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2017 Maurice “Mo” Mullet Lifetime of Service Award Recipient Dr. Marty Wasserman Shares His Experience as Past NACCHO President and How He’s Navigated the Political Landscape in Public Health

Interview by Taylarr Lopez, Communications Specialist, NACCHO

NACCHO is pleased to recognize Dr. Marty Wasserman, MD, JD, as the recipient of the 2017 Maurice “Mo” Mullet Lifetime of Service Award. This award honors current or former local health officials for noteworthy service to NACCHO that has reflected the commitment, vigor, and leadership exemplified by Mo’s distinguished career. For nearly 40 years, Dr. Marty Wasserman has proved his commitment to public health through leadership positions in service of medically underserved communities. 

During his tenure as NACCHO President from 1988 to 1992, membership and funding doubled and the organization created several “named” leadership awards to recognize deserving public health officials. In 1990, through collaboration with the Centers for Disease Control and Prevention, Dr. Wasserman helped to develop NACCHO’s first National Profile of Local Health Departments. While serving as NACCHO Board Treasurer, he helped jump start NACCHO’s work in environmental health by securing a contract with the Agency for Toxic Substances and Disease Registry. Dr. Wasserman worked with Dr. Maurice “Mo” Mullet to initiate NACCHO’s annual conference and developed resources to better align local health department nomenclature and services. Under his leadership, NACCHO’s visibility increased, which helped the organization better represent its members’ work in promoting wellness and preventing disease.

Before Dr. Wasserman was elected NACCHO President, he served as County Health Director in Arlington, VA, from 1978 to 1987. He subsequently served as local health official in Montgomery and Prince Georges Counties, Maryland until 1994 when he became Maryland Secretary of Health and Mental Hygiene. Currently, Dr. Wasserman is the Medical Director at Provider Resources, Inc., where he works on projects that aim to eliminate early elective deliveries and reduce central line infections to newborns.

NACCHO: Tell us about your career path in local public health.

I started in Arlington, VA shortly after completing my pediatric training, a tour in the Indian Health Service, and law school. I was interested in securing a leadership position outside of clinical medicine in public health and was soon offered a position as director of human resources that included the health department and social services which allowed me to merge health and social services to better serve the public. In that position I learned a lot about diversity. Early in my career as Health Director in Arlington County (VA), I was faced with addressing a tuberculosis outbreak among the Vietnamese immigrant population. Navigating the cultural and legal landscape for successfully tackling that public health issue was a valuable learning experience. During my time in Arlington County, many programs were implemented to address a number of public health issues like HIV/AIDS, domestic violence, and homelessness. In addition, we developed one of the earliest hospice programs in the country.

Eventually I took a position as Health Director in Montgomery County, MD.  When several obstetricians decided to stop delivering our county maternity patients, I worked with the hospitals in the county, other obstetricians, the county executive, the governor, and the state legislature, to create a program which allowed us to hire physicians temporarily as county employees and protect them from liability in return for serving indigent pregnant women. For this effort, we received the Ford Foundation and John F. Kennedy School Innovations Award.

After my time in Montgomery County, I transitioned to Health Director in Prince George’s County, MD which had the largest majority population of African Americans in the nation. We established a health center in that section of the county, adjacent to Washington D.C. That is when I first met George Benjamin, the current director of the American Public Health Association who, at that time, was the Commissioner of Health in Washington D.C. We both realized that this area in both of our jurisdictions struggled with the same health problems and we began a series of collaborative efforts that continued beyond both of our tenures in these two positions.

In 1994, the Governor appointed me to serve as Secretary of the Maryland Department of Health and Mental Hygiene where we developed many tobacco control programs and created Health Choice and the Children’s Health Insurance Program, our Medicaid-managed care effort. We also focused on several initiatives related to data collection, analysis, and reporting.

NACCHO: What are you most proud of accomplishing during your tenure as NACCHO President?

During my time as NACCHO President, we had a Board that consisted of several terrific people. As NACCHO expanded, we watched the membership grow, the budget increased, and a number of these board members later served as NACCHO Presidents. I was very fortunate to have been able to work with so many competent leaders in local public health. Helping to build NACCHO’s organization and creating a powerful group of local health departments is something I’m very proud of. During this time we contracted for NACCHO’s first environmental health grant from the Agency for Toxic Substances and Disease Registry which helped launch NACCHO’s efforts in environmental health matters.

