Tara Hardy on Changing the Lens:

A New Focus on Public Health and Self-Identity

Edited by Taruni Donti

Taruni: What sparked your interest in public health?

Tara: I started working in public health before I really understood what the field is. I stumbled upon a job that allowed me to work with youth on substance abuse prevention and community coalition building. This job just happened to be in the public health department. As I spent more time there, I gained a deeper understanding of all the different roles that public health plays. I took classes and learned about the breadth of public health and how it differs from direct health care. Then I became more interested in learning more about how funding worked and how to keep projects going. We were grant based, so we spent a lot of time chasing the funding to implement projects that would impact our health outcomes. I was really interested in that administrative side of public health. I also really enjoyed working with the kids and the coalition. The role developed me as a human being.  

I think what keeps me interested in this field is seeing this shift in how public health has taken a more systemic approach to prevention work. We’re not just exploring social determinants of health but also addressing underlying root causes like social isolation, racism, and more. We don’t just focus on band-aid fixes.

Things feel chaotic right now. What gives me hope is that public health is a very resilient field.

Taruni: Can you share a moment when you truly felt the impact of your work on public health, and how did that affect you personally? 

Tara: Here’s a story from my early days at public health. As I mentioned, when I first started out in this field, I focused on substance use prevention with young people. Our tobacco rates were off the charts. Our middle school and high school rates in tobacco use were around 56%. Keep in mind – I’m from a very small community, so sometimes those statistics look a little skewed on paper, but 56% was still pretty high for our students. Often in small towns, you’re forced to play this numbers game. This involves trying to convince funders that impacting 35 students is worth it. The numbers seem small, but then when we implement a program, we’re probably reaching 100% of those 35. In comparison, in bigger communities with many more students, you might only reach a small portion of them. 

My work involved leading a coalition of students on tobacco prevention. We weren’t just saying ‘don’t smoke tobacco’. We used a youth empowerment approach that built youth skills around policy change and on how to be a catalyst for systemic change within the community. Many of the young people didn’t have other extracurriculars. So when I engaged with this group, we had many students show up every single week to talk about tobacco policies and tobacco prevention. 

At one point, I really saw the power of positive peer influence. Even if some students dabbled in smoking, so many more students would say things like, ‘oh, we don’t do that here’. This wasn’t peer pressure to smoke. It was peer pressure not to smoke, which was really fascinating to me. And we maintained that for quite a while. It took a couple years. Then, our Healthy Kids survey showed that we went from about 56% tobacco use to zero.  At that point, our goal was to sustain zero percent tobacco use in middle school and high school. 

It was incredible. I realized the impact then, but not fully. I mean, I was young. I was still learning the ropes. It was only a few years later when I realized the substantial impact that work had on our community. I still keep in touch with a lot of those original students. It was a state program, so I can’t take all the credit for it. I just happened to be the one adult facilitator leading that group. But it was here that I saw the power of the youth self-empowerment model. It was an amazing approach. It was an effective approach. 

Photo Credit: Adventure_Photo

Taruni: 100% success rate is amazing. Speaking of working with youth, collaboration is key in public health and is one of Trailhead’s core values. Can you share another time when working together with other organizations or people created real change for your community?   

Tara: I have several examples. The one that I’m most proud of involved taking two independent county public health organizations and combining them into a public health district – the first in over 50 years in Colorado.  

In 2008, Colorado passed the Public Health Act that mandated core public health services in the state. For context, I’m in Hinsdale County. Sometime after 2014, the commissioners of neighboring Mineral County reached out to the Hinsdale commissioners for support in keeping their public health department running. They were having a hard time maintaining and properly investing in their department. They asked if we could collaborate and, since I was already the director in Hinsdale County, asked if I could also be the director for Mineral County.  

We worked with the Colorado Department of Public Health and Environment’s [CDPHE] Office of Public Health Practice, Planning, and Local Partnerships to look at what our options were. We could go down two different routes. In one, we could have dual roles across the two counties’ public health departments. In the other, we could actually combine the departments.  

I was glad that we decided to combine because for a while, everything was duplicated – all our contracts, payroll, invoicing. It was a lot. As we worked together on next steps, we learned we would need a legislative change to make this happen. The way that the Public Health Act was written wasn’t conducive for rural communities because of how it phrased district financial oversight and county contributions. So, this ended up being a two-year process. We worked with legislators to make sure we could get the bill sponsored. We worked with the Colorado Association of Local Public Health Officials [CALPHO] to ensure that other public health departments were on board with the proposed legislative changes. And we worked with our commissioners, internal staff, external partners, and community members.  

