2) to examine, characterize, and differentiate funded and unfunded applicants of a government funded public health initiative; and 3) to explicate what a community-led public health approach looks like in a Chicago. This case study used the Chicago COVID-19 Contact Tracing Corps as a case study context, which was an initiative funded in 2020 by the Chicago Department of Public Health for CBOs to hire contact tracers from the community. Six interviews in-depth 90-minute interviews with CBO managers and leaders at small organizations were conducted and analyzed to address the first and third study aims. A thematic analysis of interview data revealed that CBOs chose not to apply because the initiative was outside of their scope of work, it was not responsive to pressing community needs, and technical and administrative concerns. Furthermore, cross-cutting themes of the community coming first and doubts about long-term impact were identified. To address the second aim, a mixed methods document analysis showed that workforce, financial, organizational capacity may be the most important determining factors to a CBO getting funded, not necessarily the mission or programmatic alignment. To address the third aim, a secondary critical discourse analysis of the interview data provided insights like the need for the LHD to give up control, allow for participatory spaces, and establish systems that demonstrate trust in the CBOs. These findings suggest that CBOs are theoretically equipped to lead public health efforts but there needs to be system transformation and wise investment from LHDs and CBOs that support an infrastructure for community-led public health.