NACCHO’s Member Spotlight series features interviews with local health department leaders and staff about their careers in public health. This interview features Jeff Kuhr, PhD, Director of the Mesa County Health Department in Grand Junction, CO. He has served on many boards and committees, including the current NACCHO Board of Directors and previously on the Accreditation Preparation and Quality Improvement Committee. He has been a member of NACCHO for 12 years. Below, he explains how his career in public health began, shares the highlights of his career, and discusses the challenges facing his department.
Tell us about your career path in public health.
I received both my Bachelor’s and Master’s degrees in community health education from the University of Nebraska at Omaha and my doctorate in Educational Psychology from the University of Nebraska, Lincoln. While working on my PhD, one of my professors asked me if I was interested in conducting a needs assessment for a new health department in Nebraska. At the time, Nebraska didn’t have local public health coverage in all of its counties. After 9/11, the state needed to put local public health in place so it could receive federal funds for bioterrorism. Soon, all of these local health departments began to form. I put in a bid to conduct a community assessment for one of the departments, which was right outside of Omaha. I began working on behalf of the local health departments and decided to apply to a public health director position. I was offered a job and became the founding public health director of the Three Rivers District Health Department in eastern Nebraska in 2003.
My health department in Nebraska was small. The population was about 75,000 in eastern Nebraska and consisted of three counties. After eight years I started to think that I’d like to be at a larger health department. I knew that I really wanted to live in Colorado so I started to look for positions there. I was offered a job in Southwest Colorado but turned it down because of the location. Soon thereafter, a director position at the Mesa County Health Department opened. I applied and was accepted for the position. I’ve been here for six years, since January 2011. It’s a really great place to be. Grand Junction is in Western Colorado along I-70, about 30 miles from the Utah border.
What are some of the highlights of your career in public health? What makes the work that you do worthwhile?
In Nebraska I got to build a health department from scratch. I started by working out of my home while I acquired office space and furniture and hired staff. It was a great opportunity because I got to personally experience all of the components of what we do in public health; in some form I was playing every role until I hired new staff.
As the local health department system grew in Nebraska, I was part of a project with Kay Oestmann and Bruce Dart, currently the director of the Tulsa Health Department in Oklahoma. The project was part of the National Public Health Leadership Institute in 2006 and aimed to create assessment capacity for the local health departments in Nebraska. Part of that assessment capacity building process was to ask for funds. We worked with some folks to write legislation to request some funding for public health statewide, which resulted in every local health department in the state receiving $100,000 from the general fund. That was a great thing to be involved with. For most of those health departments, that was the first general fund money they received. We were instrumental in building local public health infrastructure in the state. I’m very proud of that.
In Colorado, I’m very involved with statewide efforts. I’ve been selected by the governor to serve on the State Board of Human Services and I’m getting ready to serve a second term. It’s very exciting to talk to the State Department of Human Services about how public health gets integrated into the work they do. I believe that we can all do a better job at integrating across our disciplines, so for me to be able to work with human services in that aspect has been very rewarding. I was also appointed by the governor to serve on the Colorado Early Childhood Leadership Commission. I do a lot of work with early learning and child care processes so I’m very honored to be considered as a key representative for that in our state.
Our business is certainly something that we pay attention to; however, what drives us are the leadership opportunities. I still feel like I’m in the first month of the job because there are always so many new opportunities from a leadership perspective in the communities we serve. To me it’s a question of how can we serve the community in the role of chief health strategist. In February 2016, as part of the NACCHO board, we approved a policy recognizing the concept of the chief health strategist. I feel like I’ve been striving toward that position in the communities that I serve for the past 10 years. That’s exciting to me because we try to convey to our local partners the role public health plays in our systems. We work with the healthcare system, various human service agencies, mental health, the school system, and so on. We contribute to each of these systems by assessing community health needs, convening partners around issues, providing technical assistance, and evaluating programs.
What challenges are you or your health department currently facing?
Although we’re making gains in proving our value, many people still don’t see it. All of what we do gets tied back to funding and you want your local elected officials to value you to the point where they’re giving you adequate funds.
Nationally, I think many local health departments are funded primarily from categorical funds. Of my $7 million dollar budget, about 14% of that is discretionary. It’s difficult to administer my community health needs assessment in partnership with our three hospitals, develop and implement a community health improvement plan, and fill all the gaps for programs that are underfunded with only $1 million of discretionary funds. So the funding structure of public health is definitely something that needs to be addressed. So many health departments across the country define themselves by the categorical funds they use to build their agencies. I honestly don’t think that’s our role. I think we need to break beyond being defined by the funding.
What is the biggest change you’ve seen in public health since you’ve started in this field?
I think the biggest shift I’ve seen has been external. I feel that we try to stay with what we’ve been traditionally. The folks outside of our system, community, and state need us to play a different role, especially with health reform. We’re expected to become more integrated into these larger systems and I think we’ve had a hard time breaking free of our traditional role. I don’t think we’re shifting as quickly as we could be.
How are you positioning yourself and/or your health department for the future?
We are at a lot of tables. I’m fortunate that locally we are seen as having a role in the larger health and human services systems. To prepare for that, I see my job as primarily outside the agency. I serve on many boards including our largest hospital board, the board of directors for our developmental disabilities agency, the community clinic board, and I am the facilitator of the Mesa County Health Leadership Consortium. With that said, people recognize me as someone having a role in integration in the community. While I’m thankful for that, I’ve put myself in that position because I plan to prepare my agency for what we’re going to have to deal with in the future.
How long have you been a member of NACCHO and what value do you find in belonging?
I believe I’ve been a member of NACCHO for 12 years. In those 12 years, I’ve learned to appreciate having a combined voice and someone to represent local public health departments at the national level. The most value that I find is what can occur from the legislative perspective. The difference between NACCHO and the American Public Health Association is very similar to the difference between the Colorado Public Health Association and our local public health director’s organization. Local public health agencies have issues that are often more focused or specialized, or are viewed from a different perspective. Oftentimes, there aren’t opportunities for us to have a political viewpoint when it comes to certain areas. A few years ago we legalized marijuana in the state of Colorado. At the time, I had a board member who suggested that our health department missed a real opportunity to go out and advocate for the passage of that constitutional amendment. I feel that it’s really not my place to be an advocate for certain things, as we need to maintain a balance that considers health along with our local economy, the overall interests of our county commissioners, and the diverse views of our residents.
What do you enjoy doing in your time away from work?
I try to do everything that a Coloradan does. I am heavily into mountain biking; we have some of the best mountain biking in western Colorado. I also enjoy snow skiing and hiking as well. My family has a camper that we use often. We try to take advantage of everything Colorado has to offer. I love this state. In contrast, when I lived in eastern Nebraska, I mostly golfed—oddly enough, I hardly golf anymore. When I moved to Colorado, I ended up losing 75 pounds because of all the things I wanted to do and did outdoors. This year I’m thinking of taking up fly fishing. Colorado has certainly been good for me and my family.
Thank you so much, Jeff! For more interviews in the series, visit NACCHO Voice Member Spotlight.