NACCHO: As Secretary of the Maryland Department of Health and Mental Hygiene, you developed several initiatives related to data collection, analysis, and reporting. You were also instrumental in developing NACCHO’s definitive National Profile of Local Health Departments study. How has the availability and use of data changed over the course of your career and how can LHD leaders strategically use data to improve public health today?

I’ve always believed that knowledge and information were very powerful. Having accurate data gives us the ability to make appropriate and informed decisions. Having an analysis of gathered data and information gives us a leg up against competition. Professionals in public health know that there’s never enough money to address all the issues in this field, so having data allows one to be able to set goals and objectives, track and monitor programs, and provide continuous quality assurance. Having data grants organizations the opportunity to hold programs accountable, regroup and review the issues, and make modifications to get the preferred outcomes. The most relevant example today, I believe, is the opioid epidemic. Data has sufficiently increased over the past several years as it relates to the number of overdoses, deaths, visits to hospitals, and number of prescriptions written. This data can be used to educate healthcare professionals and the public and develop evidence-based initiatives to deal with this problem.

NACCHO: In your nomination, your colleague mentioned you tell it like it is and do not dwell on political correctness. How have you navigated the sometimes tricky political issues that health department leaders encounter?

Sometimes dealing with political issues in this field isn’t always easy. I’ve always tried to be honest and hardworking. I’m dedicated to the work that I do and the population that I serve. As a health director, I was responsible for examining the health of that community, gathering data, and determining what steps to take when addressing public health concerns. Putting assessment, policy, and assurance into everyday practice guide the actions of those of us in local public health. We then bring this information to our county councils or boards of health to gain support for present and future public health needs in the community.

When there were political issues, people were aware that I had done extensive research and always tried to adequately serve my population. I think they respected those efforts and provided a little freedom when I had to bring controversial issues before them.

NACCHO: What value have you found in being a NACCHO member?

NACCHO provides so much support for local public health. When dealing with things such as natural disasters, outbreaks, and prevention efforts, NACCHO has provided public health officials with a wide range of effective and up-to-date resources to help communities across the nation. Getting essential information out to print and broadcast media has helped communities in a tremendous way with receiving the necessary guidance for responding to and preparing for emergencies and addressing public health issues. NACCHO has and will continue to be an excellent resource for local health departments.

NACCHO: What does winning the Mo Mullet Award mean to you?

I had worked very closely with Mo for a number of years. I had the utmost respect for him. His integrity is unmatched. Although he was extremely professional and passionate about his work, Mo did like to have fun. He was a huge Ohio State supporter and established teaching programs for medical students and alumni.  But his love of Buckeye football was unsurpassed. One year, he and Phyllis invited Barbara, and me to see a big ten football game. It was very exciting! To receive an honor in his name and to be honored by your peers is something that I will treasure for the rest of my life. I thank NACCHO and its members for choosing to honor me this way and Mo for his service and accomplishments.

NACCHO: What advice would you give to young professionals just starting their careers in local public health?

Any career serving others is very rewarding but having the opportunity to help serve your community and improve lives at the same time is both exciting and challenging. I believe local public health is a calling that provides immense personal satisfaction. I’ve loved every minute serving as a local public health official and know that these words reflect the feelings of all those who have had a similar opportunity.

American Diabetes Month: Local Health Departments Work to Mitigate the Burden of Diabetes Across the Nation

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston

Today, over 30 million people in the United States live with diabetes—the seventh leading cause of death in the nation.1 Every day, local health departments (LHDs) work with community partners including schools, city planners, businesses, and restaurants to educate the public about diabetes and develop programs and policies to aid prevention, screening, and management.

November is American Diabetes Month, a time for the nation’s LHDs and other healthcare organizations to bring awareness to their efforts in preventing, screening, and managing diabetes.

The Burden of Diabetes in the United States

According to the 2017 National Diabetes Statistics Report, 30 million people in the U.S. have diabetes—that’s over 9% of the U.S. population.1 In 2014, approximately “14.2 million emergency department visits were reported with diabetes as any listed diagnosis among adults aged 18 years or older.”1 In 2015,, approximately 80,000 death certificates listed diabetes as the underlying cause of death.1 Adults with diabetes have a 50% greater risk of premature death than adults without diabetes.

