Association for Public Policy Analysis & Management

“No identity, no budget.” This is the standard line in the Kansas City, Missouri  halls of Government—one that the Kansas City Health Department has been struggling with for years. The Kansas City, Missouri Health Department is a large, multi-program department of nearly 300 employees burdened with what some in Public Health call “the invisibility curse”—if Public Health is doing its job correctly, a resident wouldn’t even know it exists. Public Health is designed to be in the shadows, working to create a safe environment for the city’s residents and visitors. The success of Public Health work runs counter to the theories of local priority setting.

Kansas City, Missouri is unique in the attention it pays to customer service. Annually, the city oversees a representative, randomized survey that measures resident satisfaction with city services. What troubled the Public Health department the most was not our rates of dissatisfaction but rather the fact that over 40% of residents in the city did not know what the health department did, or didn’t have enough interaction with the department to make an informed response.

This paper analyzes the determinants of a “don’t know” response, and the results have shaped the work of the department. Our analysis found statistically significant patterns of “don’t know” responses—more affluent, educated residents had the highest rates of “don’t know” responses, as did the overwhelming majority of white residents and residents in city council districts outside the urban core of the city. With the department’s strong commitment to racial equity and social justice, it was clear that in focusing on our most vulnerable citizens, we were failing in marketing Public Health to the rest of the city.

Our analysis ends with examples of efforts in the department to overcome the invisibility curse—a renewed emphasis on social marketing, power mapping of council districts, increased media visibility on legislative issues, and the creation of a new division devoted to community engagement and public policy. This case study of local governance will be informative to policymakers struggling to balance the work of the department with the realities of constrained budget priorities.