On the Front Lines of the Opioid Epidemic

By Kevin G. Sumner, MPH, NACCHO President and Health Officer and Director of the Middle-Brook Regional Health Commission in Green Brook, New Jersey

The opioid epidemic has claimed thousands of lives and engulfed entire communities, yet often feels too monumental to be seen as anything other than relentless and unending. But with as many harrowing stories that we have read and heard in regards to this profound public health crisis, there are also glimpses of hope: what’s working, the moderately sized successes that might work on a larger scale, and what adequately funded interventions look like.

According to the Centers for Disease Control and Prevention’s 2018 report, Morbidity and Mortality Weekly Report (MMWR), 47,600 Americans died because of opioid-related overdoses in 2017—far outpacing the mortalities associated with car crashes in 2017 and those of the peak years of the AIDS epidemic. Opioid misuse was declared a national public health emergency in October 2017, and the National Association of County and City Health Officials (NACCHO) affirms that local health departments (LHDs) play a critical role in responding to opioid misuse and overdose within their own communities.

Our LHDs are well-suited to serve as conveners or supporters of coalitions and partnerships. In the way that Public Health 3.0 points to partnerships as a key toward advancing a local public health department’s work, we know that collaboration at the local level is essential in addressing the multifaceted nature of the opioid epidemic. The coordination of federal, state, and local partners, along with the engagement of community agencies and organizations, is critical in implementing strategies to prevent and respond to opioid misuse and overdose.

Opioid use looks different across jurisdictions and communities. During a crisis, communities often focus on the biggest threat at hand: while some struggle to control prescription opioids, others may be battling an illicit supply of synthetic opioids. The economics, demographics, and cultural characteristics of a community shape its particular landscape of drug use; therefore, the community’s interventions for both prevention and response need to be appropriately local in considering resources and systems. As critical as a nationwide response is, specificity is needed for relevant and effective activities at the local level.

In New Jersey, we clearly see the diversity of issues and approaches. In some areas of the state, we have LHDs leading or collaborating with community partners to conduct routine, robust fatality reviews to identify the roots causes of problems and possible solutions. In other areas, local health has had little-to-no involvement and is just now finding their way toward a seat at the table. As such, we have noted the disparities across the state.

As a result, the New Jersey Association of County and City Health Officials, is currently in the process of conducting a statewide assessment to identify both gaps in knowledge and resources as well as what resources are available in our communities and for our local health departments. We will be revealing the results of this assessment at a statewide meeting in August, which will provide our LHDs with tools to advance their efforts and knowledge to better advocate for the needed resources.

LHDs are often at the forefront of conducting monitoring and surveillance activities, or supporting the implementation of prescription drug monitoring programs in collaboration with other agencies. By tapping into their role as educators and prevention experts, they can develop programs to raise awareness about the risks of overdose, educate the public and key stakeholders about drug use and harm reduction, and implement programs. Stigma around drug use remains prominent in communities across the nation, and many LHDs conduct activities to better understand, address, and reverse stigma, with the goal of improving outcomes for people who use drugs or seek treatment.

To support individuals living with OUD, LHDs can also develop treatment options, such as medication-assisted treatment, and can improve community linkages to care for OUD treatment, as well as for other physical and mental health services related to opioid use. They are also well-suited, with adequate funding, to support active drug use communities and to develop and enhance support systems for individuals engaging in treatment.

How Can We Support LHD Efforts?

Despite their critical role, LHDs are under-resourced to give the epidemic proper attention and often lack dedicated funding for opioid activities. The lack of dedicated funding for LHD opioid efforts is a feature of continued, across-the-board budget cuts to local public health. To mitigate the substantial threats of the opioid epidemic, an investment of sufficient and stable funding is essential if LHDs are to bolster their work-force and address the dynamic health needs of their communities.

A potential solution to support increased, sustainable funding streams for LHDs engaging in this type of work is a model based on the Ryan White funding structure for HIV/AIDS. Legislation based on this model, the “Comprehensive Addiction Resources Emergency Act,” has been proposed but has yet to be approved out of the Senate HELP Committee and brought to the floor for a vote. By ensuring sustainable and adequate funding, this type of legislation could support long-term, comprehensive programs and enhance workforce capacity.

There will always be another crisis, and the lessons learned from a variety of domestic drug use epidemics tell us that when we fail to prepare, we fail far too many. Instead of reactionary responses to each new public health emergency, LHDs have a unique opportunity to harness the national conversation around opioids to push for structural improvements in our official response to drug use of all kinds.

For NACCHO resources on the opioid epidemic, visit NACCHO’s Opioid Epidemic webpage.

Big Data Offers Big Insights into Links Between Environment, Heart Health

By Dr. Cavin Ward-Caviness, Principal Investigator (Computational Biologist), U.S. Environmental Protection Agency, ORD, NHEERL, EPHD, CRB

This post originally appeared on the EPA blog.

