Incoming NACCHO President Claude-Alix Jacob Shares His Priorities for Local Health Departments and Explains Why a Career in Local Public Health is One of the Best-Kept Secrets

Claude JacobOn July 1, Claude-Alix Jacob, MPH, Chief Public Health Officer for the Cambridge (MA) Public Health Department, became NACCHO’s President. Jacob is a long-standing and dedicated member of NACCHO and has served on a variety of different advisory groups including the Annual Conference Workgroup, the Health Equity and Social Justice Committee, the Survive and Thrive Workgroup, and the Finance Committee. He has served on NACCHO’s Board of Directors since 2010. He recently spoke to NACCHO Voice about his career path, the challenges his health department is currently facing, the priorities for his Presidency, and his advice for those just starting their careers in local public health.

  • Tell us about your career path in public health and how you got to where you are today.

I am the local health officer here in Cambridge, MA, and have served in this capacity since April 2007. We are a medium-sized local health department with a jurisdiction of about 110,000 residents. The geography of Cambridge is very small—it’s only six and a half square miles. By scale, we’re the second largest health department in Massachusetts. The Commonwealth of Massachusetts has the most decentralized public health system in the nation, with over 300 local health departments covering a population of 6.6 million residents.

I have a Master’s in Public Health from the University of Illinois at Chicago School of Public Health. I started out my career at the Sinai Health System located on the West Side of Chicago where I ran community outreach programs that included a high school health careers program, youth violence prevention and education initiative, and a senior wellness program. After a few years, I moved to Baltimore where I served as a senior staffer at the Baltimore City Health Department. That was my introduction to working in a local health department. Initially I worked on community health policy initiatives for the department. Eventually, I was promoted to Bureau Chief, where I oversaw communicable disease programming that included HIV education and testing, as well as the operations of the city’s TB and STD clinics.

Prior to my arrival in Cambridge, I served as the Deputy Director of the Office of Health Promotion at the Illinois Department of Public Health, where I was responsible for chronic disease programming, oral health initiatives, injury prevention efforts, and the state’s newborn screening programs.

  • How do you think about your role as Chief Public Health Officer for the Cambridge Public Health Department?

I see my role as a connector. We work very closely with the city’s department of human service programs, with the schools, with our partners in public safety and community development, and with the area non-profit organizations. Most folks think of the health department in our regulatory role, but there is also a substantial planning function that supports our work related to emergency preparedness and climate change, as well as innovative community engagement strategies to address the pressing needs of residents and visitors alike to the city.

The nature of our work in local public health keeps changing. It’s not just about giving out flu shots every fall or having walking programs every spring. It’s also about being an active member of the community by coordinating with our partners to develop a sense of a shared “village” and helping maintain the balance between physical health, emotional wellness, and connectedness across various social networks. It’s about remaining vigilant in the work that we do, looking at the transmission of disease and the various vectors that require our attention. It’s also being cognizant of the fact that there are different determinants that affect the overall health of the community that include community members’ income, education, and employment status.

  • What is a typical day like for you?

One of the characteristics of this job that I most enjoy is that each day is different. Depending on the week or the season, there may be a lot of paperwork and meetings involved. If it’s an election year, there may be other expectations that we try to manage when working with our local elected officials. I also need to be available to support my staff, which is a bit of a juggling act between managing the day-to-day operations while tending to the external affairs functions of the department. Each day presents a new set of challenges or opportunities, which makes for an adventure. In other words, there’s never a dull moment.

  • What issues are especially pressing for your community right now?

We recently went through a series of outbreaks that involved meningitis, mumps, and measles in our region. These were outbreaks that kept my nurses and epidemiologists on their toes for a number of weeks as we were actively keeping an eye on the cases around the city and the Boston metro area. There is a lot of talk these days about the Zika virus. In Massachusetts, although that particular mosquito is not endemic here, we do want to make sure that residents are taking the necessary precautions if they are traveling to the hot zones in the Caribbean and South America.

