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NACCHO Annual 2017: Bridging Clinical Medicine and Population Health

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Dr. Shah and members of NACCHO’s leadership team address the crowd at the inaugural Member Connect session

By Lindsay Tiffany, Lead of Publications, NACCHO

On July 11–13, more than 1,200 local health department (LHD) leaders and staff assembled in Pittsburgh for the 2017 NACCHO Annual Conference, the largest annual gathering of local public health leaders and partners in the United States. Over the course of the three-day conference, attendees learned from national public health experts, shared effective programs and strategies for improving local population health, and tackled the most pressing issues affecting the work of LHDs today.

The theme of this year’s conference, “Public Health Revolution: Bridging Clinical Medicine and Population Health,” set the stage for discussions about how LHDs, healthcare providers, and non-traditional partners can more effectively work together to improve population health outcomes. The program focused on ways LHDs can amplify their value and impact, forge new collaborations to affect the social determinants of health, and leverage data and policy to address critical public health issues such as chronic disease, opioids, and health inequity.

The conference featured plenty of peer-networking opportunities to help members create affirming professional connections. The schedule included several social events including a President’s welcome reception, a first-time and new member breakfast, and sponsored dinners. Social media also played an important role in the event; the conference hashtag, #NA17, generated more than seven million impressions on Twitter over the three days.

Tuesday: Connecting Clinical Providers and Local Public Health

On the opening day of NACCHO Annual 2017, attendees participated in a variety of pre-conference sessions and were welcomed to Pittsburgh by Rich Fitzgerald, County Executive of Allegheny County, PA. Karen Hacker, MD, MPH, Health Director of the Allegheny County Health Department, gave an overview of the conference highlights.

New NACCHO President Umair A. Shah, MD, MPH, Executive Director of Harris County Public Health in Houston, TX, recognized outgoing President Claude-Alix Jacob, MPH, Chief Public Health Officer and Director of the Cambridge Public Health Department in Cambridge, MA, and introduced new members of the NACCHO Board.

NACCHO Interim Executive Director and Chief of Government Affairs Laura Hanen, MPP, gave the State of the Association address, which focused on NACCHO’s considerable accomplishments over the last year. She emphasized that NACCHO members set the association’s priorities and shape its work and underscored the importance of ensuring policymakers and the media understand the value of local public health.

The opening general session, “Bridging Clinical Medicine and Population Health,” was moderated by Lawrence Eisenstein, MD, MPH, FACP, Commissioner of Health for the Nassau County Department of Health in Mineola, NY, who shared how the close professional connections he has made through NACCHO have enriched his career as a local health official. He noted that there is an imaginary, yet very real, “brick wall” that prevents collaboration and communication between clinical care and public health and urged LHD leaders to create bridges to unite the two fields.

Sandro Galea, MD, MPH, DrPH, Epidemiologist, Professor, and Dean, Boston University School of Public Health, highlighted the importance of prevention and pointed out the importance of addressing the social determinants of health such as transportation, housing, and education. Michael Meit, MA, MPH, Senior Public Health Systems Researcher at NORC at the University of Chicago, shared the history of how LHDs came into being. He described budget cuts, reliance on categorical federal funding, and healthcare reform as the driving forces of change in public health today. Picking up on a theme mentioned throughout the session, Meit also stressed that LHDs must communicate the benefit they bring to communities to generate support and funding.

Attendees also mingled and toured the Exhibit Hall during the President’s Welcome Reception and enjoyed a networking event, The Impact of the Opioid Epidemic on Cities and LHDs Combatting HCV and Other Infectious Diseases, sponsored by OraSure Technologies.

Wednesday: Broadening Our Impact

Wednesday was full of insightful programming about how LHDs can engage their communities, clinical providers, and nontraditional partners to improve population health. Attendees heard from Dr. Shah, in his first official address as NACCHO President, about his path in public health and his vision for the future of NACCHO. He shared a variety of new strategies his health department used to engage its residents to improve outcomes. He also encouraged LHDs to innovate and find new ways to ensure the public’s understanding of health includes public health, not just healthcare. Finally, Dr. Shah highlighted NACCHO’s commitment to serving as the collective voice of LHDs to move public health forward.