Air Quality Awareness Week, April 29–May 3, is a perfect time to think about how far we have come in understanding how air pollution affects the cardiovascular system. As a U.S. Environmental Protection Agency (EPA) scientist studying heart disease, I am very excited about current and future research in this area. Though the burden of heart disease on our society remains high (see the American Heart Association 2018 Statistics on Heart Disease and Stroke), we have only to look at the promising lines of current, cutting-edge research to find reasons to be optimistic about the progress we are making in our understanding and treatment of heart disease. Continue reading

NACCHO Annual 2019: Interim Health Officer Nasseam McPherson James Gives an Inside Look into the Florida Department of Health in Orange County

Interview by Taylarr Lopez, Communications Specialist

Nasseam McPherson James, MBA, MSW, is the Interim Health Officer for the Florida Department of Health in Orange County (FL DOH). In the following post, she discusses her role within the department, shares how FL DOH in Orange County is addressing infant mortality and decreasing new HIV infection rates, and highlights ways in which other local health departments can prepare themselves to address public health challenges for decades to come. Continue reading

Local Public Health Confronting Climate Change in Communities

By Kevin G. Sumner, MPH, NACCHO President and Health Officer and Director of the Middle-Brook Regional Health Commission in Green Brook, New Jersey

The effects of climate change are visible in communities across the country, from increasingly severe storms (e.g., the recent “bomb cyclone” in the Plains and Midwest) to more frequent wildfires, record-breaking floods, and prolonged heat waves. These extreme weather events and corresponding changes to the ecosystem threaten the public’s health.

As traditionally cooler regions experience warmer and longer summers, for example, mosquitoes and other vectors are migrating north and infecting populations previously not at risk. According to the Lancet Countdown on Health and Climate Change, vector-borne diseases transmitted by mosquitoes, ticks, and fleas, including Lyme disease and West Nile virus, tripled from 2004 to 2016. Continue reading

NACCHO CEO Releases Statement on Ongoing Measles Outbreaks

By Lori Tremmel Freeman, NACCHO CEO

“Yesterday, the Centers for Disease Control and Prevention confirmed there have been 626 individual cases of measles diagnosed across 22 states in the United States since the first of this year. We are on track to have the highest number of measles cases in the United States in 25 years, and for man this disease of the past is becoming a threat of the present.

“626 cases are far too many. These cases are not just numbers—they represent sick children, missed days of work, and an incredible financial strain on our tax dollars that must be pulled away from other public health priorities. Continue reading

NACCHO Highlights Need for Greater Support for Local Health Departments to Combat Rise in STDs

STD Awareness Month is an opportunity to raise awareness about Sexually Transmitted Diseases (STDs), also referred to as Sexually Transmitted Infections (STIs), with local health departments and with local and national policymakers, stakeholders, and the public. The National Association of County and City Health Officials (NACCHO), the voice of the nation’s nearly 3,000 local health departments is working diligently to support their members’ work to address rising STD rates across the country and to implement innovative projects, such as its Express STI Visits Initiative, to provide new ways to link individuals to testing and treatment.

“Local health departments work hard every day to reduce STD rates and improve health outcomes in their communities by testing for, treating, and ultimately, preventing STDs. This includes strong prevention and treatment messaging, as well as the essential work of disease intervention specialists (DIS) who are on the frontlines of efforts to disrupt the spread of STDs and prevent outbreaks,” said NACCHO Chief Executive Officer Lori Tremmel Freeman. “But as NACCHO’s research shows, they need more support—stagnant or decreasing resources are not enough, and local health departments and their partners need more resources to address these rapidly rising STD rates.”

While STD rates are quickly increasing, federal, state, and local resources have stayed the same or decreased, leaving public health systems strained, including local health departments. In 2017, NACCHO queried its HIV, STI, and Viral Hepatitis Sentinel Network and found that nearly one-third of local health departments reported anticipating budget cuts in the next fiscal year and the majority experiencing stagnant funding for STD programs at best.

As the latest Centers for Disease Control and Prevention (CDC) STD Surveillance Report shows, STD rates increased for the fourth consecutive year in 2017, and there has been a steep, sustained increases in the incidence of all three reportable STDs.

Gonorrhea diagnoses increased by almost 70% percent overall and nearly doubled among men. Increases in diagnoses among women — and the speed with which they are increasing — are also concerning, with cases going up for the third year in a row.

Primary and secondary syphilis diagnoses increased 76%. Congenital syphilis (transmitted from the pregnant person to the fetus) cases rose sharply with 918 cases in 2017, a number that has more than doubled since 2013. This included 64 reported stillbirths as a result of congenital syphilis (up from 41 in 2016).

Chlamydia remained the most common condition reported to CDC. More than 1.7 million cases were diagnosed in 2017, with 45% of cases among 15- to 24-year-old females. The preliminary data for 2018 sadly shows these trends continuing and a new CDC analysis suggests that gay and bisexual men are at higher risk for extragenital STDs (e.g. chlamydia or gonorrhea in the throat or rectum), which increases treatment difficulty, drug resistance, and the risk of HIV infection. While these STDs are treatable, if untreated, they can cause serious health consequences such as pelvic inflammatory disease, infertility, and stillbirth.

Throughout STD Awareness Month, NACCHO is highlighting each of CDC’s four STD Awareness campaigns: Syphilis Strikes Back, GYT: Get Yourself Tested, Treat Me Right, and Talk. Test. Treat. New blog posts are available each Thursday of April and will feature work that local health departments and NACCHO are doing around the country to address STDs.

For more information, read about our STD work and check out our STD policy statement.

Using Data to Improve Local Public Health Practice

By Kevin G. Sumner, MPH, NACCHO President and Health Officer and Director of the Middle-Brook Regional Health Commission in Green Brook, New Jersey

Data and research help us to understand our world and make informed decisions. As local health officials, data allow us to measure progress over time, identify emerging trends, and understand how our jurisdictions compare to others in a variety of different ways. Data inform much of our community health improvement planning; they lend credibility to our policy positions and support our funding requests. They also provide a common language as we work with our partners across sectors to address the social determinants of health, helping us to communicate and form a shared understanding of the issues we face. Continue reading