Community Health Assessment and Improvement Plans: Integrating Research and Practice

By Ian Goldstein, Web and New Media Specialist

The following is an excerpt from NACCHO’s latest podcast featuring Gretchen Sampson, Director, Polk County (WI) Health Department, and Julie Willems Van Dijk, Associate Scientist at the University of Wisconsin Population Health Institute. 

NACCHO: Community health assessments and community health improvement plans (CHAs/CHIPS) are essential and complex functions of a local health department. Julie, you’re in research and Gretchen, your work is practice-based. How are your skill sets complementary and how have the integrated findings of your two projects made a difference?

Sampson: Well, our skill sets are very complementary because Julie has done what I do in her previous life and is very familiar with what practice involves at the local level. I think we both know that to do community health improvement work, it’s all about relationships—relationships with partners and with the people that live in your community. I think that’s how we accomplish what we do, by really nurturing those relationships throughout the years and calling on those partners when we want to look at the health of our population and plan strategies to deal with health focus areas identified.

Willems Van Dijk: Yes, I definitely agree with Gretchen. One of the things we have been able to do with the project that we’ve presented at NACCHO is look at this in a truly integrated way between practice and research. One component of the project has been looking at doing an environmental scan with our local health departments and finding out what their needs are and being very responsive in terms of addressing many of those needs right away, in real time. Another component of the project has been studying what’s already been done in our state. Wisconsin is somewhat unique in that for over 20 years, we’ve had a requirement that local health departments conduct community health assessments, so we’re really a rich source of data around this topic. We’ve been able, through the University of Wisconsin and a practice-based research network grant, to study what has already happened in terms of community health assessment and improvement plans.

I have to echo what Gretchen said about that as a researcher: The practice community really informed me and said to me, “You can’t do a study of the quality of community health assessments and improvement plans simply from looking at paper documents or Web-based documents; you really need our input.” So, as part of the study design, we not only reviewed the paper documents and what was available online, but we also did a survey with local health officers to get their input on the quality of their community health assessment and improvement planning process. We had a really good response rate, upwards of 75 percent on those surveys and I really think it is because people knew me, knew that this work was really going to be used in an effective way to move progress forward.

Hear more from this interview, including Sampson and Willem Van Dijk’s lessons learned from integrating research and practice to improve the CHA/CHIP process, by listening to the podcast.

Electronic Laboratory Reporting and the Public Health Workforce

By Roland Gamache, PhD, MBA, Senior Director, Informatics, NACCHO

An informative article in this month’s Online Journal of Public Health Informatics, “Estimating Increased Electronic Laboratory Reporting Volumes for Meaningful Use: Implications for the Public Health Workforce,” shows the value electronic laboratory results reporting can bring to the public’s health. The article also describes how electronic reporting can capture the large portion of communicable disease cases that go unreported to better contain the spread of those diseases, confirming the efforts of the Office of the National Coordinator for Health IT (ONC) and the impact of Meaningful Use activities towards achieving these goals.

More complete reporting through Electronic Laboratory Reporting (ELR) allows better prioritization of case investigation by public health, with increased focus on high priority/high impact diseases that pose the greatest threat to a community. This information allows health departments to investigate these events more rapidly and more efficiently, therefore preventing disease. According to Joseph Gibson, PhD, a co-author of this paper, “Without ELR, public health has been like a physician who only gets half of the test results ordered to determine how to treat a patient.”

Public health departments can better protect their community’s health because this information will provide public health practitioners with a more complete picture of the unmet need in the community. This level of information will allow agencies to prioritize their resources more efficiently and effectively.

ELR makes the act of understanding the disease burden in the community more efficient while requiring less time for hospitals and labs to provide information to public health departments.

Additional lab reports are an important part of case investigations. More complete case reporting creates a better picture of actual diseases circulating in a community. An influx in lab reports or more thorough case reports do not hinder case investigations, but strengthens them because they create a better picture of actual diseases that are circulating in the community, and also allows for a larger data bank that can be used for future public health studies.

Nor does ELR increase the amount of disease in a community; it just provides more information about the notifiable diseases. The resources needed by public health required to respond to these diseases are just better understood because this information is reported more often to health departments. If we do not have a clear picture of what is going on in the community, how can public health departments do their job and protect the community?

The National Association of County and City Health Officials and the Association of State and Territorial Health Officials have documented the resource constraints in health departments as highlighted in the article. However, health departments are working with local, state and federal partners to build capacity so they can capitalize on the type of data flow that is envisioned in the scenarios described by this article.

