Ready vs. Project Public Health Ready

By Leigh Wilsey, Preparedness Coordinator, Florida Department of Health in Clay County

This article was originally published in NACCHO Exchange. To read the entire issue, download the newsletter from NACCHO’s online bookstore (login required).

PPHR-Logo-2006-300x203As a local health department (LHD), the Florida Department of Health in Clay County (DOH-Clay) has had many opportunities to respond to emergencies and disasters that impact public health. Large statewide public health response activations have included the following:

  • Hurricane Andrew, 1992;
  • Wildfires, 1998;
  • Hurricane Floyd, 1999;
  • Hurricanes Bonnie, Charley, Francis, and Jeanne, 2004, known in Florida as “The 4 of ’04”; and
  • Local activations for tropical storms, flooding, and wildfires.

Prior to 2006, DOH-Clay’s role in public health response was limited to staffing special medical needs shelters. Even though a basic written plan existed, staff had experience running the shelter and rarely referred to it. While staff always had a “we will get the job done” attitude, the lack of coordinated planning and training presented many challenges in the back-to-back activations during the 2004 hurricane season.  Continue reading

Stories from the Field: Food Safety Calendar Educates Entire Community

food-safety-calendar-storyThe following story was submitted to NACCHO’s Stories from the Field website by Jeanne Garbarino from Vineland City (NJ) Health Department on Sept. 17. NACCHO’s Stories from the Field website provides a means for local health departments (LHDs) to share their experiences and demonstrate the value of public health. Stories from the Field can be used to support advocacy, peer learning, and collaboration with state and federal partners. Share your story at http://nacchostories.org.

When the Vineland City Health Department (VCHD) in Vineland, NJ, discovered that a lack of education around proper hand washing was the number one public health offense in the city’s retail food establishments, local health department (LHD) and Food Safety Council staff thought up an unusual solution: let students do the teaching. Through a contest with cash prizes, the department tasked K-12 students to contribute drawings illustrating best practices related to hand washing; the winning art was then published in the VCHD’s inaugural “Serving Safe Food Calendar,” distributed to every retail food establishment in the city.

The calendar project began in 2005, after the VCHD conducted its first risk-factor study with the U.S. Food and Drug Administration’s voluntary standards program and identified poor personal hygiene as the biggest health issue present in the city’s restaurants. A lack of hand washing spreads the viruses and bacteria that can lead to a number of foodborne illnesses, such as norovirus and salmonella. The LHD wanted to combat this issue in a creative, original way in hopes of gaining more attention from the food service community, and raising a higher level of awareness surrounding hygiene issues. Along with the Food Safety Council, the VCHD began brainstorming education campaigns and someone suggested enlisting local students to draw posters; the idea quickly evolved into a calendar.

The original production focused only on hand washing, but in subsequent years, the VCHD has expanded its focus to also cover proper food temperatures and foodborne illnesses. It isn’t a regular series – in total, the project costs about $4,000, so the department only produces them when funds are available – but when the opportunity arises students, parents, teachers and food service industry workers jump at the chance to take part, whether that means contributing a drawing or just pinning a calendar on a wall. Calendars have since been produced in 2009, 2011, 2012, and 2014. Artwork is selected through a contest that offers 12 winners a $50 Visa gift card and the opportunity to receive their prize during a televised city council meeting. Surprisingly, it’s the brief TV appearance that really drives kids to participate, and not the cash.

To garner enough submissions, the VCHD reached out to local teachers – a challenge in itself, as catching teachers when they weren’t busy was not always achievable – and asked that they promote the contest to their students. Some biology teachers even turned contest participation into a graded classroom assignment; they studied the various foodborne illness that can arise due to improper hand washing or refrigeration and students incorporated their lessons into their drawings. Simple outreach efforts expanded the scope of the VCHD’s original project; students and teachers were able to engage with public health education in a more meaningful way, and came away from the project with a strong personal understanding of the issues.