Minorities have a greater risk for being diagnosed with type 2 diabetes. Additionally, people who are overweight, have high blood pressure, have a family history of gestational or type 2 diabetes, are over 45 years old, or are physically active less than three times per week are at a higher risk for getting diabetes.

Medical expenses for people living with diabetes is double compared to those without. In 2012, the total estimated cost of diagnosed diabetes in the U.S. was $245 billion. On average, the medical costs for a person with diabetes totaled $13,700, with $7,900 attributed to the disease.1 High blood sugar levels damage blood vessels and nerves, resulting in harm to vital organs, like kidneys. People with diabetes have a greater risk for experiencing serious health complications including heart disease and stroke, blindness and other eye issues, renal failure, and possible amputations.

Local Health Departments Support Diabetes Control and Prevention

Nationwide, LHDs play a critical role in arresting and reversing the diabetes epidemic. The Frederick County Health Department (FCHD) in Maryland developed the Power to Prevent Diabetes Prevention Program to reduce the number of residents who develop type 2 diabetes, and prevent or delay the health complications associated with the disease. This 2011 award winning model practice also implemented an environmental change component called the “Frederick Restaurant Challenge” in which participating restaurants offered healthy meal options for people with diabetes. This initiative gave diners the opportunity to rate their dishes, and the restaurants with the highest rating won an award. Objectives of the program included having overweight participants lose 5-7% of their body weight, getting participants to be physically active for at least 30 minutes per day, five days per week, and helping to find a medical home for participants who haven’t seen a healthcare provider in the past year. FCHD’s prevention program activities that supported their objectives included the 12-week Power to Prevent Classes, sessions with a registered dietician, and food activity tracker tools.

At my health department, we are attempting to bend the diabetes curve with our Healthy Living Matters (HLM) program. This program mobilizes policy action to reduce childhood obesity, often a precursor diabetes as an adult. With an estimated 34% of children in Harris County being overweight/obese, our community faces a significant health burden. Without action, many of these children will go on to develop type 2 diabetes and other sequelae of obesity.

With such a large fraction of our children being overweight, HLM decided to focus on policy. Our focus on policy means that any success will reach large numbers of the population. Our efforts are multi-prong and focus on where kids eat, play, and learn. We encourage use of available public lands in Harris County for the development of community gardens and farmers’ markets. We also are partnering with Harris County School Health Advisory Councils to support policy that requires physical activities subcommittees and recommendations for joint-use agreements and community/school partnerships. And we are promoting outdoor classrooms and the incorporation of active learning into core curriculum subjects to increase physical activity in Harris County school districts.

Our goal is to focus on prevention. If we can teach children healthy habits, work within communities to change policy, and leverage the skills of our partners, our children have a chance to grow up into healthy adults. It truly does take a village and with the health department leading these improvements, it will lead to healthier outcomes of lowered obesity and less diabetes for our community. It will have an additional benefit of reducing the total cost of care within our community, as fewer people will need to pay for the expensive complications that arise from being obese or diabetic.

NACCHO Assists Local Health Departments in Prevention and Control Efforts

NACCHO has many resources dedicated to the prevention and management of diabetes. The “Local Health Departments’ Capacity to Prevent and Control Diabetes in Priority Populations” research brief highlights the results of the Centers for Disease Control and Prevention’s (CDC’s) Diabetes Today training, delivered by NACCHO at 36 LHDs. The program was designed to assist public health professionals in developing a strategic and effective plan for addressing diabetes. The research brief explains the methodology; discusses the impact of the training, challenges and barriers, resource needs, and collaborations; and highlights dissemination activities.

As part of the CDC’s National Diabetes Prevention Program (NDPP) Local Sub-Awardee Community of Practice Project, NACCHO has compiled details from three practices that have worked with CBOs and healthcare providers to integrate the NDPP into clinical and community systems of care. The success stories of the three practices — PartnerSHIP 4 Health in Minnesota, ProMedica Bixby Hospital in Michigan, and the Salt Lake County Health Department in Utah — all highlight their progress in scaling and sustaining the project.

NACCHO offers several applicable policy statements that LHDs can tailor to their programs regarding issues including obesity prevention, access to healthy food, and healthy community landscapes. Additionally, NACCHO’s toolbox houses many replicable practices dedicated to the prevention and management of chronic diseases, including diabetes.