Similarly, ELR has increased efficiency for lab reporting, helping to ensure that electronic case submissions can increase efficiency. Case reports submitted by clinicians with complete information will reduce the burden on public health.

In summary, ELR will improve the health status of the community by allowing health departments to more effectively and efficiently deploy its resources to improve their investigations about the spread of disease in their jurisdictions.

The views expressed within do not necessarily represent those of the sponsor.

Reducing the Risk of Exposure to Polychlorinated Biphenyls in Older School Buildings

By Tina Yuen, MPH MCP CPH, Program Analyst

The presence of polychlorinated biphenyls (PCBs) in buildings, especially school buildings, is an emerging environmental public health issue. In 2009, the Environmental Protection Agency (EPA) issued new guidance for school administrators and building managers with information to help minimize possible exposures.

As local health departments (LHDs) are central to protecting and promoting the health of communities, their participation in efforts to assess and address potential exposures to PCBs in schools is often necessary. NACCHO has produced a fact sheet to help LHDs understand the risk of exposure to PCBs in school buildings and identify strategies to reduce exposure risks in partnership with schools and other public agencies.

PCBs are a group of chemicals previously manufactured and used in the United States from the early twentieth century until they were banned in 1979 due to their toxicity. Before their ban, they were widely used in building materials and electrical equipment, such as caulking and fluorescent light ballasts. Buildings constructed or renovated during this period, including schools, may still contain materials and equipment with elevated levels of PCBs.

PCBs are problematic because they are toxic, persistent chemicals that biomagnify in the food chain and bioaccumulate in the bodies of animals and people. Although PCBs have not been manufactured since 1979 in the United States, these chemicals remain in the environment and present a risk to human health because they do not readily break down. PCBs have a variety of adverse health effects.

The presence of PCBs in schools poses different health concerns for school-age children, who are especially vulnerable to toxic chemicals. Children possess developing physiologies and unique explorative behaviors that could increase their exposures and susceptibilities to environmental pollutants compared to adults. The spectrum of potential health effects of PCBs in children is also more complex given the timing of exposure during critical periods of growth and development. PCBs may also remain stored in fatty tissue and other organs for many years.

An investigation of 24 schools and other public buildings in the Greater Boston Area revealed that 13 contained caulking materials with detectable levels of PCBs. Of these, eight buildings contained caulking materials with PCB content exceeding 50 parts-per-million by weight, the specific limit above which material is considered PCB bulk product waste and is required to be disposed of.

PCBs were found in the soil at a high school in Greenwich, CT. It is thought that contaminated fill had been brought to the site when the school was built in the late 1960s. The local health department has been working with the Board of Education, the Board of Education’s environmental contractors, Connecticut Department of Public Health, the Department of Energy & Environmental Protection, and the EPA to address the issue. The majority of concerns were on potential exposures to students and staff from the PCBs in the fill and determining the extent of contamination. Both indoor and outdoor testing was performed during remediation efforts.

The cost of remediating contaminated buildings can present an obstacle for resource-limited public agencies and school districts. But the concerns over the cost of cleanup should be balanced against concerns over protecting the public’s health and mitigating risks to the most vulnerable populations, such as school-age children.

It is also important to note that the risks associated with indoor sources of PCB exposure are not well understood. The EPA is currently conducting research to better characterize this link in school buildings.

Has your LHD been dealing with PCBs in schools or other public buildings? Tell us about it in the comments section.

Promoting Healthy Lifestyles with the Help of the Medical Reserve Corps

Group Of Children Running In ParkBy Alyson Jordan, Communications Specialist, NACCHO,  and Lisa Lee, School Health Project Coordinator, Monmouth County (NJ) Health Department

How can you take your community’s talents and use them to make children healthy and active? Monmouth County, NJ, found a way by engaging a variety of health and educational professionals to pilot a “School Health Council” project called, “Action for Fitness in Monmouth County.” In 2010, Monmouth County piloted a School Health Council to promote healthy eating and exercise among schoolchildren and educate students and families about nutrition and fitness. The School Health Council was comprised of local health officials, a school administrator, school nurses, teachers, parents and members of the local Medical Reserve Corps (MRC) unit, the Monmouth County Health Department MRC.

The MRC is a national network of over 200,000 volunteers organized into almost 1,000 local units across the country. While many volunteers have a medical background, a significant number of volunteers are non-medical people who are interested in making their communities a better place by educating residents on how to be prepared for a disaster or sharing healthy lifestyle information. MRC units participate in activities based on the needs of their communities; in this instance, five volunteers were happy to share their medical expertise in the implementation of the School Health Council project.