Once published, every licensed retail food establishment in the city, from top-tier restaurants to coffee carts, receives a copy of the calendar. The VCHD even provides them to the supermarket departments that handle and prepare raw foods. And though there are no established, direct links between calendar production and changed habits, risk factor studies conducted in the nine years since the project began have shown an improvement in personal hygiene practices among the city’s food service professionals. Additionally, VCHD staff have heard anecdotal evidence about community members whose children have taken to monitoring their family’s hand washing habits, or contest winners who now manage restaurants. And, perhaps most poignantly, retail food establishments sing the praises of the calendars and greatly appreciate the educational opportunity they provide.

Despite the clear successes, the calendar project has not been without struggles. Every new production cycle the VCHD undertook illuminated new strategies they needed to follow in order to ensure a useful product. For instance, one of the biggest challenges was timing their initial outreach campaign with a break in teachers’ schedules. If teachers were too busy to deviate from their planned curriculum, the calendars didn’t receive the classroom promotion the VCHD relied on for success. The department has since identified May as the best month to solicit artwork from students and teachers. Another important step was ensuring students had quality information to inform their projects. The VCHD found that it was often necessary to provide resources directly to the teachers; as schools do not typically teach food safety, classrooms really relied on the health department to educate them about proper behaviors.

Any LHDs interested in replicating Vineland’s calendar project, or initiating their own food safety education campaign, should remember the importance of including the whole community in the process. By involving students in the calendar, the VCHD was able to educate children, parents, and teachers in addition to the food service establishments originally targeted. Food safety became education became the whole city’s mission, not just the health department’s.


Read more LHD stories from the field at http://nacchostories.org.

Tackling the Root Causes of Health Inequity

By Tiffany J. Huang, Program Analyst, Assessment and Planning, NACCHO

The Roots of Health Inequity is an online learning collaborative and Web-based course designed for the public health workforce. The site offers a starting place for those who want to address systemic inequities in health and wellness. Based on a social justice framework, the course introduces public health practitioners to concepts and strategies for taking action in everyday practice.

Launched in 2011, this course now has over 4,500 registered users and more than 120 multi-person learning groups, formed by local health departments, universities, community organizations, and other institutions. To help groups interested in exploring the concepts behind this course more deeply, NACCHO has recently released the following:

  • NA616PDFRoots of Health Inequity Facilitator’s Guide: In its first version, this resource manual provides further guidance for groups and organizations seeking to facilitate in-depth online and in-person discussions about the course content.

 

  • NA615PDFExploring the Roots of Health Inequity: Essays for Reflection: This collection of four short essays is designed to explore conceptual themes associated with health inequity. The essays are intended to generate dialogue among public health practitioners concerned about growing health inequities and to inspire reflection about strategies directed toward preventing inequities by focusing on the institutions and interests that drive them.

 

  • NA614PDFExpanding the Boundaries: Health Equity and Public Health Practice: This brief explores the ways in which health equity practitioners might act on the underlying social inequalities that are the root of health inequities, rather than only their consequences. It aims to invite dialogue among local health departments and their community allies.

The Cook County (IL) Department of Public Health is one local health department whose use of the course has helped to further their understanding of their community. As James E. Bloyd, Regional Health Officer, states, “Our jurisdiction has sharp and longstanding divisions along lines of race, class and neighborhood. The Roots of Health Inequity training helped our multi-disciplinary group come to grips with the complexity of the issues. We now have a base of staff who are better equipped to change how we practice in order to fulfill our mission. The monthly brown bag lunches we organized for discussions of each unit were a hit.”

To learn more and register, visit rootsofhealthinequity.org. NACCHO staff are available to provide more information, including guidance documents on how organizations can use the course and obtain continuing education credits. Contact us at rootsofhealthinequity@naccho.org.

Has your organization experienced the Roots of Health Inequity course? Are you interested in participating? Let us know in the comments.

What Local Health Departments Need to Know About Ebola

ebola

This post originally ran on NACCHO’s Preparedness Brief blog. For the latest updates on Ebola, visit http://www.nacchopreparedness.org.

