Author Archives: nacchovoice

Fostering Agency Through Local Public Health

By Grenadier, Andrea, BA; Holtgrave, Peter, MPH, MA; Aldridge, Chris, MSW, NACCHO

This article originally ran in the Journal of Public Health Management and Practice.

When public health departments support all aspects of the public’s well-being—beginning with striking at the roots of health inequity—it can create transformational change. Part of this process is encouraging people in communities to determine their own futures, to express agency; something that is rooted in action and power. So, how does local public health get there?

We already have examples of success. For instance, local health departments have been at the forefront of health equity work by building internal capacity and infrastructure, fostering strategic community partnerships to build power and engage in social justice work, and working across government agencies to develop shared ownership for health equity.

However, although these examples exist, all too often public health’s efforts fail to improve population health—often because of the fear of failure.

There is fear of trying new initiatives that might not work out. There is fear of running out of time, will, allies, and money. There is fear of not meeting funders’ expectations, even when their expectations do not align with the community’s needs. There is fear of going against the governing bodies, such as mayors and other officials, even when their agendas may conflict with the community’s needs. And underlying all of this is the fear of losing ever-dwindling vital resources.

Addressing the roots of health inequity requires operating out of a social justice—and not just a medical—framework. In their role as scientists, public health practitioners can no longer shy away from addressing issues of unequal power and structural bias, such as racism.

The Seattle-based Bridging Health and Community is dedicated to exploring health from the perspective of communities. Its Creating Health Collaborative comprises innovators exploring health from the perspective of people and communities and how that perspective influences local efforts to create it. The Collaborative came to focus on the importance of agency to health and developed 12 Principles1 that describe inclusive, participatory, and responsive process to holistically shift how healthy communities might be developed.

Read the full article in the Journal of Public Health Management and Practice.

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.

Minneapolis Health Department Supports a Young Food Entrepreneur

By Dan Huff, Director of Environmental Health, and Gretchen Musicant, Commissioner of Health, Minneapolis Health Department

This story originally ran in NACCHO’s Essential Elements blog.

Jaequan Faulkner, 13, started selling hot dogs in front of his Minneapolis home in 2016, calling his establishment “Mr. Faulkner’s Old Fashioned Hot Dogs.” His food stand came back this summer bigger and better than before, and it grew popular with customers in the neighborhood. Continue reading

NACCHO Annual 2018: Unleashing the Power of Local Public Health

By Taylarr Lopez, Communications Specialist, NACCHO

On July 10–12, over 1,200 local public health professionals convened in New Orleans for the 2018 NACCHO Annual Conference. Throughout the conference, attendees learned from leading experts in the field, gained new insights in dozens of sharing sessions, and addressed the challenges affecting the work of local health departments (LHDs) and the nation’s health. Continue reading

NACCHO Annual Preview 2018: Community Resilience After Hurricane Harvey

Interview by Taylarr Lopez, Communications Specialist, NACCHO

This entry is the second in a series of “NACCHO Annual preview” blog posts, which feature interviews with presenters ahead of NACCHO Annual 2018. Alison Hare, MIA, Community Resilience Officer and Jennifer Kiger, MPH, Chief of the Office of Public Health Preparedness and Response at Harris County Public Health (HCPH), will discuss the importance of community resilience in preparedness and recovery in their upcoming presentation, “Community Resilience After Hurricane Harvey.” Below, they share how Hurricane Harvey created a need for HCPH to create a Community Resilience Officer position and methods used to evaluate a community’s resilience after a catastrophic event.

How do you define resilience and why is it important? What led to HCPH to create the Community Resilience Officer position?

We define community resilience as a community’s capacity to prepare for, withstand, mitigate the effects, and recover from public health emergencies, using a health equity lens. Community resilience is important to us because the healthier and stronger a community is, the more able they are to get through and rebuild after a disaster. Consequently, the more assistance and information we can provide on healthy living, preventative care, and preparedness before a disaster, the better off the community members will be during the disaster and in the long term as they recover and rebuild. Therefore, when Harris County is hit with a disaster, the response and recovery assistance needed within these more resilient communities may be lessened.

HCPH looks at health at the local, state, national, and global levels. When responding to recent global health issues such as Ebola, it became even more apparent that the health concerns of our citizens are affected by what is happening globally. There are some communities within Harris County that are harder to reach than others due to cultural and linguistic isolation, and the Community Resilience Officer (CRO) position was created to make connections with these communities—to link them to the information and services at HCPH, to assist in strengthening their resilience, and to be a resource to them during local and global disasters. The mission of the CRO is to address and strengthen the health and preparedness of individuals and communities within Harris County by creating and sustaining strong relationships between HCPH, external partners, and communities.