Adopting a Healthy Lifestyle Makes a Difference

With the current trend in incidence and prevalence of diagnosed diabetes in the U.S., as many as one in three adults could have diabetes by 2050. There are many steps people can take to prevent being diagnosed with diabetes and greatly reduce their risk of diabetes-related health problems, including:

  • Eating more fruits and vegetables and reducing salt and sugar intake;
  • Getting physically active;
  • Checking blood sugar regularly;
  • Taking diabetes medicine as prescribed;
  • Stopping or not starting to smoke; and
  • Making regular visits to a healthcare provider.

Throughout American Diabetes Month, NACCHO encourages the nation’s LHDs to raise awareness of diabetes and continue to develop innovative, sustainable, and effective programs that reduce the prevalence of this disease in their communities.

 

Resources

Model Practice – Frederick County Health Department’s Power to Prevent Diabetes Prevention Program

CDC Diabetes At A Glance Fact Sheet

CDC Diabetes Information Homepage

NACCHO’s Diabetes Webpage

References

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2017.

Laying the Infrastructure for Breastfeeding Partnerships in Lee County

By Emily Bernard, IBCLC, NACCHO consultant in collaboration with Carol Lawrence, PhD, MS, BSN, RNC-OB and Lori Riddle, Lori H. Riddle, RD, LD/N, CLC  Florida DOH and Lee Health

Synopsis

The Florida Department of Health in Lee County (DOH Lee) worked alongside three hospitals during NACCHO’s Reducing Breastfeeding Disparities through Peer and Professional Support project. DOH Lee’s project was designed to improve the county’s environment to support breastfeeding for black families through the establishment of a strategically developed coalition, as well as through the provision of advanced training of agency and hospital staff, other than nurses, to improve breastfeeding support within the hospital and the community. DOH Lee helped to implement the EMPower Breastfeeding Project by providing prenatal education and postpartum support to low-income, black families delivering in these enrolled hospitals.

Challenge

Although Florida breastfeeding initiation rates have already achieved Healthy People 2020 goals, inequities among African Americans are evident (See Table with rates comparison). Increasing the percentage of mothers who exclusively breastfeed is one of the core goals of the State Health Improvement Plan (SHIP). To achieve this goal, it is essential that hospitals and community agencies work together to support breastfeeding initiation and continuation. With funding from NACCHO, Lee Health and DOH Lee was able to develop a vital collaboration to boost breastfeeding rates.

Florida  2014 Lee County  2014
Average (2014) 84.2% 75.8%
African American (2014) 75.1% 59.9%

The DOH Lee WIC (Women, Infants, and Children) program had previously implemented the Loving Support© Makes Breastfeeding Work to guide staff training, ensure the provision of quality client education and appropriate support, and expand outreach efforts. However, there was a lack of diversity in the lactation workforce, few coordinated breastfeeding efforts, and no community-wide discussions on these issues.

Solution

DOH Lee developed formal partnerships by establishing a local breastfeeding coalition to support the project. Under supportive leadership, they were able to use the same framework of the successful pre-existing countywide coalition by creating the project’s mission, vision and goals. The newly established diverse community-wide coalition identified effective strategies to address breastfeeding inequities in its community.

DOH Lee also provided professional lactation education to women within the targeted underserved community. The need for a higher level of support was identified in both hospitals and at WIC. Five candidates were selected to receive advanced breastfeeding training. Hospital policy prevented its staff from providing direct breastfeeding assistance without additional training; thus, the hospital scholarship recipients included two certified nursing assistants and one child advocate with no formal breastfeeding education. The remaining scholarship recipients worked for WIC as Breastfeeding Peer Counselors and had limited breastfeeding education. Both groups reported frustration that they could not help women and families with assistance when lactation issues arose.

In addition to training, these candidates also received a paid mentorship.  DOH Lee believed that the bi-directional training between the hospital and WIC was imperative in order to address continuity of care. They wanted them to be exposed to each other’s setting to broaden perceptions, understand challenges faced with breastfeeding initiation immediately post-delivery, and the issues faced post-discharge. A policy for hospital staff training at the WIC clinic was developed, but the short grant period made it a challenge to complete the policy for WIC staff to go the hospital. These trainings required a high level of collaboration between the two systems and removing the barriers that frustrate and inhibit many short-term projects.