The Wednesday general session, “Sharing Our Vision – Broadening Our Impact,” featured a dynamic panel of experts. Don Bradley, MD, MHS-CL, Director of The Practical Playbook, opened the session by discussing the work of the playbook, which brings together public health, primary care, and other stakeholders to improve the health and well-being of communities. Dr. Bradley was joined by Scott Hall, Senior Vice President of Civic and Community Initiatives at the Greater Kansas City Chamber of Commerce, who discussed how LHDs can work with the private sector. He pointed to tobacco 21, workplace wellness, and mental health initiatives as programs that can unite LHDs and the business community.

Jay Bhatt, DO, MPH, MA, FACP, Senior Vice President and Chief Medical Officer of the American Hospital Association, shared his perspective on how LHDs and hospitals can better collaborate. He emphasized the importance of improving community well-being through cross-sector partnerships that address the social determinants of health. Sandra Lobo, Executive Director of the Northwest Bronx Community and Clergy Coalition, described how her organization worked with community partners, including the LHD, to address the upstream determinants of asthma through the Bronx Health Buildings program. She stressed the importance of engaging residents at the grassroots level and ensuring that they are at the center of decision-making processes.

Attendees also celebrated this year’s award winners at the Grand Awards Ceremony and Reception—including 41 Model Practice Award winners, four Local Health Department of the Year awardees, the Mo Mullet Lifetime of Service recipient, and five National Health Security Strategy awardees.

Thursday: Using Policy and Data to Improve Population Health

The Thursday morning general session, “From the Lab to the Legislature: How Policy Is Our Most Impactful Tool,” featured a rich discussion about how LHDs can use policy to address the causes of morbidity and mortality in their jurisdictions. The session featured speakers Monica Valdes Lupi, JD, MPH, Executive Director at the Boston Public Health Commission; Marcus Plescia, MPH, MD, Health Director at the Mecklenburg County Health Department; and Brian Castrucci, MA, Chief Program and Strategy Officer at the de Beaumont Foundation.

Castrucci began the session by describing how public health has successfully used policy to influence health outcomes, citing vaccination requirements and seatbelt laws as key examples. He stressed that policy is “the vaccine” for chronic disease, noting that LHDs will have to find innovative ways—and prepare their workforces—to successfully enact policies that address the root causes of chronic disease.

Lupi discussed the importance of building relationships with key policymakers and other stakeholders who can serve as surrogates for LHDs when public health is excluded from decision-making. She underscored the importance of combining data and stories from the community to persuasively demonstrate how policy affects health. Lupi also noted that policy does not always happen in the legislature and shared how her health department worked with local small business owners to combat opioid overdose in public restrooms.

Dr. Plescia provided his perspective on advancing policy in cities and counties in which political support for public health issues is thin. He emphasized the importance of finding areas of common ground with policymakers and encouraged LHD leaders to use their local media outlets to raise the visibility of local public health work.

Thursday also saw NACCHO’s inaugural Member Connect session, hosted by Dr. Shah, Hanen, Interim Executive Director and Chief of Programs William M. Barnes, PhD, MBA, and members of NACCHO’s Executive Committee. NACCHO leaders presented updates about key organizational initiatives and encouraged NACCHO members to ask questions and offer suggestions. Hanen revealed that NACCHO is working to establish a rural health section that will address the unique needs and challenges of small and rural health departments. Dr. Barnes stated that in addition to advocacy, membership, communications, and programmatic work, NACCHO’s focus in the coming months will be recruiting a permanent executive director for the organization, developing a new strategic plan with the Board, and building NACCHO’s development enterprise, The Foundation for the Public’s Health.

The closing general session, “Using Data Integration to Improve Population Health,” touched on the importance of access to local-level data and described how LHDs can leverage data to effectively improve the health of communities. Oscar Alleyne, DrPH, MPH, Senior Advisor for Public Health Programs at NACCHO, introduced the plenary and shared that LHDs experience difficulty obtaining high-quality, local-level data because of issues related to interoperability, timeliness, and workforce capacity. Nick Macchione, FACHE, Director and Deputy Chief Administrative Officer at the Health and Human Services Agency in San Diego County, described a data-integration initiative, a part of his city’s Live Well San Diego program, that aggregated data from the LHD, social service agencies, and clinical providers to improve decision-making and communicate with the public.

