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


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.

Resources and Information for National Food Safety Month

meat thermometerLocal health departments (LHDs) are on the front lines of foodborne illness prevention and response. According to the 2013 National Profile of Local Health Departments, 78% of LHDs provide food service establishment inspections and 72% of LHDs provide food safety education in their jurisdictions.

September marks the 20th anniversary of National Food Safety Month (NFSM), an initiative by the National Restaurant Association designed to heighten the importance of food safety education. Each week highlights a different food safety issue—such as cleaning and sanitizing, cross-contamination, and personal hygiene—with educational activities and posters. Visit the NFSM website for more information.

NACCHO and its public health partners have also developed a variety of resources to help LHDs provide food safety services.

The Centers for Disease Control and Prevention (CDC) has released two eLearning tools to assist LHDs in their food safety work. Environmental Assessment of Foodborne Illness Outbreaks is a free interactive course that teaches participants how to (1) investigate foodborne illness outbreaks as part of a larger team; (2) identify the environmental causes of an outbreak; and (3) recommend control measures.

The second CDC tool is the National Voluntary Environmental Assessment Information System, which fosters information-sharing between LHDs to improve response to, and prevention of, future outbreaks. CDC encourages LHDs to register and provide data about their foodborne illness investigations.

NACCHO works with the Food and Drug Administration (FDA) to increase the use of the FDA Voluntary National Retail Food Regulatory Program Standards (Retail Program Standards), a continuous quality improvement and quality assurance program that helps LHDs achieve optimal performance in food safety programs, services, and processes. NACCHO’s Retail Program Standards mentorship program partners LHDs together to implement the Retail Program Standards. Participating LHDs benefit from the experience of other LHDs in best applying the Retail Program Standards to their food protection programs. NACCHO has also collaborated with FDA to develop a crosswalk that outlines the areas of alignment between the Retail Program Standards and the Public Health Accreditation Board’s Standards and Measures.

NACCHO co-chairs the Council to Improve Foodborne Outbreak Response (CIFOR), a multidisciplinary working group that aims to reduce the burden of foodborne illness. The council publishes the CIFOR Guidelines for Foodborne Disease Outbreak Response, which guides LHDs on how to prepare for, detect, investigate, and control a foodborne illness outbreak. Find additional CIFOR resources.

NACCHO also works closely with LHDs through its Food Safety Workgroup and the Food Safety Toolkit. NACCHO staff participate in national initiatives including the Partnership for Food Protection, the National School Safety Coalition, the Food Safety Modernization Act Working Group, and Government Coordinating Council Food and Agriculture Sector.

NACCHO, in collaboration with the National Center for Environmental Health at CDC, selected 12 LHDs to implement innovative programs in food safety within their health departments and communities. The projects focused on infrastructure, marketing, training, and program assessment. Read the report.

For more information, visit NACCHO’s food safety webpage.

Public Health Preparedness in the 21st Century: Local Health Departments’ Role in Global Health Security

September is National Preparedness Month. Visit NACCHO’s Preparedness Brief blog for more local public health preparedness news, tools, and resources.

By Laura Biesiadecki, Director of Strategic Partnerships, Outreach, and Education, Preparedness, NACCHO

“Our vision is a world safe and secure from global health threats posed by infectious diseases—where we can prevent or mitigate the impact of naturally occurring outbreaks and intentional or accidental releases of dangerous pathogens, rapidly detect and transparently report outbreaks when they occur, and employ an interconnected global network that can respond effectively to limit the spread of infectious disease outbreaks in humans and animals, mitigate human suffering and the loss of human life, and reduce economic impact.” –United States Government’s Global Health Security Vision [1]

global-prep-1In February 2014, the United States joined 28 other countries, the World Health Organization, the Food and Agriculture Organization, and the World Organization for Animal Health to commit to goals specified within the Global Health Security Agenda, which contains a vision statement and nine objectives. As part of this commitment, the United States has developed the United States Global Health Security Strategy and pledged to work with at least 30 partner countries to prevent, detect, and effectively respond to infectious disease threats, whether naturally occurring or caused by accidental or intentional releases of dangerous pathogens, over the next five years. The President’s 2015 budget has proposed an additional $45 million to prevent avoidable catastrophes, detect threats early, and mobilize effective responses to contain outbreaks. The funds would also allow for programs to enhance workforce capacity by training field epidemiologists, developing new diagnostic tests, building capacities to detect new pathogens, and building public health emergency management capacity to support outbreak responses.[2] How implementing the Global Health Security Strategy will impact programming and funding for infectious disease preparedness over the next five years at the state and local levels remains to be seen.