In 2010, the School Health Council project pilot launched at Farmingdale Public School in Farmingdale, NJ, with the goal of increasing fitness, improving nutrition education and decreasing students’ body mass indexes (BMIs). To do so, the School Health Council implemented strategies recommended by the Centers for Disease Control and Prevention to promote healthy lifestyles in children and parents. These strategies, which could be implemented in any community, included the following:

  • Adopting health policies for school parties and celebrations;
  • Planting an edible garden at the school where students can garden and eat the vegetables grown;
  • Measuring students’ activity levels by giving each a pedometer; and
  • Developing in-class and after school fitness activities; and instituting healthy cooking classes

MRC volunteers helped to support these activities in a variety of ways. One MRC volunteer, a chef by profession, hosted a demonstration to teach families how to make healthy and kid-friendly snacks. Other MRC volunteers provided expertise and gave feedback as medical professionals during School Health Council meetings. Non-medical volunteers walked weekly with groups of students to school and coordinated a Family Fitness Olympics.

This post originally ran on the Together Counts blog. Learn more at

Become a Licensed HAM Radio Operator at the Preparedness Summit

Man Operating Ham RadioBy Andy Roszak, Senior Director for Environmental Health, Pandemic Preparedness, and Catastrophic Response, NACCHO

This post originally ran on NACCHO’s new Preparedness Brief Blog. For more preparedness news and resources, visit

Incidents over the past year have once again demonstrated that developing a robust and reliable system for communicating during a disaster continues to be a challenging task. Landlines tend to be one of the first victims of natural and manmade disasters, with cell phone networks generally close behind. During times of disaster, many organizations are turning to amateur radio (HAM radio) to maintain communications and ensure continuity of operations.

Become a Licensed Amateur Radio Operator
On Thursday, April 3,Volunteer Examiners will be on-site at the Preparedness Summit to administer the Federal Communication Commission’s amateur radio examination. This examination is required to become a HAM radio operator. The examination costs $15 dollars and takes approximately 45 minutes to complete.

Learn About HAM Radio
NACCHO will be hosting a series of free webinars designed to educate the preparedness community about HAM radio and prepare them for the examination.The webinars will be recorded and made available on NACCHO’s website. In addition, NACCHO is hosting an in-person ‘HAM-Cram’ review session the night before the examination at the Preparedness Summit to ensure your success! If you are interested in participating in the webinars and/or taking the HAM radio license exam at the Summit please sign up for more information.

HAM Radio Test Resources
Operation of an amateur radio requires an operator license granted by the Federal Communications Commission. There are three classes of license: Technician Class, General Class, and Amateur Extra Class. Before receiving a license, you must pass an examination. Most new amateur radio operators start with the Technician Class operator license. There are numerous resources to help you prepare for the Technician examination. The American Radio Relay League provides resources and information for individuals seeking licensure. Numerous study guides, question banks and resources are available for little to no cost.

Additional study resources:

NACCHO Members Carry their Message to Capitol Hill


Florida NACCHO members outside the office of Senator Bill Nelson (D-FL)

By Eli Briggs, Director of Government Affairs, NACCHO

On Dec. 12, 2013, a record number of local health officials went to Capitol Hill to meet with Congressional staff and Members of Congress as an optional part of NACCHO’s Survive and Thrive program for new and aspiring health officials. NACCHO members met with nearly 100 Congressional offices representing 30 states.

This year, it is important that as many NACCHO members as possible educate Congressional staff and Members of Congress about how local health departments improve health and safety with the support of federal programs. While Congress has taken action to reduce expected federal budget cuts for this year, spending levels for non-defense programs still remain at historically low levels; both the FY 2014 and FY 2015 funding levels are well below the FY 2010 funding level, even without adjusting for inflation. In FY 2013, the Centers for Disease Control and Prevention’s budget was reduced to the lowest level since FY 2003, while health threats and challenges have increased since then.

To get involved, sign up for NACCHO’s Congressional Action Network. You can also learn about the issues NACCHO is currently involved in at the Legislative Action Center.

