Author Archives: nacchovoice

Dakota County Public Health Builds on Breastfeeding Program to Create Rapid Referral System

By Harumi Reis-Reilly, MS, LDN, CHES, IBCLC, Lead Program Analyst, NACCHO, and Katie Galloway, MBA, RD, LD, IBCLC, Dakota County WIC Program

Dakota County Public Health Department (DCPHD) in Minnesota, a 2017 NACCHO Model Practice awardee, built upon their comprehensive breastfeeding program and implemented a rapid referral system to expand access to critical lactation care to low-income families. Through the Reducing Breastfeeding Disparities through Peer and Professional Support grant, DCPHD increased participation by 68% in prenatal breastfeeding classes and more than doubled their rapid-response lactation visits.

DCPHD provides many services to the large underserved members of its community, especially pregnant women and new mothers. For example, in 2010, about 33% of babies born were to low-income women on Minnesota’s Medicaid Program. Dakota County WIC participants started breastfeeding at high rates (85%) in 2013, however only 38% of them were still breastfeeding at six months. While breastfeeding initiation among African

Americans in the Dakota County WIC program are among the highest in Minnesota, there are concerning inequities related to the exclusively breastfeeding rates. For instance, according to the WIC database, African American clients are more than four times less likely to exclusively breastfeed than white, non-Hispanic women.

One of the reasons for low exclusivity breastfeeding rates among African American moms was the limited availability of affordable lactation support services in Dakota County. Hospitals and medical providers outsource prenatal and postpartum breastfeeding classes and support services to for-profit businesses, whose fees pose a financial barrier that prevents low-income families from receiving appropriate breastfeeding education and support. Due to staffing limitations and inadequate lactation training for public health professionals, there are few affordable breastfeeding services available in the area.

Although DCPHD’s family health nursing staff regularly promoted breastfeeding, only 8% of its staff had have completed advanced breastfeeding training. While all DCPHD WIC staff was trained at the Certified Lactation Counselor (CLC) level, staff and clinic scheduling constraints made it difficult to provide adequate support.

Prior to NACCHO funding, DCPHD led the Breastfeeding-Friendly Health Department initiative, designed to improve the breastfeeding environment and increase organizational capacity to support breastfeeding. This initiative was piloted in ten local health departments (LHD) in the state. Pilot sites implemented the ten-step protocol, including supportive policies and use of champions as outlined in the Breastfeeding-Friendly Health Department Toolkit. This program has been successful and is now recognized as a Model Practice, receiving the 2017 NACCHO Award due to its contribution to the overall improvement of public health through effective evidence-based practice methods. Watch their presentation here: Link to Dakota Presentation.

In 2015, with funds from NACCHO and the Centers for Disease Control and Prevention (CDC), DCPHD enhanced its comprehensive breastfeeding program by implementing a new component: the rapid response system. This initiative provided advanced lactation support by trained public health nurses within 24 hours of referral. The program addressed critical gaps in breastfeeding support services for African American, low-income, and underserved communities in Dakota County.

DCPHD works cooperatively with the Dakota County WIC program to support prenatal breastfeeding classes, since most DCPHD clients who are pregnant women and new mothers are also WIC participants. DCPHD also worked with Dakota County’s 360 Communities, a faith-based organization, and the Community Action Program to provide breastfeeding education training to home visitors with the goal of increasing the provision of lactation education among nursing mothers.

DCPHD was able to meet the identified community needs of access to immediate, critical support through the implementation of the rapid-response to lactation referrals. DCPHD increased organizational capacity by training 60 staff members on basic and advanced lactation management. This increased number of available trained lactation support providers led to greater availability of free-of-charge breastfeeding classes throughout the community, and a 68% increase in participation in classes. In addition, the rapid referral system more than doubled the number of rapid-response lactation visits (from 2.8 to 6.9 visits/month) during the grant period.

In addition to training public health nurses who visit clients, DCPHD was also able to build on the capabilities of additional home visitors, enabling them to provide basic lactation support and make appropriate referrals to sustain breastfeeding.

Since Dakota County already had a foundation of supportive policies and systems in their Breastfeeding-Friendly Health Department before NACCHO’s grant, they were able to build upon this supportive environment and quickly implement additional components to its program. The key factors in their success were the supportive leadership within the organization, the previously built foundation of implemented policies and systems, and prior key partnerships with WIC and a home visiting agency.