Joshua Sharfstein, MD, Associate Dean for Public Health Practice and Training and Professor of the Practice in Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, illustrated how LHDs can leverage existing data in their communities by better understanding the Health Insurance Portability and Accountability Act of 1996 (HIPPA). Finally, John Lumpkin, MD, MPH, Program Senior Vice President at the Robert Wood Johnson Foundation, shared his organization’s Digital Bridge initiative, which aims to create bidirectional data-sharing among healthcare and public health organizations to improve population health.

All in all, the conference provided LHD leaders and staff with new tools, useful resources, and thought-provoking perspectives to help them advance the work of public health in their jurisdictions. For more about the conference, visit http://nacchoannual.org. Save the date for NACCHO Annual 2018, July 10–13 in New Orleans, which will explore the theme, “Unleashing the Power of Local Public Health.”

Shifting Internal Policies and Systems to Create Breastfeeding Continuity of Care

By Carmen Vergara, RN, MPH (ESPERANZA HEALTH CENTERS) and Harumi Reis-Reilly, MS, CNS, CHES, IBCLC (NACCHO)  

Esperanza Health Centers, a former grantee of NACCHO’s Breastfeeding Initiative, is a Federally Qualified Health Center (FQHC) on the Southwest side of Chicago. The main population served is predominately low-income and Latino, and families in Esperanza’s service area experience significant economic, educational, and health inequities. Over 70% of area residents live 200% below the poverty level. Esperanza’s main services are adult primary care, pediatrics, prenatal care, and behavioral health. Additional public health services include programs related to children’s weight management, diabetes management, and physical activity.

Healthy Tomorrows Program (HTP)

In 2013, the HTP was launched with funds from Health Resources and Services Administration (HRSA). The program has been endorsed by the Department of Public Health in Chicago, owing to its potential to reduce inequities by providing access to high-quality culturally appropriate care. The program is designed to improve breastfeeding rates among Latinas, who typically initiate breastfeeding, but have lower rates of duration and higher rates of formula supplementation. 

Beyond providing culturally appropriate breastfeeding education and support, the HTP seeks toaddress client social service needs and remove barriers to care access by helping Latinas navigate the U.S. healthcare system, as well as insurance issues, to ensure that they receive comprehensive prenatal and postpartum care. The HTP aligns the medical specialties, including, but not limited to, OB/GYNs and pediatricians, and frontline staff within the FQHC to work together to increase breastfeeding rates. 

In 2015, with funds from the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC) and other sources, Esperanza expanded the HTP by implementing weekly breastfeeding peer support groups in a highly visible public area at one of its three clinic locations, and partnered with a local library branch to host offsite support groups within the broader community. Esperanza went beyond the provision of direct services by implementing internal policy and system changes to improve the consistency and quality of breastfeeding support services provided by staff in a way that would be sustained after the grant funding ended.

Policy System and Environmental (PSE) Changes and Partnerships

Esperanza implemented an agency-wide Breastfeeding Support and Education Work Flow system by establishing protocols to ensure that clients receive seven points of breastfeeding support contact, starting from the first prenatal medical visit to the infant’s first month of life, and at least two or more contacts until the baby’s first birthday.

Figure 1

Figure 1 illustrates the client contact points and indicates who and how breastfeeding support services are provided.

The center updated its electronic medical record (EMR) system to capture client breastfeeding intentions and status, and to document all breastfeeding education and support sessions (e.g., during client medical visits, by phone, and at the hospital post-birth) by different staff within the center.

A goal of the program was to increase broad acceptance and support of breastfeeding by training all center employees, including front-desk staff, medical assistants, and physicians, on the importance of breastfeeding and lactation support management. They tested staff knowledge and attitudes through pre- and post-training assessment. In addition, Esperanza instituted weekly breastfeeding support groups in a highly visible clinic area and at a local library branch.

To address community continuity of care and close the gap in services that often occurs between hospital delivery and the early postpartum period, Esperanza enhanced its partnership with Saint Anthony Hospital, a local facility where most FQHC clients deliver. Esperanza joined the hospital’s baby-friendly committee, and also invited hospital staff to join the center’s advisory board. A result of the partnership is the Birth Visit by Esperanza’s lactation staff or covering pediatrician at the hospital, which is one of the seven points of contact in the HTP Breastfeeding Support and Education Work Flow system. The main facilitators for this key partnership and program implementation were leadership buy-in, and the use of physician champions that were engaged and active program advocates.

