2017–2018 NACCHO President Dr. Umair A. Shah Shares Highlights from His Term and Describes How LHDs Can Combat the “#InvisibilityCrisis”

Interview by Lindsay Tiffany, Lead of Publications, NACCHO

On June 30, Umair A. Shah, MD, MPH, Executive Director of Harris County Public Health (HCPH) in Houston, concluded his term as NACCHO President. Dr. Shah is a long-standing and enthusiastic member of NACCHO and has served on a variety of different NACCHO-related groups including the Health Equity and Social Justice Committee, the Global Health Workgroup, the Media Champions Network, and the Finance Committee. He can be found tweeting often from the handle @ushahmd on Twitter. He has served on NACCHO’s Board of Directors since 2014. He recently spoke to NACCHO Voice about his experience as president, the “invisibility crisis” facing local health departments, and what he is looking forward to doing now that his term is over.

What has surprised you most about your tenure as president? What have you learned?

During my tenure as NACCHO President, I was surprised at how absolutely integrated NACCHO is, how many moving pieces there are, and how those pieces are interconnected. There are so many disciplines, areas, and team members in the NACCHO enterprise, including everything from the SACCHOs, the Big Cities Health Coalition, the Past Presidents Council, and all the advisory and other workgroups. It’s amazing how NACCHO can pull all those pieces together sometimes methodically over a long period of time and other times very quickly during an emergency. Seeing what goes on behind the scenes has been interesting, especially after having always seeing the end product.

My time as president also reinforced how important NACCHO’s role is. NACCHO shows the power of the “collective” and serves as the voice of local health departments across the country, both in national circles and in areas of concern like opioids, health promotion, vector control, chronic disease, emergency response, etc. These roles make NACCHO not just relevant but crucial to the success of LHDs.

What were some of the most important projects you worked on as president?

During my presidency, I worked on several activities that were critical to NACCHO operations. Those included strategic planning, revision of bylaws, executive director search, review of the workgroup structure, and ensuring the communication strategies were sound, to name a few. In my mind, strategic planning was the key piece of the whole puzzle as it was important to align our strategic priorities with the financial and operational aspects of what NACCHO is tasked with doing.

Incorporating the voices of our members, the board, and strategic partners, both externally and internally, is what helps bring this plan together. We even had a strategic planning session to bring together these voices in Houston and also provided insights into a community that was so severely impacted by Hurricane Harvey. The strategic planning process was the culmination of a lot of insights and careful deliberations—all together these move NACCHO in a strategic direction. With the new executive director in place and the finished strategic plan in hand, I am excited about the next phase of what lies ahead in implementing the plan.

What have you most enjoyed about serving as President? What are you most proud of?

I have enjoyed the opportunity to show that when you are in the field of local public health, you don’t have to be behind the scenes only. Yes, it is okay to be out front communicating and describing the work we do across the country and telling the story of what local public health means for local communities. Bringing my communication skills, my style, and my energy to the national level has been very rewarding. But I could not have done it without the incredible support of our talented and deeply committed NACCHO Board members and NACCHO staff who demonstrated why what we do matters each and every day. Of course, I would be remiss if I did not recognize our incredible support team here at HCPH that ensured nothing fell through the cracks as I juggled a lot of things simultaneously with the NACCHO role.

Traveling across the country and representing local public health and describing the important roles of the professionals in this field has been so rewarding. Bringing energy to meaningful areas that I feel are important to NACCHO as an organization—some of those are the more invisible “back office” things I talked about like the bylaws, structure, and the executive director search—has been equally gratifying.

It was also important to look at NACCHO’s role in the midst of emergencies and think about how to define that role better. Obviously, that was very important to me because several weeks after taking the helm at NACCHO Annual in Pittsburgh, our community (and others across Texas) were hit by Hurricane Harvey. We were very much in the throes of emergency response—not just in theory but in real, practical response activities. It made a lot of sense to be able to represent the perspective of an impacted community and how the reality of what is happening on the ground is translating to policy work at the national level. And yet hurricanes were just one of many emergencies our country has faced—from wildfires to winter storms to infectious disease outbreaks, it has been a busy year for all of us.

In addition to that, I had articulated “values” when I assumed the NACCHO helm and these included innovation, equity, engagement, partnerships, capacity-building, and global-domestic health. I am excited that over the past couple months, I have had the opportunity to speak about this last global health work to a number of partners such that we have created an ad-hoc global health taskforce here at NACCHO. I am hopeful it will translate into an additional exploration of what global health work really means at the local health department level here domestically and how NACCHO can play an important role.