How do you evaluate your community’s resilience—both before and after a catastrophic event like Hurricane Harvey?

As there is a growing body of research around measuring community resilience, we have started using several techniques to measure community resilience and are still evaluating best practices. We have conducted several non-emergency and post-disaster Community Assessments for Public Health Emergency Response (CASPERs). These have allowed us to gather a variety of resilience-specific data such as mental health needs, how individual households receive information/communication, and community cohesion before and after floods. Immediately after Hurricane Harvey, we conducted two CASPERs in different areas of the county that were impacted to both evaluate preparedness levels before the storm and quickly assess disaster impact and current needs after the storm. This data was used to respond to immediate needs and guide our priorities and planning for the future.

We are also using geographic information systems to map vulnerabilities and assets with census data, and are fostering partnerships through meetings, focus groups, interviews. We are also currently working on defining a set of indicators, using a mix of data already being captured by HCPH—like mosquito data and epidemiological data—and “resilience-specific” data—like social cohesion indicators among others—to create a numerical base line to determine community’s resilience, and a methodology to measure the impact of HCPH on community resilience.

How involved were the affected communities in providing information about response and recovery efforts?

On the planning side, as we created the Community Health Resilience Strategic Plan, we spoke with a variety of community members and community partners to provide information on what community resilience is and how we, as the public health department, can best support our communities in strengthening our resilience. This influenced how we designed our community engagement plan and how we plan to communicate with our communities and partners.

During our response to Hurricane Harvey, affected communities were also able to provide information to our efforts through our CASPER. The CASPER questions captured the immediate needs of the community—including access to mental health, food, and assistance with mucking/gutting homes. We then used this information to inform where we took our public health services and what services and resources we provided. In addition, we were able to provide this information to our Office of Emergency Management partners, who were able to work with FEMA and other state and federal partners to bring services to the areas that needed it the most.

What was the most valuable lesson learned about resilience after Harvey? How does the department plan to use the information gathered to prepare for the next disaster?

So much of our work is focused on assisting those communities with fewer economic resources, and linguistic or cultural barriers, that we can lose sight of one of the biggest lessons we found from data after Hurricane Harvey. Resilience is needed in all Harris County communities. After Harvey and other recent flooding events, data has shown that even the communities most financially equipped to bounce back from a disaster also need to be better prepared physically, emotionally, and mentally. For example, our assessment of two communities impacted by Hurricane Harvey (one was more affluent, and the other less so) revealed that about 25% of the population in each community demonstrated symptoms of depression or anxiety after the storm that signaled a need for mental health services. However, in the less affluent community, over 50% of the households that reported a mental health need also reported not knowing how to access mental health services. Therefore, it is also important to remember that although all our communities will have needs following a disaster, one of our most important roles can be in facilitating access to care, resources, and information.

Interested in learning more about innovative initiatives like this one? View the full schedule, conference tracks, and objectives, and start making your plans to join hundreds of local public health professionals from across the nation for NACCHO Annual 2018. We look forward to seeing you and your team July 10–12 in New Orleans!

NACCHO Annual 2018: Preview the Power of Collaboration—The Arizona Athlete Opioid Initiative

Interview by Taylarr Lopez, Communications Specialist, NACCHO

This entry is the first in a series of “NACCHO Annual preview” blog posts, which feature interviews with presenters ahead of NACCHO Annual 2018. Tracy Cruickshank, MBA, MSW, Manager for the Office of Healthcare Innovation at the Maricopa County Department of Public Health (MCDPH), will discuss her department’s Arizona Athlete Opioid Initiative, which was developed to prevent prescription opioid misuse among high school athletes, in her upcoming presentation, “The Power of Collaboration: The Arizona Athlete Opioid Initiative.” Below, she shares how and why this initiative was implemented, how it expanded to include partners with much greater reach and influence over high school athletes, and the benefits of this collaborative effort. Continue reading

NACCHO Annual 2018: Take a Glimpse into New Orleans Public Health

Interview by Taylarr Lopez, Communications Specialist, NACCHO

Torrie Harris, Dr.P.H., MPH is a Health & Equity Strategist at the New Orleans Health Department (NOHD). In the following post, she discusses her role within the department, shares how NOHD is addressing the public health burdens of maternal and infant issues and mental health, and highlights the fun things NACCHO Annual 2018 conference attendees can do during their visit to New Orleans. Continue reading