Since July 2014, NACCHO has been working to increase preparedness for Ebola in the United States by coordinating between our members at local health departments and federal and public health partners such as the Center for Disease Control and Prevention (CDC) and the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services. As local health departments consider their role in Ebola preparedness and response, NACCHO has assembled a list of Ebola resources for local health departments and their communities. For the latest Ebola resources and news, visit http://www.nacchopreparedness.org.

For Local Health Departments

For Heathcare Providers and Facilities

For EMS

For Travelers/Airlines/Points-of-Entry

For the General Public

For More Information

Do you have a resource on Ebola to share with local health departments? Please add it to the comments section below.

How is your local health department preparing for Ebola? Add your comments below or share your story on NACCHO’s Stories from the Field website.

New Health Equity Resources for Community Health Assessments

Health inequities exist when differences in the distribution of disease and mortality are systematic, patterned, unjust, unnecessary, and actionable.[1] Achieving health equity involves identifying, preventing, and reversing the effects of patterned decisions, policies, investments, rules, and laws that have caused social and economic inequities that affect people’s abilities to live healthy lives.[2]

Increasingly, communities are developing a growing awareness of health inequities that exist in their populations. As these communities seek to address health inequities and their root causes, local health departments (LHDs) are a critical convening point for partners seeking to engage community members and develop strategies to tackle health inequities.

NACCHO is developing resources to support their efforts. Recent releases include the following:

  • NACCHO University eLearning series on Health Equity and Social Justice. NACCHO’s online learning platform offers many courses to help LHD staff develop knowledge and competencies. Three modules, “What Is Health Equity?”, “Health Equity, Data Collection, and Analysis”, and “Using MAPP to Achieve Health Equity” define health equity and describe how to apply a social justice perspective in your public health practice.
  • MAPP User’s Handbook Health Equity supplement. Mobilizing for Action through Planning and Partnerships (MAPP) is a community-driven strategic planning tool for improving community health. NACCHO recently released guidance for communities implementing MAPP who seek to frame their community health improvement process around health equity and social justice. This guidance is now included in the MAPP User’s Handbook PDF in the NACCHO Bookstore, in addition to being available separately.

Are you or your LHD using one of these resources to help confront health inequity in your community? Share your story in the comments.


[1] Whitehead, M. M. (1992). The concepts and principles of equity and health. International Journal of Health Services, 22, 3: 429-445.

[2] NACCHO. (2014). MAPP User’s Handbook. Washington, DC: NACCHO.

Bruce Pomer, Retiring Executive Director of the Health Officers Association of California, Reflects on His Long Career in Local Public Health

bruce-pomerBruce Pomer’s career in public health spans 40 years in state government and the nonprofit sector in Sacramento. He has been executive director of the Health Officers Association of California (HOAC) since 1993. From 1983 to 1993, Mr. Pomer was director of governmental affairs for HOAC. From 1971 to 1983, he held a number of executive positions at the California State Department of Health Services, including chief of external affairs and chief of the Medi-Cal Field Services Section, where he supervised a staff of over 400 employees. Bruce retired from HOAC at the end of September. He spoke with NACCHO Voice on Sept. 23.

  • Please tell us a little bit about your career path.

I imagined myself becoming a policy expert in some area and having a niche in Sacramento. I thought that I would get involved in public policy and that before I finished my career, I would make one credible run for office. After I graduated from University of California, Davis, in 1971, there weren’t many jobs available. But I got a graduate assistant position with the old state department of mental health.

A few years later I was moved to what was then the state department of health. At the time, I was staffing advisory groups to the state; within that staffing was the California Conference of Local Health Officers. They needed a staff person so they placed me, at 24 years old, in that position. As it so happens, I didn’t know anything about public health. In the beginning, the doctors (health officers) were talking to me about stuff that I didn’t understand but over time I learned.

In public health at that time, experts really controlled the action. People did not question science like they do today. My members had a lot of power because of their expertise but that expertise was starting to be questioned. I realized that I had to help the health officers strengthen their ability to present expertise within the policy development process.

