Interview by Taylarr Lopez, Communications Specialist, NACCHO

Let me preface this conversation by mentioning how hard it was to gather these reflections. It’s not that this past year has been so difficult—quite the contrary because it has been so rewarding, and busy— but because the end of the year is bittersweet. In many ways, the energy and passion of NACCHO, its members, its staff, its Chief Executive Officer Lori Tremmel Freeman, and the public health workforce in general, has provided a source of fuel to keep me engaged with and motivated about public health.

Firstly, I want to thank the NACCHO staff that are so dedicated and talented and keep the NACCHO operation in motion. The staff has worked hard to support my efforts over the past year. I am grateful to the Board of Directors whose visions and thoughts guide the NACCHO operation and assure that we are working for all the local health departments across the country. Finally, I’d like to thank the Officers: Dr. Umair Shah, Past-President, Jennifer Kertanis, President-Elect; and George Roberts, NACCHO’s incoming President.

I am comforted by the upcoming leadership and the support system around them. NACCHO is in great hands and I am confident it will continue to grow, improve, and prosper in the future. Although I will always be available to support and assist, I will dearly miss the direct involvement.

What have you learned during your tenure as president and what advice would you like to pass on to the next president?

This past year has solidified my long-held belief that the NACCHO staff and members are some of the most awesome people. It has affirmed my belief that the public health workforce is indomitable. They work on challenging issues, in trying, stressful, under-resourced conditions, and yet they do it with a smile on their face and an unending belief that they will make a difference.

While local health departments and communities across the country have issues that are different, we are essentially all the same in many ways. We are working on many of the same public health concerns, struggling with similar challenges, and yet, are regularly achieving positive outcomes for our communities. As I listened to our members across the country, it was evident that the public health workforce is a community unto itself and we can—and do—share with and learn from each other. Our shared experiences and expertise are likely to be useful no matter where we are. For this reason I encourage you all to get engaged with NACCHO and your colleagues across the country.

At the same time, NACCHO is made up of an incredibly diverse group of members and we must remember that NACCHO is here to serve all local health departments in the best way possible. Although we may have structural or political differences, we need to address all concerns, provide for all types of local health departments, and find common ground that can lead to greater consistency and efficiencies across the country.

To George Roberts, the incoming NACCHO President, and those who will follow, I remind you to always remember whom you are representing. We all come to this position with our own unique education, experiences, beliefs, and biases, but we should try to set them aside to assure equitable representation for all local health departments. As leaders, we need to take a stand, but do so in a way that reflects the needs of local health across the country. The diversity and dedication of the NACCHO Board of Directors makes this fairly easy, as they are truly representative of local health and provide the insight needed to assure equity.

What are some of the most notable initiatives or projects you worked on as NACCHO president?

At the 2018 NACCHO Annual Conference, I outlined three initiatives I hoped to begin work on throughout the year and that would be carried forward in future years. First was to support our newly hired Chief Executive Officer (CEO) Lori Tremmel Freeman. Lori has done a tremendous job in her position, and while the Board and I will continue to support her and the staff, I have great confidence that she will continue to lead NACCHO in a positive direction. Lori made this initiative especially easy.

Second, I expressed a desire to improve existing and create new partnerships. Through the efforts of the Board, the CEO, and other NACCHO staff, I am happy to say that existing partner relations have greatly improved and new partnerships have been developed. NACCHO has been asked by partners to take on new projects, exhibiting the level of trust our partners have in us. More specifically, the Robert Wood Johnson Foundation (RWJF) is providing funding for NACCHO’s new global health initiative. This area was initially broached by Past-President Dr. Umair Shah. Through the efforts of Umair and Lori, who continued to foster the relationship with RWJF, we are moving forward with new funding.

The most thrilling example of our partnership development came in March 2019. For the first time, we collaborated with the Association of State and Territorial Health Officials (ASTHO) and the National Association of Local Board of Health (NALBOH) during our annual visits in Washington D.C. to advocate for public health on Capitol Hill. As a result, three different organizations descended upon policymakers with the same message to support public health. We had an unprecedented number of visits with policymakers. Our public health voice was collective and loud. Recognizing that coordinating this effort placed a large burden on NACCHO staff, I do hope that we find a way to continue, and maybe even expand, these collaborative efforts to amplify the voice of public health in the future.