In May 2014, Dr. Thomas Frieden, Director of the Centers for Disease Control and Prevention (CDC), participated in the first Global Health Security Commitment Development Meeting in Helsinki, Finland, which was attended by 200 experts from 20 countries. The meeting marked an important opportunity for other countries to commit to accelerating global health security. Fewer than 20 percent of countries report that they are adequately prepared to effectively detect, respond to, or prevent global health threats caused by emerging diseases.[3] To address this issue, the CDC is combining resources and expertise with the Defense Threat Reduction Agency of the Department of Defense (DOD) to support demonstration projects in developing countries. In 2013, the CDC worked successfully with the Uganda Ministry of Health to implement upgrades in three areas: (1) strengthening the public health laboratory system by increasing the capacity of diagnostic and specimen referral networks; (2) enhancing the existing communications and information systems for outbreak response; and (3) developing a public health emergency operations center. In 2014, the CDC and DOD will commit $40 million to expand the list of demonstration site countries to include Ethiopia, Georgia, India, Jordan, Kazakhstan, Kenya, Philippines, South Africa, Tanzania, and Thailand.[4]

Over the past 12 years, catastrophic events such as 9/11, Hurricane Katrina, and the H1N1 influenza outbreak have led to large infusions of federal funding to state and local governments. However, such funding has been spent historically on disaster relief,[5] and funds are traditionally allocated categorically in response to events rather than sustained and directed to maintaining readiness. During the response and recovery phases of events, local health departments (LHDs) will increase programs and workforce but will eventually have to reduce staff and programming as funds are reduced. This cyclical response focused funding cycle creates inefficiencies and challenges in all levels of government and costs more than if the investment had been made in preparedness activities up front, leaving communities scrambling to respond to the next event.[6]

With public health preparedness funding and jobs shrinking, communities are vulnerable to emerging threats. From FY2012 to FY2013, the Department of Health and Human Services (HHS) cut $35 million from Public Health Emergency Preparedness funding and $20 million from the Hospital Preparedness Program.[7, 8] In January of FY2015, President Obama signed into law a federal spending bill that included a cut of over $100 million to the HHS Hospital Preparedness Program. That equals nearly a 30-percent reduction in a program specifically aimed at strengthening healthcare preparedness for public health emergencies. These cuts could have severe and dire consequences on the ability of communities to respond when disaster strikes. As indicated in the National Association of County and City Health Officials’ 2010 National Profile of Local Health Departments (Profile) report, 59 percent of LHDs relied solely on federal funding for public health preparedness. The 2013 Profile report shows that 23 percent of LHDs reduced or eliminated at least one emergency preparedness program in 2011, and the trend continued in 2012 with a 15-percent reduction.

As funding concerns persist, LHDs’ responsibility to remain vigilant to threats remains constant. Not only must LHDs be watchful of global health infectious disease threats, they must also acknowledge and plan for emerging threats both natural and manmade. Two examples of emerging threats related to global health security that may involve LHDs are cyber attacks on healthcare facilities and health threats that result from climate change.