In a democracy, competing values occur and legislators have to balance a lot of competing demands. It was my job to make sure that science, expertise, and professionalism were considered. I remember one of the health officers telling me, “Bruce, the key to this organization is its professionalism. That’s its strength. They can’t take that away. Ultimately, we know how to stop an epidemic, we know how to give proper advice to the public and enable them to protect themselves. People respect the physician’s medical expertise.”

I represent a group of public health physicians but I’ve never once thought I was the expert. I knew it was my job to make sure that their expertise got to the table and was part of the public discussion.

  • You’ve been in public health for more than 40 years. What’s changed for state and local health officials since you started?

There was a lot more respect for public service and a lot more respect for professional expertise. It was less political then. In other words, the complexity of interest groups involved in the discussion of issues didn’t exist like they do today. It doesn’t mean that expertise doesn’t have a role now; you just have to be smarter about how you leverage it and get it into the process.

The other thing is the “fiscalization” of policy. I saw the tail end of the great era, the 25 years after World War II when California was building highways, the university system, and the hospital system. But as we got into the 1970s, as we had some of these recessions, policy became more about dollars and less about substance. When I started, a director of a department had power. A director could go to the legislature and directly lobby for something. Now everything is controlled by the department of finance. Directors run the departments but they don’t have the influence.

  • How have you raised the visibility of local health departments with policymakers?

Once you introduce people to who you are, you have to have ownership, you have to have a program that you’re pushing in the Capitol. If you don’t have your own legislation, if you don’t have your own specific budget item that everybody knows you’re sponsoring, you can’t take it to the next level.

About 20 years ago, I realized that was the single thing I needed to do with HOAC. Up to that time, we reviewed legislation, we provided testimony and expertise, and we talked to people about what local health departments did. We even sought amendments to things when we thought things wouldn’t work. But we didn’t proactively sponsor bills. It wasn’t until we proactively sponsored our own bills that we became real players in the system.

You have to develop relationships. You have to think long-term. If you’re not going to be in this battle for a long time, you’re not going to get anything done. A great political consultant that I know in Sacramento said this to me: “There are no winners or losers—just short-term and long-term players.” The people who play for the long haul eventually win. Case in point: we lost our department of public health in 1973. When I took the job with the health officers, the primary thing on our mind was to recreate that separate department of public health. You know how long it took us? Until 2006. We never lost sight and we always kept our eye on the ball.

  • What has been the most challenging issue you’ve faced at HOAC?

I’d say the most challenging issue I’ve faced was keeping the role of the physician health officer alive. When I first took the job, I remember a lobbyist saying to me “Physician health officers are dinosaurs. In a couple of years, they aren’t even going to be around.” People didn’t necessarily like physicians in positions of power because their allegiance isn’t to a bureaucracy; it’s to a professional set of ideals. The worst of the battle was between the late 1980s up to 9/11. There were actually attempts to take the physician requirement out of the statute. I remember getting into a pitched battle with the counties about it and them threatening to cut off our dues. It was really a difficult time.

  • What are you most proud of in your career?

Our succession plan to replace me as executive director is the thing that I’m most proud of. About 10 years ago we were awarded a grant that enabled us to hire Kat DeBurgh.  She was 26 when we hired her. It became pretty clear after a few years that she was someone special and that’s why we decided to finance her master’s of public health, which she received from the University of North Carolina at Chapel Hill with honors. She is smart, she has leadership capability, and she knows how to take charge of a situation.

About three years ago, I went to my membership and I said “I think it’s time for me to look at where the end is going to be.” It was a very difficult decision for me to make, to give up the love of my life, the way of my life, the passion that it turned out to be. But I told them we needed to do a final three-year contract and a succession plan and that I thought Kat is up to leading the organization.

This year Kat got two bills on the governor’s desk, which will probably get two signatures. She’s done great work around the Capitol; people are raving about her. Her staff are motivated because she knows how to frame a goal and leave them alone. What I’m most proud of is that when I leave the organization on Sept. 30, my group isn’t going to miss a beat.

