Member Spotlight: Health Director Joey Smith Highlights His Department’s Role as a “Choice Architect” and Describes His Hopes of Helping His Community Live One Million Years Longer

Interview by Taylarr Lopez, Communications Specialist, NACCHO

NACCHO’s Member Spotlight series features interviews with local health department leaders and staff about their careers in public health. This interview features Joey Smith, Health Director of the Montgomery County Health Department in Tennessee and NACCHO Board Member. Below he shares how his health department is bridging the gap to healthcare by providing primary care services and highlights the success of the department’s Healthier Streets & Neighborhoods program.

Tell us about your career path in public health.

Early in life, I learned about social services through experience. Because of my family’s low-income, we used a lot of public health services. I was enrolled in the early education program, Head Start, and my family often used the services offered by our local health department, which was the Montgomery County Health Department. I remember as a child sitting in the lobby of the health department waiting to receive my vaccinations for school, and I noticed the employees smiling and appearing like they really enjoyed their jobs. At that moment, I wondered what it would be like to work at that health department and what it would take to do that.

After I graduated high school, I joined the Navy and ended up going to Austin Peay State University in Clarksville. Shortly after graduating, a position as an Environmental Health Specialist at the Montgomery County Health Department became available and I jumped at that opportunity.

In 2000, I began my career at Montgomery County and in 2004, one of my mentors from our Regional Office asked me would I consider being a director of a health department. I started taking graduate courses that would prepare me for leadership roles. In 2008, I was offered the position to be the director of the Dickson County Health Department. In early 2012, fellow NACCHO board member Andre Fresco, who was the director of the Montgomery County Health Department at the time, was transitioning to another department and told me not to be surprised if I got offered the director position. In May of that year, I was called to be the director and I’ve been here ever since.

What are some of the highlights of your career in public health? What makes the work that you do worthwhile?

Prior to working as a director, I would say that many of my career highlights involved being part of successful projects. I would never want to take credit for something and saying that I did it, especially if it was a team effort. I take pride in knowing that I can work with a team and be involved with a project that is results-driven. I’ve received a few honors over the years, including being named Public Health Worker of the Year by the Tennessee Public Health Association; selected as one of 12 public health officials in the nation to be named to the Emerging Leaders in Public Health by the Kresge Foundation; chosen for the 2015 Class of Pink Tie Guys by Susan G. Komen Central Tennessee; and being one of 22 out of nearly 40,000 state employees selected to the inaugural class of Governor’s Excellence in Service by Governor Bill Haslam.

Additionally, being nominated by my colleagues to serve on NACCHO’s Board of Directors is a major highlight of my career. I was very humbled and honored that my colleagues thought so highly of me and felt that I would be a great fit for the board.

What challenges are you or your health department currently facing?

Analyzing the community’s decision-making habits and behavioral economics has been one of the biggest challenges. Trying to find out what drives population health and figuring out how to increase the life expectancy of my community has been challenging. We are researching why people make certain health choices, especially those not-so-good health choices like smoking and not eating healthy. I strongly believe that there are solutions for improving the health of communities across the nation. I believe we can use the same techniques that cigarette companies once used to encourage people to smoke to make people want to choose a better, healthier lifestyle.

My health department makes a conscious effort to show the public all the healthy alternatives that are available to them while being careful not to completely hide or take away other choices. I really like the term “choice architect” because it implies that people still have the choice to make the decision they want, whether healthy or unhealthy.

What is the biggest change you’ve seen in public health since you’ve started in this field?

At the beginning of my career 18 years ago, I was told that in public health, people see us as gap-fillers.  For the past 15 years, the gap in Tennessee was access to primary care. In the early 1990s, Tennessee introduced a state Medicaid system, giving many of our citizens health coverage but many people still faced the challenge of health providers not accepting their insurance thus preventing access to healthcare. Over time, we began bringing on physicians and nurse practitioners to help bridge that gap. Many of our health departments in the state have continued to provide primary care services to the community, even after the Affordable Care Act (ACA) was passed. The passing of the ACA was a huge change in public health because a lot of the people we were providing health services to got health insurance. Shortly thereafter, our department worked to establish contracts with health insurance companies so we could continue to provide clinical services for a larger group of people. Although many of our patients received health coverage through the ACA, several of them still wanted to be treated by us.

How are you positioning yourself and/or your health department for the future?

I was recently interviewed by Austin Peay State University and they asked me what I would like the results of my work to be. I thought long about their question and a memory of a retirement party came to me. The guest of honor’s speech was inspiring because in addition to talking about the work they had done throughout the years, they also presented measurable results of that work. Immediately I began to think about what I’d like the results of my department’s work to be after I retire.

I concluded that I wanted the population I serve to live one million years longer. I know that sounds very farfetched but based on census estimates, the population in Montgomery County is expected to be around 300,000 people by the time I retire. If I can get everyone in my community to live three more years, collectively that is 900,000 years. To do this, I have been tailoring many of my department’s activities towards smoking cessation, being active, and eating healthier. We strive to make sure those activities are evidenced-based and show proven results.

Modeled after the science of “Blue Zones,” our health department developed a program called Healthier Streets and Neighborhoods. In creating this initiative, we had to think about where people live, work, worship, and play. Considering people spend most of their time at home and at work, we took our best ideas and designed activities to make these places better. Volunteers of the program go to the participating neighborhoods and help residents grow gardens. There’s been plenty interest in our walking programs as well. We thought this was going to be a challenge, but it ended up being one of our greatest accomplishments. This program has been so successful, it’s been identified as a best practice in the category of ‘“Place Making.”

How long have you been a member of NACCHO and what value do you find in belonging?

I’ve been a member of NACCHO for nine years. There are many organizations that are very similar but NACCHO is specifically for the people who do exactly what I do. The publications and the education programs that NACCHO develops are very helpful to the nearly 3,000 local health departments it serves. Whenever I go to a NACCHO-sponsored event or conference, I am around other people that I can relate to and that understand this field. I love that events like the Preparedness Summit and NACCHO Annual gives attendees the opportunity to learn from peers and network. I think it’s great that NACCHO provides resources and tools catered to small and rural local health departments as well.

What do you enjoy doing in your time away from work?

I love going on trips with my family. We like traveling to the Gulf and the Florida panhandle. We enjoy going to Disney as much as we can. In between trips and vacations, I like to play tennis. In high school, I played on my tennis team, and here in Clarksville, we have a tennis association and I serve on its board.

Check out another interesting article from The Leaf Chronicle highlighting Joey Smith’s work with the Montgomery County Health Department.

For more interviews in the series, visit NACCHO Voice Member Spotlight.