By shifting internal policies and systems and integrating breastfeeding support into other existing culturally appropriate, population-based services within the clinic, Esperanza Health Center’s HTP was able to increase breastfeeding community continuity of care for the predominately low-income Latino community served by the FQHC in Southwest Chicago.

To learn more about this project, watch the recording of the webinar Breastfeeding in the Community: Closing the Care Gap No Cost Continuing Education Available here: http://bit.ly/2mRL48m.

 

NACCHO Annual 2017 Preview: Transforming Community Health and Managing Multi-Collaborative Solutions for Better Health Outcomes

Interview by Taylarr Lopez, NACCHO Communications Specialist

This entry is the second in a series of “NACCHO Annual preview” blog posts, which feature interviews with presenters ahead of NACCHO Annual 2017. Ron Bialek, MPP, President of the Public Health Foundation, and Jack Moran, MBA, PhD, CMC, CQM, Senior Quality Advisor for the Public Health Foundation, discuss ways that local health departments can build strategic partnerships to address health threats in the community in their upcoming presentation, “Community Chief Health Strategist: Transforming the Way You Approach Health in Your Community.” Below, Mr. Ron Bialek shares the importance of local health departments becoming Chief Health Strategists. Continue reading

NACCHO Outgoing President Claude-Alix Jacob, MPH, Reflects on His Year at the Helm of NACCHO and Charts a Course for the Future

Interview by Lindsay Tiffany, Lead of Publications, NACCHO

Claude-Alix Jacob, MPH, Chief Public Health Officer for the Cambridge Public Health Department (MA), has served as NACCHO’s President since last July. Jacob is a long-standing and dedicated member of NACCHO and has served on a variety of different advisory groups including the Annual Conference Workgroup, the Health Equity and Social Justice Committee, the Survive and Thrive Workgroup, and the Finance Committee. He has served on NACCHO’s Board of Directors since 2010. He recently spoke to NACCHO Voice about his experience as president, the challenges facing local health departments, and what he is looking forward to doing after his term is over. Continue reading

Connecting Community Data for Population Health: Supporting Use of EHR Data for Community Health Assessments

By Bree Allen, MPH, SHINE Fellow, Office of Health IT, Minnesota Department of Health; Karen Soderberg, MS, Research Scientist, Office of Health IT, Minnesota Department of Health; and Marty Laventure, PhD, Director, Office of Health IT, Minnesota Department of Health

This article is a supplement to the Spring 2017 issue of NACCHO Exchange, which focuses on how local health departments are implementing the concepts of Public Health 3.0 to improve population health. NACCHO thanks the authors for their important contributions. To download the issue, visit http://eweb.naccho.org/prd/?na753pdf and create or log into your MyNACCHO account. Continue reading

Growing Informatics Capabilities at Local Health Departments Can Effectively Address Poor Health Outcomes and Improve Efficiency

This entry is the first in a series of “NACCHO Annual preview” blog posts, which feature interviews with presenters ahead of NACCHO Annual 2017. Joseph Gibson, MPH, PhD, Director of Epidemiology at Marion County Public Health Department in Indiana, highlights the importance of acquiring informatics capabilities in his upcoming presentation, “From Top to Bottom: Building Informatics Skills throughout Your Agency,” and offers advice to other local health departments working to obtain these skills. Continue reading

Member Spotlight: Director and Health Officer Dawn C. Allicock Discusses Innovative Management Models and Addresses the Public Health Effects of Zika and Hurricane Matthew

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 Dawn C. Allicock, MD, MPH, CPH, Director and Health Officer with the Florida Department of Health in St. Johns County. She is a member of NACCHO’s Board of Directors.  Below she shares her background in public health and highlights a few of her greatest accomplishments in the field.

Tell us about your career path in public health.

I have been the Director and Health Officer with the Florida Department of Health in St. Johns County (DOH – St. Johns) since 2004. I have a varied and diverse medical education and public health background that forms my focused vision for public health.

I received a BA from Dartmouth College, an MD from the Eugenio Maria de Hostos University School of Medicine in the Dominican Republic, and an MPH from the University of South Florida, College of Public Health Practice Executive Program. In 2008, as a member of the Charter Class for Voluntary National Certification in Public Health, I became one of the first in the nation to become certified in public health. I completed my pediatric residency training at the University of Missouri, Columbia and I am licensed to practice medicine in Florida, Texas, and Nebraska. I am board certified in urgent care medicine and board eligible in pediatrics. Continue reading