  • What advice would you give to young professionals just starting their careers in local public health?

I’d say, like anything, loyalty and persistence are the most important qualities. If you really want to be successful, you have to commit to it. Don’t let people tell you you’re a fool because you’re hanging in there, that you should jump around and be ambitious to get up the ladder. The bottom line is that if you believe in something and have passion for it, you’re going to be successful.

Pick your team and stick with it. You have to be smart about seeing opportunity. You have to be flexible. In the long run, you’re going to win some things you don’t deserve to win and you’re going to lose some things that you don’t deserve to lose. You can’t get too high when you win and too low when you lose. Sometimes, the deck is going to be stacked against you and sometimes you’ll be incredibly lucky. But you have to stay in the game. You can’t win if you don’t stay in the game.


Interview by Lindsay Tiffany, Communications Specialist, NACCHO

OMB Visit Highlights Minnesota Health Departments

By Britta Orr, Executive Director, Local Public Health Association of Minnesota

OMB-MN

From left to right: Jane Braun, Minnesota Department of Health; Gina Adasiewicz, Dakota County Department of Health; Bonnie Brueshoff, Dakota County Department of Health; Tricia Schmitt, Office of Management and Budget; Denise Dunn, Minnesota Department of Health; Britta Orr, Local Public Health Association of Minnesota (author); and Elizabeth Parilla, Minnesota Department of Health.

On Aug. 18–19, the Local Public Health Association of Minnesota (LPHA) hosted Tricia Schmitt, who is responsible for Centers for Disease Control and Prevention (CDC) programs at the Office of Management and Budget (OMB). The staff at OMB are the budget experts within the White House and write the President’s annual budget proposal to Congress, in collaboration with various federal agencies. Ms. Schmitt toured and met with staff from the Minnesota Department of Health, Washington County Department of Health, Minneapolis Health Department, and Dakota County Department of Health.

This visit was jointly planned by NACCHO and the Association of State and Territorial Health Officials to showcase the work of local and state health departments and how federal investment supports their efforts to protect the public.

During the visit, local health officials discussed a variety of issues, including accreditation and foundational capabilities for health departments, emergency preparedness grant requirements, and changes to local health department activities in the wake of the Affordable Care Act.

At the Washington County Department of Public Health and Environment, Ms. Schmitt saw a hazardous waste disposal site that doubles as a local distribution network in the event of an emergency. Staff emphasized the federal support that has allowed them to train to be ready when they are called upon in an emergency.

In Minneapolis, Ms. Schmitt visited the public housing authority where Community Transformation Grant dollars have been leveraged alongside Statewide Health Improvement Program funding to improve nutrition, physical activity, and smoking policies for low-income residents. She also met a staff member in the Minneapolis Health Department who is funded through CDC’s Public Health Associate Program, which trains entry-level public health professionals through serving in federal, local, state, tribal or territorial health roles.

Ms. Schmitt also visited an immunization clinic at Dakota County Health Department that demonstrated the use of emergency preparedness structure and processes. This gave her a feel for the on-the-ground service delivery, patient flow, and incident command structures for emergency response.

After the visit, Ms. Schmitt said, the site visit “reinforced the critical role state and local health departments serve in transforming our healthcare system.” This experience was a true highlight of the past year at LPHA, and a great example of the value of NACCHO membership. We learned a lot about the federal budget process and landscape, and Ms. Schmitt got to see Minnesota governmental public health in action. We all hope and plan that the relationship will continue into the future.

While not all local health departments may have the opportunity to talk with staff who work for the President, there are many other opportunities to educate policymakers. All local health departments should make sure that Members of Congress and others who make decisions that affect the health of our communities understand the work you do.

NACCHO has resources that can help you, including sample meeting request letters, template factsheets, guidance videos and more. Go to NACCHO’s website to learn more or contact Eli Briggs, NACCHO Government Affairs Director.