Category Archives: community health

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.



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


  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


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.


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.


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.


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 Continuing Education credits are available.

Contact info:

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

Supervisor, Perinatal Practice, Education, Research, and Lactation


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

WIC Director

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

Local Health Department Engagement in Teen Driver Safety Week

In 2015, 2,333 teens (ages 16 to 19) were killed in motor vehicle crashes; that is six teens dying from motor vehicle injuries every day.1 Per mile driven, teen drivers are almost three times more likely than drivers aged 20 and older to be in a fatal crash.1 Among teen drivers, those most at risk for crashes are males, teens driving with teen passengers, and newly licensed teens.1

The National Association of County and City Health Officials (NACCHO) encourages local health departments (LHDs) to engage their communities in prevention activities during Teen Driver Safety Week (October 15–21). Placing a focus on parents and schools is a great way to engage families of teens. Continue reading

Evaluating Health Impact Assessment and the Role of Funding for Local Health Departments

By Ali Aslam, NACCHO Environmental Health Intern

This story originally ran in NACCHO’s Healthy People, Healthy Places blog.

In June 2017, NACCHO released a new report titled Evaluation of Technical Assistance for Local Health Departments. This report is part of NACCHO’s ongoing evaluation of Health Impact Assessment (HIA) at local health departments to examine implementation practices, common challenges, and resource gaps. The report provides practical recommendations for local health departments administering HIA and national organizations that support HIA at the local level. NACCHO’s evaluation showed that funding and staff time were the most significant barriers for local health departments conducting HIA. Furthermore, local health departments with HIA funding were shown to prioritize HIA activities while having a higher capacity than their non-funded counterparts. Continue reading

NACCHO Annual 2017 Sharing Session Recap: Community Partnerships Help Tri-County Health Department Curb Prescription Drug Misuse

This entry features an interview with NACCHO Annual 2017 presenter and Substance Abuse Prevention Coordinator for the Tri-County Health Department in Colorado, Steven A. Martinez, MA. His session, “Tri-County Overdose Prevention Partnership: A Community-Led, Local Health Department-Facilitated, Collaborative Effort,” described the importance of partnerships to address prescription drug misuse in local communities. Below he shares his health department’s process for convening partnerships and assessing, planning, and implementing collaborative strategies. Continue reading