Foreword: Exploring the Public Health and Healthcare Connection to Advance Population Health

By E. Oscar Alleyne, DrPH, MPH, Senior Advisor for Public Health Programs, NACCHO

The following is an excerpt from the winter issue of NACCHO Exchange.


Historically, America’s public health and healthcare systems have worked in isolation from one another. But as our nation continues to face complex and cross-cutting threats to population health, it is more important than ever to identify and advance the connection between public health and healthcare. Recently, public health has witnessed several benefits from bridging the two sectors. The Patient Protection and Affordable Care Act, enacted by the U.S. Congress in 2010, marked the greatest revolution in U.S. health policy since the 1960s. The law established the first National Prevention Strategy,1 added new funding for prevention and public health programs, promoted the use of clinical preventive services and other measures, and provided the impetus for greater collaboration across the health system. In fact, since the release of the Institute of Medicine’s 2012 report, Primary Care and Public Health: Exploring Integration to Improve Population Health, there has been an uptick in initiatives that support the creation of linkages across public health and healthcare to address national health priorities.

In 2013, the Centers for Disease Control and Prevention (CDC) launched the Primary Care and Public Health Initiative to integrate population health into medical residency program curricula and competencies; increase clinician understanding of public health problems and national initiatives offering potential solutions; and increase clinician awareness and use of CDC resources. Three years later, the de Beaumont Foundation, in partnership with CDC and Duke University Community & Family Medicine, developed the Practical Playbook: Public Health and Primary Care Together to advance collaboration between public health and primary care. The Practical Playbook aims to improve population health by providing practical implementation tools, guidance, and resources.3 NACCHO began exploring this issue at its 2017 annual conference, themed “Public Health Revolution: Bridging Clinical Medicine and Population Health.” The conference highlighted successes and challenges related to linking public health and clinical medicine; managing systems that measure health and healthcare outcomes; and advancing population health. Through these discussions, one thing became very clear: in order to bridge the gap between healthcare and public health, there must be strong local level involvement.

Improving Population Health at the Local Level

While ‘population health’ is a term that could mean slightly different things depending on who you ask, the broad definition is “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”4 While these outcomes are partially influenced by genetics and individual behaviors, they are also a result of the social determinants of health, which include economic stability, education, social and community context, health and healthcare, and neighborhood and built environment. Social determinants reflect the conditions of the environments in which people are born, live, learn, work, play, worship, and age, and they affect a wide range of health, functioning, and quality-of-life outcomes and risks.5 Being the boots-on-the-ground, local health departments (LHDs) are well-positioned to address the social determinants that impact health in their communities, thereby improving health outcomes and, consequently, population health. In particular, with more departments adopting the role of Community Health Strategist,6 an increasing number of local public health leaders are spearheading efforts to:

  • Interpret data and diagnose the implications on a community scale;
  • Illuminate health inequities and encourage social justice;
  • Partner with non-health sectors working toward a culture of health;
  • Broaden local policymakers’ understanding of health inequities and health outcomes;
  • Convene and support community organizations; and,
  • Identify evidence-based strategies for improving population health.

Through these efforts, LHDs are demonstrating a commitment to be more nimble and viable, while embracing comprehensive strategies for delivering care to their communities. For example, more than half of local public health agencies (61%) encourage primary care providers to use evidence-based public health services, such as interventions to reduce asthma triggers in children’s home environments.7 But despite their desire to explore new ways to collaborate with healthcare entities, challenges still exist. In particular, funding for partnership activities and competing priorities are a major roadblock to developing these partnerships.8 Still, in the face of increasingly complex health challenges, LHDs are finding ways to adapt to the changing public health system and continue to increase their involvement in multi-sectoral partnerships on issues disproportionately affecting their communities.

Read more in the winter issue of NACCHO Exchange.


  1. Office of the U.S. Surgeon General. National prevention strategy. Retrieved from
  1. Centers for Disease Control and Prevention. (2016). Primary care and public health initiative. Retrieved from
  1. de Beaumont Foundation. (2016). Practical playbook: Public health and primary care together. Retrieved from
  1. Kindig, D. and Stoddart, G. (2003). What is population health? American Journal of Public Health, 93(3), 380-383. Retrieved from articles/PMC1447747/
  1. Healthy People 2020. (2010). Social determinants of health. Retrieved from
  1. National Association of County and City Health Officials. (2016). Public Health 3.0 issue brief. Retrieved from
  1. National Association of County and City Health Officials. (2015). 2015 forces of change survey. Retrieved from
  1. National Association of County and City Health Officials. (2017). 2017 forces of change survey. Retrieved from

SAMHSA’s National Prevention Week: Action Today, Healthier Tomorrow

May 13–19, 2018, is the Substance Abuse and Mental Health Service Administration’s (SAMHSA) National Prevention Week. NACCHO encourages local health departments (LHDs) to engage their communities in promoting mental health and substance abuse prevention efforts throughout this week. The theme this year is “Action Today, Healthier Tomorrow!”

