Violence Prevention as a Public Health Goal in Ramsey County, MN: Paths Forward for Equitable, Community-Centered Priority Setting Processes

Abstract

Public health priority setting processes through Community Health Improvement Plans at the local level are designed to be community-centered. Yet, debate continues around whether objective, data-driven decision-making or subjective, person-driven decision-making should be most influential in the priority setting processes of local health departments. When marginalized communities and health issues like domestic and sexual violence are often not adequately represented in quantitative data, questions around the equity of objective, data-driven decisions are crucial to consider. While subjective, person-driven decision-making may provide space for conversations that lift up populations and issues that data-driven processes miss, the power and privilege of those in the room – and who has the power to invite participants into the room in the first place – are paramount. This qualitative study discovered that the prioritization of violence prevention as a public health goal in Ramsey County, MN depended largely upon individual actor power (subjective) rather than data-driven (objective) factors. Opportunities remain for increased community member engagement and co-creation of public health policies through a priority setting process that acknowledges the power and privilege of individual actors who are invited and able to participate in the priority setting process. A path forward to health equity in local health department procedures and programs must center community input through continuous community member participation, relationship building, and increased accessibility of the public health priority setting process.