Finally, my third initiative was to address the needs of small- and medium-sized health departments across the country. The first step in this initiative is to define what we mean by these terms. Historically, we have defined local health departments by the size of the populations they serve, but this may not always be the best way to categorize as resources, staff size, geography, and other factors may all play a role in how we are defined and operate. This initiative is very much a work in progress, but I am pleased that the Board of Directors continues to discuss this.

These discussions are leading to strategic conversations in other venues such as NACCHO membership and accreditation through the Public Health Accreditation Board. Jurisdictions have unique challenges and opportunities based on their size and structure but we need to understand these challenges and opportunities better. By doing so NACCHO will be better positioned to find ways to assure we meet the needs of all local health departments from the “small” rural health department in Washington to the “small” urban health department in New Jersey, and everyone else. We need to understand their differences and similarities, and how we as an organization can best learn from them and serve them all.

During your time as president, what changes have you seen in public health and what challenges do you think local health departments faced the most?

I’ve noticed some changes at the highest levels of the federal government in recognizing the work of local health departments and a greater willingness to work directly with local public health. We have a long way to go, but improvements have been noticed. I have seen a change in NACCHO over the past year. Morale appears to be higher, our financial status is more stable, our partnerships and collaborations are growing and improving, and the Board of Directors is more focused on strategic activities; all positives in my mind and trends that I expect will continue through the upcoming years and leadership.

I don’t think the challenges for local health departments has changed much. We always struggle to have the resources we need to do the jobs expected of us, especially for our workforce. However, I do see a possible “silver lining” as we have a large cadre of public health students in the pipeline. Undergraduate and graduate public health programs across the country are booming. We just need to assure that we have the financial resources dedicated to local public health that allows local health departments to hire and mentor these new, young public health professionals so that local public health can continue to thrive and make a difference for our communities far into the future.

What are some of the most pressing issues you see on the horizon for local public health and how can local health departments address them?

I think the most pressing issue for public health is how we elevate its value with our residents and policymakers. We need to find a way to impress upon the community that public health is important all the time, not just during and immediately following a major incident; that public health is everywhere and everyone all the time. As we all know, if we do our jobs right public health is largely invisible. This means that we are notoriously under-resourced and unrecognized. Unfortunately, I think this often leads public health professionals, to dwell on these facts, and focus on the money.

To defend our requests for resources, we depend on science-based information that demonstrates our value. While this is completely necessary, I am not sure how successful it has been. Therefore, I have been asking my colleagues to focus on the art of public health, in addition to the science. I have asked colleagues to tell stories in a compelling and passionate way that convinces the public of our value, but does not require them to understand the science that supports our actions.

My wife, a children’s librarian, is always using stories and crafts to develop a child’s interest in reading. It is our job to continue to develop the science and to use it to our advantage, but I also think it is our duty to create an interest in public health by expressing to our communities and policymakers the value of public health through stories, images, and art. We need to be a compelling force for public health and we should hone our skills in the arts to match our scientific abilities such that we can communicate the joy and impact of public health effectively to all parties.

What was your favorite thing about being president and after your term, what are you most looking forward to doing in your free time?

Virtually, all my experiences as President over the past year have been positive, but my favorite two things are very much related. I loved travelling to meetings around the country to talk about NACCHO and the work it is doing. I’ve enjoyed meeting representatives of local health departments across the country. I also cherished the opportunities to listen and talk to different local health department representatives. Meeting with and talking to State Associations of County and City Health Officials and their members, hearing about their challenges and concerns, as well as their successes, helped me understand how NACCHO can better serve, but also helped me as a public health professional. I was able to learn from my colleagues and I hope I will be able to translate that learning into greater public health success with my department and colleagues in New Jersey.

Being President of NACCHO has been incredibly rewarding, humbling, and inspiring, but it has also been time consuming. I hope that in my “free time” I will be able to reengage with my New Jersey State colleagues on some state initiatives and focus more on public health in my jurisdiction. My staff has been great at filling the gaps of my physical and mental absence, but it is time for me to focus more efforts at home. This also includes my personal home.

I hope to spend more time with my wife doing the things we enjoy such as hiking, travelling, and visiting small, local craft breweries. Who knows—if there is enough free time, I might even work on the development of a personal art and start playing music again. A long time ago, a close friend told me when I finished an emergency medical training program, that I would soon find something to fill the free time. Sure enough, he was right and ultimately that master’s degree helped me become President of this great association. I look forward to whatever fills my free time and to the upcoming adventures. Thank you for this great opportunity!