NACCHO Annual Preview: Targeting Neighborhood Poverty, Education, and Health Burden through Policy and Prevention

logo_na2016_pms274This is the second in a series of NACCHO Annual preview posts, which feature interviews with and essays from presenters in advance of NACCHO Annual 2016. In this post, Gary Cox, JD, shares insights from his session, “Targeting Neighborhood Poverty, Education, and Health Burden through Local Public Health Policy and Prevention across Oklahoma County.” Cox brings more than 35 years of public health experience and leadership skills to his role as executive director of the Oklahoma City-County Health Department. He is a past president of both NACCHO and the Oklahoma Public Health Association. Below Cox shares his advice for LHDs pursuing health equity and his experience forging partnerships with local entities committed to improving community health.

NACCHO: You open your presentation with the idea that health outcomes are influenced by complex social and physical indicators. How do you address this reality in your health department’s pursuit of a culture of health equity?

Gary Cox: We have a basic philosophy as a local health department that we should analyze data and look at where we have inequities and disparities in our community. We have what we call a wellness score: It is about 22 data points, ranging from educational attainment and graduation rates to crime rates, mortality/morbidity rates, hospital room visits, hospital discharge data, and so on. It comes from a very wide variety of sources gathered together to create a cumulative comparative index, zip code by zip code, of our county.

We analyze that data every three years—in the future it will be more often—and we make our strategic plan around those areas where we do not have health equity and put a disproportionate amount of resources in those zip codes. The system has been in place for about five years so far.

NACCHO: The Oklahoma City-County Health Department currently boasts over 300 community partnerships. When did the initiative start and what was the catalyst for developing it?

GC: I came to the Oklahoma City-County Health Department in October 2009. In April 2010, as we were doing our strategic planning, we realized we were not going to be able to impact health outcomes unless we had a real coalition committed to improving health. We recruited our mayor and our Board of County Commissioners to co-chair the coalition that we call Wellness Now. It has developed to include over 350 different partners, and they are organized around a half-dozen different focus areas to improve health. Basically, what they do is they look at the data, they see where the issues and problems are, and they set goals and prioritize them. And it all revolves around the objective of improving health. It could be anything from adolescent health to tobacco to obesity to behavioral and mental health.

NACCHO: Can you share some examples of improved health outcomes attributable specifically to these partnerships?

GC: We initially didn’t have an adolescent health work group, and we had members of the community come to us and say, “We’d like to do something about teen pregnancy prevention.” We said we would take the issue to the coalition and see whether this was a priority; and so we did and the group made their presentation to the coalition and the coalition started a work group as a result. Actually, the people leading [the work group] were from a private philanthropic foundation here. So this group got together and began meeting, and they asked the health department to apply for a federal grant for teen pregnancy prevention. As the fiduciary grantee, the health department received a $6 million, five-year grant; as a result of our first year of efforts, our teen pregnancy rates dropped over 15%.

We also have several examples of innovative partnerships between unconventional partners. For instance, we partnered with two hospital systems and we put bilingual community health workers in each of their emergency rooms to work with high-risk or frequent users of the emergency department. As a result of the partnership between the hospitals and the health department and the referral to community resources—so that there are other partners involved, too—we reduced emergency department visits of that high-risk group from 20 to 40% in one year’s time. Of course, this resulted in a significant savings for the hospitals and our hospital partners are excited about expanding the program.

NACCHO: What advice would you give to other LHDs interested in creating such a network of partnerships for themselves?

GC: I think LHDs have to have a vision and they need to communicate that vision to the public, explaining the urgency of health and why it’s important to put improving health at the top of the list. Pick out those issues where you are really going to have to work together with your community partners to improve outcomes.

Secondly, it takes staff that are dedicated only to that coalition. You have to really put some resources behind it. We have dedicated staff not only for the coalition but also in each one of the work groups to feed them the data and give the work group members advice and evidence-based community interventions that they may want to consider.

I think the other thing I would recommend is bringing in partners. It’s just critical to reach out and bring others into the coalition and continue to grow that effort, because it’s the partners that are going to really implement the community interventions. It’s more than just a local health department can do alone. Also: Ensure the coalition has a propensity to act; don’t just meet. So many of these coalitions revolve around meetings, which are great, but nothing ever happens.

Lastly, put evidence-based interventions into play and then evaluate that effort to make sure that you’re making progress.

NACCHO: One last question: why do you attend NACCHO Annual?

GC: I was on the NACCHO Board for 10 years and have been going for 25 years, probably. The reason I go is to get new ideas. You can share the successes and failures you’ve had and learn from others as well. It’s an opportunity to network and to interact with your colleagues and both share and gain information.

You can also hear from the top leaders and just build that network base so that if you have an issue you can call someone and ask their opinion or have a colleague that you can bounce an idea off of or get advice from. I think that for public health, NACCHO Annual is the best thing going.

Hear from more leaders like Gary Cox, share best practices, and build your knowledge network at NACCHO Annual 2016, July 19-21 in Phoenix. Learn more at