Cyber Attacks

global-prep-2A cyber attack on a healthcare facility could disrupt the facility’s capacity to manage patients, prevent the facility from managing routine care, and impede the facility from handling patient surge during catastrophic events. Cyber attacks could result in identity theft or loss of patient information should personal data be exposed. Patients and practitioners might lose confidence in a healthcare provider’s ability to maintain patient privacy. System outages might disrupt care.[9]

Current policy falls short of protecting the health sector from cyber threats. To foster the improvements of the healthcare delivery system, federal guidance to state and local health departments has promoted the adoption of technology in healthcare facilities. From the executive level, President Obama issued Presidential Policy Directive (PPD) 21 and Executive Order (EO) 13636: Improving Critical Infrastructure Cybersecurity, emphasizing the need for holistic thinking about critical infrastructure security and risk management. Those directives and executive orders will drive action toward critical infrastructure systems—including healthcare—to improve network security. Additionally, those policies will help promote and incentivize the adoption of cyber security practices, increase cyber threat information-sharing, evaluate and mature public-private partnerships, and demonstrate the cascading consequences of infrastructure failures. With the release of PPD 21 and EO 13636 and their subsequent implementation, federal agencies responsible for managing preparedness funds should prioritize improving security of healthcare information systems, strengthening public-private partnerships vital to healthcare cyber security and resiliency, and adopting standards and frameworks for information-sharing and security.

Climate Change-Related Health Threats

global-prep-3The health threats that result from climate change will be inherently local, and LHDs may be best equipped to protect their communities from these threats. Such threats may include extreme weather events, wildfires, decreased air quality, threats to mental health, and illnesses transmitted by food, water, and disease carriers such as mosquitoes and ticks.[10] LHDs play an important role in preventing and preparing for the impacts of climate change. LHDs inform local policy and implement strategies to face the illnesses and potential deaths related to environmental exposure as a result of increased severe weather events, drought, and temperatures associated with climate change. The health impacts of climate change will vary community by community. LHDs can help forecast the health impacts in a region, county, or city and help community organizations, healthcare providers, and other stakeholders work to prevent the impacts of climate change and prepare for and address the impacts already occurring.

Cybersecurity and environment and global climate change are just two examples of evolving issues of concern for global and domestic health security. During the 2015 Preparedness Summit on April 14–17, preparedness professionals from across the nation and globe will meet in Atlanta to discuss the evolving vision for global health security and emerging issues that threaten community safety.

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

House Minority Whip Hoyer Visits Calvert County Health Department

By Laurence Polsky, MD, MPH, FACOG, Health Officer, Calvert County (MD) Health Department

On Aug. 25, House Minority Whip Steny Hoyer (D-MD) and several of his staff joined health officers Meena Brewster (St. Mary’s County, MD), Dianna Abney (Charles County, MD), and me at the Calvert County Health Department. For an hour and a half, we discussed issues affecting public health in our southern Maryland communities. Congressman Hoyer is second in the Democratic leadership in the House of Representatives, behind House Minority Leader Nancy Pelosi (D-CA).

We talked to Congressman Hoyer about the challenges local health departments face in light of post-recession and sequester budget cuts, how local health departments are adjusting to the Affordable Care Act (ACA), and actions we have taken to help stem opiate addiction in his district.

Dr. Abney spoke about difficulties providing accessible healthcare to underserved areas of Charles County and the work her department is doing to help these residents. Dr. Brewster spoke about the 10 essential services of public health and how budget issues and the loss of the Community Transformation Grant have impacted her health department. All three of us also discussed our concern that budget cuts have diminished our disaster response capabilities.

Calvert County has struggled with a 50% increase in transportation costs for Medicaid enrollees since the launch of the ACA. This served as an entry point to talk about the unforeseen sequelae of the new healthcare law and the strain it puts on safety net providers.

We ended on a bright note, underscoring the unique position that local health departments play in community health. In response to the impact that substance abuse has had on our region and the resource limitations we have in our rural jurisdiction, Calvert County Health Department has launched a program aimed at pregnant woman struggling with addiction. Our Healthy Beginnings program illustrates the potential for a local health department to bring together traditionally isolated private and public resources. In coordination with local obstetricians, the program brings together substance abuse and mental health counseling; social services; the Special Supplemental Nutrition Program for Women, Infants, and Children program; smoking cessation classes; expanded transportation help; coordination with prenatal care; enrollment in ACA plans; and case management all under one roof.

We are indebted to NACCHO’s Government Affairs staff for helping to arrange the visit by Congressman Hoyer as part of an effort to educate Members of Congress about the health challenges faced by local health departments as we try to improve the health and safety of our residents.