For more information, contact: Katie Galloway, MBA, RD, LD, IBCLC; Dakota County WIC Program;

Celebrating National Public Health Week through Collaboration, Engagement, and Action

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

April 2–8 is National Public Health Week (NPHW), a time to recognize the key contributions of public health and highlight issues that are important to improving our nation’s health. The celebration, organized by the American Public Health Association, is commemorated during the first full week in April each year. This year’s theme is “Healthiest Nation 2030: Changing Our Future Together” and underscores the importance of improving health in the places in which people live, learn, work, worship, and play. Each day is dedicated to a topic-specific theme: behavioral health, infectious disease, environmental health, injury and violence prevention, and ensuring the right to health. NPHW presents a terrific opportunity for local health departments (LHDs) to engage partners and community members to raise awareness about the life-saving work we do year-round. Continue reading

Are America’s Local Health Departments Prepared for a Cape Town-level Water Crisis?

This story originally ran in NACCHO’s Essential Elements.

Americans currently use about 100 gallons of water per day per person. In Cape Town, South Africa, extreme drought has limited residents to just 13 gallons of water per day since February 1. Depending on rainfall over the coming months, water taps in households and businesses may shut off entirely in this popular tourist destination, one of the wealthiest cities in Africa. Continue reading

Member Spotlight: Boston Public Health Commission Executive Director Monica Valdes Lupi Discusses the Evolution of Local Health Departments’ Role in Public Health and Her Path to Leadership

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 Monica Valdes Lupi, JD, MPH, Executive Director of the Boston Public Health Commission (MA). She is also a member of NACCHO’s Board of Directors. Below, she shares what led her to become Executive Director of the Boston Public Health Commission and steps her department is taking to prepare for the future. Continue reading

The Local Health Department Response to the Zika Virus: Lessons Learned and Looking Ahead

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

Local health departments (LHDs) have been on the front lines of responding to the Zika virus since its emergence as a public health threat in the United States (U.S.) more than two years ago. The virus, spread by Aedes aegypti (L.) and Ae. albopictus Skuse mosquitoes, carries adverse and costly health risks for pregnant women and their babies and has affected communities across the U.S. According to the Centers for Disease Control and Prevention (CDC), 2,395 pregnant women in the U.S. states and the District of Columbia have shown laboratory evidence of possible Zika virus infection to date. Additionally, NACCHO’s 2017 Forces of Change survey found that confirmed travel-related cases of Zika have been reported in nearly 90% of large LHD jurisdictions. LHDs incorporated a multi-pronged, One-Health approach to responding to the virus that included vector control, epidemiology, environmental public health, maternal and child health, community engagement, and advocacy activities. Continue reading

Member Spotlight: Health Director Dr. Muntu Davis Discusses the Social Determinants of Health and Public Health’s Focus Shifting from Infectious to Chronic Disease

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 Muntu Davis, MD, MPH, Director of the Alameda County Public Health Department in Oakland, CA. He is also a member of NACCHO’s Board of Directors. Below he shares how his health department works to address health disparities and the nation’s transition in public health priorities to address chronic disease. Continue reading

Responding to Youth Violence as a Public Health Problem

By Linda McGlone, MPH, STRYVE Coordinator, Monterey County Health Department, California

Looking at youth violence through a public health lens, the Monterey County Health Department contributed to violence reduction by offering their skills in data, strategic planning, and the public health approach.

In 2011, Salinas, California was a small city with a big city problem: gang violence. The violent crime rate for Salinas was 732.5 crimes per 100,000 residents – higher than Los Angeles’ rate of 522.4. For decades, gang-related shootings caused most of the city’s violent injuries. Monterey County had the highest rate of youth homicides in California in 2009, 2010, 2012, and 2013. Salinas is a city of 150,854 residents, 75% of whom are Hispanic or Latino. This is a young community, with a high percentage of families living below the federal poverty level, organizing to become a healthy and thriving community. The Monterey County Health Department (MCHD) recognized youth violence as a public health problem, and we saw that primary prevention was lacking from the community’s response. How could this perspective gain traction in a discussion led largely by law enforcement? Continue reading