It has certainly been gratifying to work on important public health policy issues and work with people across the field to move the needle forward. At the end of the day, recognizing the importance of story-telling and highlighting the value of local public health has been a true privilege.

What has changed for local health departments and the field of public health in the past year?

I think first and foremost we have to recognize that local public health continues to have an important role regardless of what the flavor of the month or political persuasion is, and regardless of what the public health issue at hand is. Local public health is vital to the health and well-being of the community. I don’t think that has changed. What has changed over the past year is that there have been an incredible amount of issues that have surfaced: emergencies, wildfires, hurricanes, ice storms, a busy flu season, vector control, infectious disease response, chronic diseases, and environmental health—heck, even iguanas falling out of trees!

The issue of opioids has gotten real recognition and there is now a greater understanding of mental health and behavioral health, even addiction, and the importance of the work that public health does to address those issues. When you put these together, I think some issues have started to surface maybe more so today than previously. While public health has always dealt with important issues, perhaps another way of looking at it is that our approach has changed. What I mean is that our approach really is recognizing that we cannot just be behind the scenes but that we must be visible and engaged. We must leverage technologies like social media. We need people to see our work and value it. Yes, we have a lot more work ahead but we have begun the process of raising that visibility.

What challenges are on the horizon and how can NACCHO help LHDs tackle them?

The first challenge is around our workforce. We have lost a lot of people as part of our existing public health workforce. Not just in numbers but in capacity and skill sets. You cannot just replace a sanitarian who has been in the field for 15 years with a new individual and expect the same result. Ensuring you have capacity at the local level is probably the absolute most important challenge we have.

But it is all interconnected: There is what I call an “invisibility crisis” in public health. In my tweets (@ushahmd), I have been using the hashtag #invisibilitycrisis to bring awareness to the fact there are many people, including policymakers, who don’t recognize the importance of what we do. Our work is oftentimes invisible. When people don’t recognize the value of what you do, they don’t realize it needs to be invested in. When people don’t invest in public health, communities suffer. We need to address how to bring newer ways and means of communicating the value proposition of public health. Public health is driven by the “three V’s”: visibility, value, and validation. When you show value, others want to validate that value by investing in the work.

I am excited to be part of this passionate public health workforce with creative energies that will move our work forward. It is gratifying to see how the NACCHO staff have been so strong in the last year and worked through an incredible amount of change here within the organization and have been able to move forward in a way that has equally shown resilience. These are the “people behind the people” who are even more-so behind the scenes. It has been wonderful to put the pieces in places to make NACCHO a stronger organization and one that is better able to serve the LHDs that rely on it for support.

What are you looking forward to doing once your tenure concludes and you have more free time?

I am looking forward to taking some time to spend with my family—to re-charge. To watch (and play some as well) sports—my favorite football or basketball teams or watch the Astros win another World Series! Yes, it has been a challenging year. I am also looking forward to seeing what comes of the initiatives that we launched at the national level like emergency response roles and global health. I want to see those continue to grow under the leadership of the incoming NACCHO President Kevin Sumner. I am excited to be working with him. He’s going to be great for NACCHO and local public health. I am also excited to be working with NACCHO’s new Chief Executive Officer, Lori Freeman. I am interested to see how she shapes NACCHO as an organization and how she frames how NACCHO will better support all of us in our work.
And yes, I am eager to get back to the work that we have launched here at Harris County Public Health – a lot of really exciting things that I know will keep our team busy here locally. It is critical that we continue to focus our efforts on how to serve both our community and consider what it means to be part of the spectrum of 3,000 local health departments across the country. No matter how large or small we are, at the end of the day, we are all trying to do the same thing: promote the health and well-being of our communities.

I want to recognize the essential work of the NACCHO Board of Directors. They are really connected to what is happening within the field because they are themselves local public health practitioners. The board is very mindful of representing local public health at the national level; it’s not a job that any of us take lightly. I want to say thank you to my fellow board members because they have done a great job and have been very supportive, including when our community was impacted by Hurricane Harvey or when there was a high school shooting nearby. I could always rely on a board member or the board collectively to take on a project or activity. This was truly the power of the “we.”

Our members do not always know what the board does or why they take on these additional responsibilities. Well, I can tell you: They take them on because they believe in local public health and the professionals who work in this field. I think it is important to give gratitude to our board for all they do along with the NACCHO leadership and staff. This group works hard to ensure that local health departments are adequately and appropriately represented—I am proud that I was able to give of myself this past year to see this work through. And now I get to sit back and do my continued part in fighting that #invisibilitycrisis.