Finally, we created the Silver Thread Public Health District. In 2016, the legislative changes were passed. We signed the contracts between the two counties in September of that year. Having the district has been really helpful in sharing services across jurisdictions. It’s expanded our ability to offer more programs in both of our rural communities, helped us braid our funding, and supported cross-collaboration of staff. The district has opened doors for that shared service approach. This was a big undertaking, and I’m really proud of the work we did. 

I have been at the local public health agency in my small community for over 23 years and served as the public health director for over 16 of those years. My entire identity has involved public health in my community.

Taruni: Public health touches so many lives in ways that people may not even realize. How would you explain its importance to someone who may not fully understand its role? 

Tara: This has come up before in community meetings where people ask, “what do you actually do”? I think it’s been helpful to describe public health’s role by looking at the three different layers of prevention work.  

The first level and public health’s foundational role is primary prevention. This is harder to see, right? For example, how do you measure people that don’t come down with communicable diseases? How do you measure the impact of that? The work we do primarily lives in this space. Then you have secondary prevention, which involves access to services. Maybe you have a communicable disease, and our role is to link you to the right resources and provide screenings for diagnosis. This is a little bit easier to measure. Then in tertiary prevention, we’re helping manage chronic diseases through education and information about how to navigate a condition that could have been preventable.   

Public health works across all three levels, all of which are different than primary care, which involves doctors treating patients. Public health is more behind the scenes – usually less noticeable if we’re doing our job right. 

Primary, secondary, and tertiary levels of public health prevention. Image from PDHI.

Taruni: What are some of the biggest challenges in public health that keep you up at night, and what gives you hope?

Tara: In my answer to the first question about what excites me about public health, I mentioned that we’ve shifted our approach to address root causes and change systems. Things feel chaotic right now. Our political climate seeks to unravel all the work that we’ve done to bring in marginalized populations, to address social isolation, to build belonging as actual prevention work. We’ve come so far in recognizing how these root causes affect health outcomes. To see our field under attack, the divisiveness, taking away of people’s access to care, making certain populations feel demonized – it’s discouraging and heartbreaking. 

What gives me hope is that public health is a very resilient field. We’ve been through a lot, and staying connected to our values feels good. I still always try to find something good every day (laughs). Sometimes that’s just saying, okay, I haven’t wavered on my values. I think it will take a while to undo these recent changes, but I also believe we had some really strong momentum. I’m hopeful that momentum will come back around eventually, and, in the meantime, we’ll stick true to our values and commit to what we know works. 

Taruni: If you could go back and have coffee with younger self before they started their public health career, what is one piece of advice you would have for them?

Tara: If I’m going back to my younger self that didn’t quite know public health yet, I would highlight how vast public health is. It’s never boring. It’s ever changing and will keep your interest sparked the entire time.  

I would also like to let myself know that you’re going to face probably the hardest challenge of your entire career – possibly life – through this thing in 2020 called a global pandemic. It will challenge your belief system more than you could ever imagine. It will challenge your mental, physical, and emotional well-being. And at times it will feel never ending and very hostile. But it will eventually end. And here are three things that I took away from it that helped keep me going. 

First, find one thing every day to be grateful for – even if it’s small, especially if it’s small – because those add up and will help build your morale.  

Second, learn who your true supports are. They will naturally appear. Lean on them, because they are there to help get you through this time.  

Last, see others as human, even when you don’t feel like they deserve that level of respect – even when it feels like there’s so much hate against you. At the end of the day, we’re all human. We have a lot more in common than what divides us. Learn where others are coming from. More often than not, people come from a place of fear and handle it in different ways. There is not as much ill intention as there may seem. 

Taruni: If you were to write a memoir about your life, or perhaps this current chapter, what would you title it and why? 

Tara: This is a hard one for me (laughs). Okay, so here’s what I’ve landed on – Changing the Lens: A New Focus on Public Health and Self-Identity. Why I would name it that is two-fold.  

Most of my career in public health has focused on how public health operates at the local government level. I feel pretty well-versed in that. Now at Trailhead, I’m changing my focus to a nonprofit organization that works in public health more broadly across the state. I’m very excited, but it’s been a shift – in how this work is seen, how we operate, how relationships work.