I encourage all my colleagues at local health departments to pursue opportunities to invite Members of Congress and their staff to visit you and learn about what you do. This was an invaluable opportunity to raise our visibility and make sure that when decisions are made in Washington, our elected representative has a picture of how those decisions will affect our community.

NACCHO has resources to help you and make it easy to navigate setting up a visit. Learn more in NACCHO’s Legislative Action Center or contact Eli Briggs, NACCHO’s Government Affairs Director.

Chicago Health Commissioner Describes How Community Engagement Helped Advance Rigorous Tobacco Control Policies

cigarette1Interview by Ian Goldstein, Web and New Media Specialist, NACCHO

NACCHO honored the exceptional achievements of local health departments (LHDs) and local health officials at the 2014 NACCHO Annual Conference, held July 8–10 in Atlanta. NACCHO’s LHD of the Year Award recognizes and honors outstanding accomplishment of LHDs across the country for their innovation, creativity, and impact on communities. The following winners were categorized by size of jurisdiction and recognized for accomplishments in outstanding internal and external policy: Small Jurisdiction: Macon County Public Health Center (Franklin, NC); Medium Jurisdiction: Whatcom County Health Department (Bellingham, WA); and Large Jurisdiction: Chicago Department of Public Health (Chicago, IL).

The following is an excerpt from a recent NACCHO podcast featuring an interview with Chicago Department of Public Health Commissioner Dr. Bechara Choucair, who spoke about his health department’s winning tobacco control policies.


NACCHO: What made you and your colleagues decide to apply for the LHD of the Year Award?

Choucair: Well, this past year has been a remarkable time for the Chicago Department of Public Health in tobacco control for the City of Chicago and together with all of our partners. Because of all of the work that has happened over the last year, we wanted to share the work that we’ve done with other health departments and we’re really honored and humbled to receive the Local Health Department of the Year Award.

NACCHO: Your LHD was able to implement a number of tobacco control policies. 

Choucair: A lot of tobacco policies that we’ve advanced this year in Chicago have been really cutting-edge work. In November, for example, we passed a new tobacco tax. Now we have the highest combined local, state, and federal tobacco tax in the nation and we know this is a life-saving measure. Today,  every pack of cigarettes in Chicago is taxed $7.17 in combined taxes. [The most recent measure] added 50 cents.

We’ve also passed a flavored tobacco ordinance that […] restricts the sale of tobacco including menthol within 500 feet of schools, which makes us the first and only jurisdiction in the country to restrict the sale of menthol cigarettes around schools. Also, just recently we passed an ordinance that regulates e-cigarettes just like regular tobacco products, which also makes us one of the very first big cities in the country to advance that type of ordinance.

NACCHO: What were the challenges to implementing these policies, especially with something like menthol cigarettes, which have been around for so long?

Choucair: Mayor Emmanuel asked us to engage the community in trying to identify what we could do about menthol cigarettes. What the board of health in Chicago did was host a series of town hall meetings to engage the community to see what kind of policy suggestions or intervention suggestions they had to address menthol cigarettes.

We know that menthol cigarettes are proven “starter products” for youth. We know that over 70% of black kids who smoke smoke menthol cigarettes. We know that over 70% of LGBT youth who smoke smoke menthol cigarettes. Over half of Hispanic kids who smoke smoke menthol cigarettes. Honestly, Big Tobacco is targeting our minority communities with menthol cigarettes with specific marketing and by lowering prices in African-American communities to get people addicted to this deadly product.

So by engaging the community, by engaging an amazing group of partners in Chicago and nationally, including the African-American Tobacco Control Leadership Council,  we were able to advance this ordinance that restricts the sale of flavored tobacco, including menthol cigarettes, within 500 feet of schools.


Listen to the rest of the interview with Dr. Choucair about his community’s response to the ordinance and his advice to other LHDs that are looking to implement similar policies (start at the 3:55 mark) at

Interested in listening to more of NACCHO’s podcasts? NACCHO’s podcast series is now available for subscription on iTunes. If you have iTunes or an iPhone, download the podcast app and search “NACCHO.” Once you subscribe, the latest NACCHO Podcasts will automatically download to your phone. You can also subscribe with the following link: