NACCHO Annual 2016: Cultivating a Culture of Health Equity

By Lindsay Tiffany, Lead of Publications, NACCHO

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From left: Mr. Sims, Dr. Ehlinger, Dr. Jones, and Dr. Hofrichter

On July 19–21, more than 1,300 attendees convened in Phoenix for the 2016 NACCHO Annual Conference, making it the largest gathering of local health department (LHD) leaders and other public health professionals in the United States. The meeting provided participants with an opportunity to hear from national thought leaders, learn about successful and replicable public health practices from their peers, and discuss the pressing challenges affecting LHDs today.

This year’s conference theme, Cultivating a Culture of Health Equity, provided a venue for in-depth conversations about how local health practitioners can impact the social determinants of health equity to achieve health and well-being for all members of their communities. A diverse mix of speakers addressed the theme during four general sessions and more than 100 sharing sessions, providing attendees with a range of perspectives on and approaches for tackling health inequities at the local level.

Networking is one of the hallmarks of NACCHO Annual and this year’s conference featured a variety of opportunities for attendees to forge professional connections. In response to member requests, NACCHO hosted several social and networking events including a President’s welcome reception, a first-time and new member breakfast, and a cocktail and networking reception.

Social media also played a prominent role in the conference. The conference app, downloaded by more than 800 participants, improved members’ experience by allowing them to access session information, updates to the program, speaker information, poster presenters, and exhibitor listings and enabling them to take notes. Twitter was also abuzz throughout the event; the conference hashtag generated nearly eight million impressions on the social network over the three days.

Tuesday: The Future of Public Health

To mark the start of the conference, attendees were welcomed to Phoenix by Bob England, MD, Director of the Maricopa County (AZ) Department of Public Health, and Steve Gallardo, Maricopa County Board Supervisor for District 5. New NACCHO President Claude-Alix Jacob, MPH, Chief Public Health Officer, Cambridge Public Health Department, then addressed attendees. He shared his personal and professional background, discussed how NACCHO creates linkages that set the standards of the profession, and described the complexities of being a local health official today. During his presidency, he hopes to focus on workforce development and accreditation initiatives.

The opening general session, Collaborative Pathways for Advancing the Future of Local Public Health, provided an overview of federal efforts to move public health into a new era. The panel was moderated by NACCHO Executive Director LaMar Hasbrouck, MD, MPH, and featured a riveting discussion with John Auerbach, MBA, Senior Policy Adviser to the Director, Centers for Disease Control and Prevention (CDC); Karen DeSalvo, MD, MPH, MSc, Acting Assistant Secretary for Health, U.S. Department of Health and Human Services; and Leandris Liburd, PhD, MPH, MA, Associate Director, Office of Minority of Health and Health Equity, CDC.

The panelists discussed a variety of approaches to addressing the social determinants of health to combat health inequities. Dr. DeSalvo shared her vision for Public Health 3.0, the next iteration of public health practice that leverages policy, systems, and environmental change to affect the social determinants of health in pursuit of health equity. DeSalvo encouraged local health officials to serve as the Chief Health Strategists in their communities and urged them to step outside the walls of their health departments to engage partners and stakeholders across multiple sectors. She acknowledged that LHDs require more—and more flexible—federal funding to fully serve their role in Public Health 3.0. Many LHDs are collaborating and sharing services to surmount funding gaps, she noted.

Dr. Liburd described how her office is promoting health equity through the use of evidence and data. She noted that health department efforts to reduce health inequities requires data, an effective workforce, accountability, and leadership. Mr. Auerbach discussed the “three buckets of prevention” and CDC’s 6|18 initiative. First outlined in an article he authored in the Journal of Public Health Management and Practice, the three buckets of prevention are traditional clinical prevention, innovative clinical prevention, and community-wide prevention. The framework helps ensure that efforts to improve population health encompass the community-based factors that affect health, which have historically gone unaddressed. CDC’s 6|18 initiative seeks to lower healthcare costs by prioritizing six high-burden health conditions and 18 evidence-based interventions to address them. The interventions chosen by the CDC are expected to have a significant impact over the next five years and bend the cost curve.

On Tuesday evening, attendees mingled and toured the Exhibit Hall during the President’s Welcome Reception and enjoyed a cocktail and networking reception sponsored by Afaxys. Dozens of companies and organizations exhibited this year to expose attendees to a range of public health resources and solutions.

Wednesday: Turning Public Health Challenges into Opportunities

Wednesday was a dynamic day full of inspiring stories about how LHD leaders and staff are turning public health challenges into opportunities. Conference-goers heard from NACCHO’s Executive Director LaMar Hasbrouck, MD, MPH, about his vision for the future of NACCHO. He noted that advocacy, media outreach, peer-sharing, and capacity-building are the cornerstones of how NACCHO serves its members. He articulated a vision for the future of the organization in which NACCHO convenes partners, provides funding, and leverages existing frameworks to help LHDs become the Chief Health Strategists in their communities.

Wednesday’s general session, “Building Power for Health Equity,” was sponsored by The California Endowment and featured an esteemed panel of experts. Dr. Tony Iton, MD, JD, MPH, Senior Vice President of Healthy Communities at The California Endowment, moderated the session and provided an overview of his organization’s billion-dollar, 14-site, place-based Building Healthy Communities initiative. He stressed the importance of changing the narrative about health and health equity and explored how LHDs can build power among disenfranchised groups to effect policy, systems, and environmental change.

Dr. Iton was joined by panelists Kathleen Grassi, RD, MPH, Director of the Merced County (CA) Public Health Department; Elsa Jimenez, MPH, Interim Director of Monterey County (CA) Health Department; and Melissa Jones, MPA, Executive Director of the Bay Area Regional Health Inequities Initiative. They discussed successful strategies to improve health equity at the county and regional levels. Learn more about their efforts in the latest issue of NACCHO Exchange, available at http://bit.ly/1ViFcS5.

Attendees also celebrated this year’s award winners at the Grand Awards Ceremony and Reception, including 23 Model Practice Award winners, two Local Health Department of the Year awardees, the Mo Mullet Lifetime of Service recipient, and the National Health Security Strategy awardees. Learn more about NACCHO’s awards at http://www.naccho.org/membership/awards.

Thursday: Tackling the Root Causes of Health Inequity

Thursday morning’s general session, Achieving Health Equity: A Public Health Approach, featured a powerful discussion about the structural causes of health inequity and the actions LHD leaders can take to eliminate them. The session was moderated by Richard Hofrichter, PhD, Senior Director of Health Equity at NACCHO, and featured Ron Sims, Deputy Secretary of the U.S. Department of Housing and Urban Development; Ed Ehlinger, MD, MSPH, Health Commissioner of the Minnesota Department of Health; and Camara P. Jones, MD, MPH, PhD, Senior Fellow at the Satcher Institute for Public Health Leadership at Morehouse College.

Dr. Hofrichter opened the panel, noting that achieving health equity means meeting fundamental human needs, minimizing exploitation, and ending processes that marginalize certain groups. He underscored that the panel would focus not on the social determinants of health but rather on the social determinants of health inequity.

Mr. Sims urged action by LHD leaders, explaining that while there is an abundance of data about health inequities, the lives of people being studied will not change unless communities use the data to enact change. He stressed that the environments in which people live are a critical determining factor in health and shared examples of how transportation, lighting, community gathering points, and community gardens affect the health of resident and change how cities function.

Dr. Ehlinger pointed out that most of public’s health work has focused on primary prevention among at-risk populations, which, although important, is insufficient for addressing the social determinants of health inequity. He stated that local health officials must develop the capacity and power to lead a movement to change the conditions that impact health. Ehlinger said community organizing, a hugely underutilized public health resource, may be one avenue through which public health practitioners can catalyze change.

Dr. Jones conveyed her definition of health equity, which she described as assurance of the conditions of optimal health for all people. Achieving health equity, in her perspective, requires valuing all populations equally and recognizing and rectifying injustice. She noted that racism, or a system of structuring opportunity and assigning value based on the interpretation of how one looks, is pervasive in the United States. Jones declared that addressing racism is a critical part of the job of public health professionals and observed that racism saps the strength of society as a whole by wasting human resources. She called on the audience to put racism on the agenda, examine the ways in which it currently operates, and strategize ways to eliminate it.

The final general session of the conference on Thursday afternoon was Slow Violence, Health Inequity, and the Future Well-Being of Communities. The panelists included Mindy Fullilove, MS, MD, Professor of Clinical Sociomedical Sciences and Psychiatry at Columbia University; Donald Warne, MD, MPH, Chair of the Department of Public Health, North Dakota State University; and Linda Rudolph, MD, MPH, Director of the Center for Climate Change and Health, Public Health Institute.

Dr. Fullilove called upon her background in community development and displacement to share how inequality effects the health and well-being of communities. She reminded attendees that inequality is not static; it is a process. She called for interventions to disrupt unequal processes and redistribute resources to combat inequity.

Dr. Warne discussed health inequity in the context of Native Americans, noting that Native Americans die from preventable health issues at significantly higher rates than other Americans. He presented a brief history of Native Americans since the arrival of European settlers and connected patterns of chronic disease, morbidity, and mortality among Native Americans to genocide and historical trauma. Warne described how Native Americans largely have been left out of national public health conversations and explored ways LHDs can engage tribes.

Dr. Rudolph explored the relationship between climate change and health inequity, urging conference-goers to consider the relationship between healthy people, healthy places, and a healthy planet. She noted that communities of color and low-income earners are more likely to experience the effects of climate change such as air pollution and displacement. Climate change is a threat-multiplier for all of the existing health challenges facing communities, she stated. Rudolph shared examples of several LHDs engaged in climate change-related activities and encouraged health department leaders to engage in similar activities in greater numbers and with more urgency.

na17-smallThe conference provided attendees with diverse perspectives and new resources and frameworks to help them improve the health and well-being of their communities. For more from the conference, visit www.nacchoannual.org. Save the date for NACCHO Annual 2017, July 11–13 in Pittsburgh.