Daily Themes

  • Monday, May 14: Promotion of Mental Health & Wellness
  • Tuesday, May 15: Prevention of Underage Drinking & Alcohol Misuse
  • Wednesday, May 16: Prevention of Prescription & Opioid Drug Misuse
  • Thursday, May 17: Prevention of Illicit Drug Use & Youth Marijuana
  • Friday, May 18: Prevention of Suicide
  • Saturday, May 19: Prevention of Youth Tobacco Use

Continue reading

Three Ways Local Health Departments Can Commemorate Mental Health Month

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston, Texas

May is Mental Health Month, a time for local health department (LHD) leaders and staff to bring awareness to mental health issues and help reduce the stigma associated with mental illness. Led by Mental Health America and the National Alliance on Mental Illness (NAMI), this month provides an important opportunity to reflect on the ways in which local public health agencies can support the mental health of our communities.

Mental health issues affect wide ranges of the populations we serve as LHD leaders and staff. According to the Substance Abuse and Mental Health Services Administration’s 2014 National Survey on Drug Use and Health, an estimated 44 million American adults, (nearly one in five adults) experienced some form of mental illness. Mental health disorders can include anxiety; attention deficit hyperactivity; bipolar disorder; depression; disruptive, impulse control, and conduct disorders; obsessive-compulsive disorder; schizophrenia and other psychotic disorders; and trauma- and stressor-related disorders. Continue reading

The National Board of Public Health Examiners Celebrates its 10th Anniversary

Interview by Taylarr Lopez, Communications Specialist, NACCHO

The National Board of Public Health Examiners (NBPHE) ensures public health professionals have the knowledge and skills relevant to the core areas of public health by administering a voluntary certification examination. Candidates who successfully pass the examination receive a Certification in Public Health (CPH), which demonstrates to employers that they have mastered key contemporary public health sciences. Now in its tenth year, NBPHE’s certification exam and resources are more relevant to the public health workforce than ever. Below, Allison Foster, MBA, CAE, President of the NBPHE, describes the benefits of being certified and highlights the resources candidates can use to help achieve certification. Continue reading

Taking Action to Address the Public Health Impact of Wildfire Smoke

By Alan Vette, Acting Director, Air and Energy National Research Program (ORD), United States Environmental Protection Agency (EPA) and Erika Sasser, Director, Health and Environmental Impacts Division (OAQPS), EPA

This story originally ran in NACCHO’s Essential Elements blog.

During Air Quality Awareness Week (April 30 – May 4), a focus on wildfire smoke is timely for public health because the 2018 wildfire season is about to begin for most of the U.S., and it has already started in some areas.

Exposure to wildfire smoke is a community health issue that has gained the attention of public health professionals and organizations, especially in states where fires are becoming more frequent and intense. Wildfire smoke has significant health implications for those near the fire as well as for those living farther downwind. Continue reading

Member Spotlight: Health Director Joey Smith Highlights His Department’s Role as a “Choice Architect” and Describes His Hopes of Helping His Community Live One Million Years Longer

Interview by Taylarr Lopez, Communications Specialist, NACCHO

NACCHO’s Member Spotlight series features interviews with local health department leaders and staff about their careers in public health. This interview features Joey Smith, Health Director of the Montgomery County Health Department in Tennessee and NACCHO Board Member. Below he shares how his health department is bridging the gap to healthcare by providing primary care services and highlights the success of the department’s Healthier Streets & Neighborhoods program. Continue reading

Dakota County Public Health Builds on Breastfeeding Program to Create Rapid Referral System

By Harumi Reis-Reilly, MS, LDN, CHES, IBCLC, Lead Program Analyst, NACCHO, and Katie Galloway, MBA, RD, LD, IBCLC, Dakota County WIC Program

Dakota County Public Health Department (DCPHD) in Minnesota, a 2017 NACCHO Model Practice awardee, built upon their comprehensive breastfeeding program and implemented a rapid referral system to expand access to critical lactation care to low-income families. Through the Reducing Breastfeeding Disparities through Peer and Professional Support grant, DCPHD increased participation by 68% in prenatal breastfeeding classes and more than doubled their rapid-response lactation visits. Continue reading