Some first-time participants in NACCHO Capitol Hill visits reflect on their experiences below:

“I have never had the opportunity to visit any of the elected officials in Kansas or Washington, DC, so this was a brand new experience for me. I worked hard to be prepared prior to arriving in Washington, DC, but I was still very nervous about the meetings. Through the webinars provided by NACCHO prior to the visits, the development of fact sheets and coaching from NACCHO staff, I feel like I learned more than expected.” —Allison Alejos, Director, Local Health Department, Shawnee County

“Working with colleagues from my state to coordinate our public health message to our Senator and meeting one-on-one with Representatives from our respective areas of the state is an experience not all health officers, particularly new health officers, get the opportunity to experience. NACCHO not only coordinated the visits on our behalf but prepared participants throughout the year to boost our confidence and ability to craft and communicate our message. It was an opportunity my colleagues and I will not soon forget and [for which we] are thankful. I hope more health officials will take the opportunity to meet with Members of Congress and their staff at home or in Washington, DC, and tell them about how local health departments are protecting health every day.” —Erin Hess, County Health Officer, Florida Department of Health, Hardee and Okeechobee County

“Working with NACCHO to help coordinate the Capitol Hill visits was a great experience. Supporting the members of CADH [Connecticut Association of Directors of Health] by being with them as they delivered the message of the impact of what they do in the communities that matter to their congressional representatives was very powerful. We even incorporated some intense physical activity by hustling between offices across the Capitol to make sure we delivered a timely message prior to the House members voting to approve the budget resolution.” —Charles Brown, Executive Director, Connecticut Association of Directors of Health

Please e-mail me at with any questions or for more information about NACCHO’s advocacy activities.

Health Impact Assessment: Role of Local Health Departments in Advancing Healthy Public Policies

Tina Yuen, MPH, MCP, CPH, Program Analyst, NACCHO

With a growing emphasis for public health practitioners to address the root causes of health impacts and inequities, local health departments (LHDs) have been challenged with working “upstream” to tackle the determinants of health. Health impact assessment (HIA) has emerged as a promising approach to help LHDs partner with decision-makers and other stakeholders to examine the public health implications of policy decisions that impact health.

What is HIA?
HIA is a structured process that brings together scientific data, public health expertise, and stakeholder input to assess the potential health consequences of a proposed policy, project, plan, or program that does not have health as its primary objective and to craft health-based recommendations. It is often seen as one component of an overall Health in All Policies (HiAP) approach towards decision-making that emphasizes collaborations and partnerships across sectors. Typically thought to consist of six steps, HIA provides LHDs a structured process to engage an array of organizations, residents, public agencies, and elected officials and ensure that the proposed changes support health and equity.

HIA holds promise because of the following:

  • Its applicability to a broad array of policies, programs, plans, and projects;
  • Its consideration of both adverse and beneficial health effects;
  • Its core principles and values of democracy, equity, sustainable development, ethical use of evidence, and a comprehensive approach to health;
  • Its ability to consider and incorporate various types of evidence and assessment methods; and
  • Its emphasis on engaging communities and other stakeholders in a deliberative process.

HIAs have multiple aims. Ultimately, the primary purpose of a HIA is to shape public decisions and the public discourse surrounding these decisions, and to make health a much more explicit part of the dialogue.

HIAs also have the ability to improve the process through which public decisions are made. The HIA process may be able to better engage a diverse array of stakeholders and empower impacted communities and residents to become involved in the decision-making process. HIAs are often used to expand public participation by emphasizing everyday experiences and help to build consensus among different stakeholders. Furthermore, LHDs have the capacity to build and strengthen relationships with other organizations or groups through the use of HIAs.

LHDs and HIA: A Path towards Advancing Healthy Public Policies
HIA provides LHDs with a structured approach and innovative opportunity to work collaboratively to create healthier and more equitable communities. NACCHO has supported the use of HIA among LHDs in various ways, such as the HIA Mentorship Project, and through its policy statements on HIA, healthy community design, and HiAP. Through different technical assistance and funding opportunities and simply through trial and error, LHDs have been able to increase their capacity to conduct HIAs and extend their role in public policies. The following are examples:

  • Cuyahoga County Board of Health in Ohio became involved in learning more about HIA in 2007 and 2008 as part of cross-collaborative efforts focused on health equity and the built environment. The first HIA in Cuyahoga County was initiated in 2011, and their HIA program has been steadily expanding ever since, with two new HIAs planned for 2014.
  • Crook County Health Department won the NACCHO’s 2013 LHD of the Year Award in the small LHD category for their work on a HIA related to bicycle and pedestrian safety in Prineville, OR.
  • New Orleans Health Department has begun to use HIA as a way to advance broader HiAP objectives that were generated out of their community health assessment and community health improvement planning processes.
  • San Francisco Department of Public Health was an early adopter of HIA and led one of the first HIA projects conducted in the United States. The agency now has well over ten years of HIA experience and a robust program dedicated to working in partnership with residents, public agencies, and private organizations to advance healthy environments and social justice.

Is your LHD involved in an HIA project? Tell us about it in the comments section.

For more information on HIA, visit NACCHO’s HIA webpage.