A major concern these days is the burden of opioids in our community that is impacting the city. We’ve been paying attention to the overdoses as they’ve been reported to us, whether fatal or non-fatal. We know that it’s a pressing issue and are emphasizing prevention measures by working with area pharmacies, schools/universities, and senior centers. In addition, we’re making sure to look at the programmatic linkages that support our work, whether that’s around emergency preparedness, chronic diseases, or domestic violence prevention. With our city and community partners, we’ve been implementing policies and programs around healthy eating and active living for many years, but now we need to devote greater attention to understanding why black and Latino kids in our city are disproportionately impacted by obesity and how to reverse this trend.

  • What challenges you most in your role? What keeps you up at night?

I think a lot about staffing capacity. Nationwide, we’ve seen a contraction in the number of health departments and in the workforce that supports the work of local public health over the last six to eight years. The other challenge has to do with the burdens placed on municipalities rather than our county-level governmental infrastructure in a very decentralized state. We have to become even savvier about sharing the resources across jurisdictions, which can create its own challenges of balancing the core work with the expectations of our community stakeholders and regional partners.

  • What are you most proud of in your career to date?

Having the honor and opportunity to serve as the national president for NACCHO is a special milestone in my career. Never did I imagine when I was voted onto the Board six years ago that this would be a possibility especially when I consider the incredible trail blazed by my peers and predecessors. Also, we recently completed the first stage of our application for accreditation by the Public Health Accreditation Board (PHAB). It has been a multi-year odyssey to demonstrate that we’ve met the standards in our pursuit to become one of the first accredited health departments in Massachusetts. I’m very proud of the fact that our staff and our community partners have supported this endeavor to help improve upon our work. We completed the prerequisites around the community health assessment as well as the community health improvement plan and we now have a new departmental strategic plan to guide our work for the next few years.

  • What advice would you give to someone just starting a career in a local health department?

Be patient with the planning process, which includes managing the expectations of community partners and other stakeholders. Have a focus and use frameworks, where possible. For example, in our work, we apply the 10 Essential Public Health Services and the PHAB Standards and Measures. There has also been more talk recently about the Foundational Capabilities and the seven defined practices of the chief health strategist and the role of governmental public health. NACCHO is a tremendous resource to align these concepts in our day-to-day practices.

Be true to the work. The function of public service is not for the “faint of heart.” I do feel strongly that the field of public health still serves as one of the best-kept secrets. There remain plenty of career opportunities that run the gamut as clinicians, researchers, educators, administrators, or inspectors. As long as you’re in for the thrill of a dynamic routine, you can make it a fun and fulfilling career.

  • What are you looking forward to achieving during your tenure as President of NACCHO?

There are few areas that will drive my agenda for the year ahead. The first is an emphasis on workforce development. In my NACCHO experience, I served on the Survive and Thrive Workgroup, which looked at the orientation of new local health officials. This allowed me to serve as one of the national coaches and eventually as chair of the workgroup. I want to amplify the need for effective workforce development and offer whatever I can as guidance and advice as a mid-career health professional. Magnifying the need for having a strong, competently trained workforce is a priority.

The second area is on quality improvement. Although the PHAB vetting process has been a monumental task for participating departments these past few years, I strongly believe that if you can endure the experience, your health department stands to become better-positioned and higher-performing in the future.

My third priority has to do with championing the role of local health departments as the key health strategist for their communities. I feel that health departments can serve as über-connectors, making sure that systems, policies, and environmental factors are better aligned. We can use our convening power to leverage assets to help create a better environment for all those who live, learn, work, and play in our respective jurisdictions.

Finally, the thread of health equity and social justice is woven into all of our work, which is consistent with NACCHO’s mission. The theme of our national conference that was held a few weeks ago in Phoenix was ”cultivating a culture of health equity” and provided an opportunity to engage our members while bringing together thought-leaders to inspire our work on the ground. I see local health departments as the main vanguard for addressing health inequities by drawing attention to the factors that determine overall well-being regardless of one’s zip code.