Results

As a result of this project, there was an improved continuity of care for low-income, African American  and Hispanic families in Lee County. There is now a hospital-WIC policy in place and available trained staff, which allows for support during bedside “teachable moments” at the hospital. In addition, breastfeeding messaging is accurate and consistent, which is a result of the improved communication among partners.

Furthermore, the stand-alone breastfeeding coalition is growing and building momentum for lasting environmental changes and future policy. The countywide coalition, HealthyLee, incorporated breastfeeding as a health and nutrition improvement goal into the strategic plan for a healthy community. The breastfeeding coalition is now moving breastfeeding into the policy arena with participation on the infant mortality taskforce. They have also created a pathway for professional lactation education.

A significant project outcome was the development of a strong partnership among the county’s three local hospitals and the County Health Department. These newly formed partnerships have opened up communication to reduce barriers for clients between hospital and WIC offices. The training allowed for an increased potential staffing pool for future program growth and development. This grant opened up lines of communication that will improve breastfeeding support and reduce barriers along racial, ethnic, and economic fronts.

To learn more about DOH Lee County project, watch this webinar on Building Sustainable Projects through PSE Changes https://naccho.adobeconnect.com/_a1053915029/pmlwrb7ewnjw/. Continuing Education credits are available.

Contact info:

Carol Lawrence, PhD, MS, BSN, RNC-OB

Supervisor, Perinatal Practice, Education, Research, and Lactation Carol.Lawrence@LeeHealth.org Carol.Lawrence@LeeHealth.org

 

Lori H. Riddle, RD, LD/N, CLC

WIC Director

Lori.Riddle@flhealth.gov

Meet NACCHO’s 2017–2018 Health and Disability Fellows

This story originally ran in NACCHO’s Essential Elements.

The NACCHO Health and Disability Program is thrilled to introduce the 2017-18 cohort of Health and Disability fellows. NACCHO’s Health and Disability Fellowship program is an invaluable opportunity for graduate students pursing degrees in public health to receive hands-on experience in the health and disability field. The fellowship includes providing support to local health departments (LHDs) through NACCHO’s Health and Disability Technical Assistance Program; expanding written and oral communication skills; and participating in networking opportunities with leaders in the health and disability field. This year’s fellows, Katelynd Todd, Vanessa Vassall and Whitney Thurman, come with impressive public health backgrounds. Continue reading

Understanding the Changing Public Health Landscape: Findings from the 2017 Forces of Change Survey

The National Association of County and City Health Officials (NACCHO) has released its 2017 Forces of Change report, The Changing Public Health Landscape, containing new findings on the forces that are affecting the nation’s local health departments (LHDs). LHDs face both challenges and opportunities as the public health environment evolves, and the Forces of Change survey helps to identify infrastructure gaps, as well as strategies for strengthening public health capacity. Continue reading

Convening Cross-Sector Partnerships to Implement Health in All Policies at the Local Level

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston

Local health departments (LHDs) play a critical role in ensuring that communities across the nation are healthy. We work every day to ensure the safety of the water we drink, the food we eat, and the air we breathe. Over time, many LHDs have broadened their missions and scope of services to address the root causes that influence health. It’s becoming commonly understood that factors like our socioeconomic status, education, the physical environmental, employment status, social supports, and access to care all play a part in shaping our health and quality of life. In addition to addressing infectious disease and chronic disease, we’re now focusing our efforts on the social determinants of health. With this increasingly complex view of health, it is imperative that LHDs move beyond the walls of our health departments to collaborate with the myriad other organizations that impact the social determinants of health and help them take into account how their policies and programs affect the health of communities. One promising tool for engaging in this work is the Health in All Policies (HiAP) framework. Continue reading

Member Spotlight: DeKalb County Health Director Sandra Ford Discusses Her Department’s Wellness Policy and Highlights Successes from the MORE Moms Program

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 Sandra Ford, MD, MBA, FAAP, District Health Director and CEO of District 3, Unit 5 DeKalb County Board of Health in Georgia. She is also a member of NACCHO’s Board of Directors. Below, she shares how her department was the first in the state to implement a wellness policy, which encourages staff members to be active during the day, and highlights the successes of the Mothers Offering Resources and Education (MORE) Moms programs. Continue reading