Category Archives: community health

NACCHO Book Club — Evicted: Poverty and Profit in the American City

By Emily Yox, MPH, Global Health Program Analyst, NACCHO

Each month, we will bring you a new public health book, read and reviewed by NACCHO staff. We hope to provide a well-rounded reading list that you will find enjoyable as well as informative.

Our second book recommendation, Evicted: Poverty and Profit in the American City, was published in 2017 and written by sociologist Matthew Desmond. Evicted follows eight families as they struggle to find and maintain consistent housing in Milwaukee’s low-income rental market. As the book’s website states: “without a home, everything else falls apart.” Desmond explores both the political and cultural systems that create systemic poverty, the role that housing plays in this system, and the significant social and health effects that directly influence an individual’s ability to thrive.

Evictions used to be a rare occurrence, but they have become much more common in the United States in recent decades, particularly among single mothers. Often, mothers and children are forced to live in homes without reliable water or heat, and with the majority of income being spent on rent, little is left for food or healthcare. While based in Milwaukee, the stories of this book mirror those in cities across the United States.

While not explicitly about public health, this book is an important read for any public health practitioner who wants to dive deeper into social determinants of health, the complex challenges that low-income renters face, and the repercussions that those challenges have in other aspects of their lives.

Evicted is a New York Times bestseller and winner of the Pulitzer Prize, among other accolades.

Want to discuss this book and others? Head over to NACCHO’s Virtual Communities page and connect with peers.

Three Leading National Public Health Organizations Ring the Alarm About All-Time Highs of STDs

Data released this week by the Centers for Disease Control and Prevention (CDC) show STDs have surged for the fifth consecutive year, reaching an all-time high in the U.S. These dangerous trends in chlamydia, gonorrhea, and syphilis show no sign of slowing and affect millions of lives each year in the United States. Particularly worrisome is the emerging trend of newborn syphilis (congenital syphilis) with a 40 percent increase in one year and the growing number of associated fetal and newborn deaths.

“Pregnant women and their babies are at risk for congenital syphilis, a disease we thought was all but eradicated decades ago,” says Michael Fraser, CEO of the Association of State and Territorial Health Officials (ASTHO). The rapid increases in STD rates are stark evidence of the need to invest in our national, state, and local public health infrastructure. “This is a warning,” Fraser continues. “We need to increase federal funding for STD prevention, and that is why ASTHO and its partners are seeking a 22% increase to the Centers for Disease Control budget by the year 2022. We know how to prevent STDs but state and local health agencies need more resources to tackle these rising rates head on.”

The nation’s health department workforce is the backbone of our public health infrastructure  and essential to our nation’s health. With fewer health department employees, fewer health department services can be offered, and that leads directly to diminished health in our communities. “Nowhere is this more evident than in addressing STIs and HIV where this staff  are the frontlines of STD prevention and treatment,” states Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials (NACCHO). She continues,” Data from NACCHO’s Profile of Local Health Departments study shows that local health departments have lost 22 percent of their workforce from 2012 to 2016—a decrease almost simultaneous with STD increases. We will not be able to turn the tide on rising STD rates—and the real impacts those illnesses have on people living in communities across the country—without a strong and supported workforce.”

This will require investment in prevention and treatment programs that work. Unfortunately, the rise in STDs has not been mirrored by increased investment in programs and the federal STD funding is now operating at effectively 40 percent reduction since 2003. For many health departments, this is the only funding that they receive to address STDs.

“Without Increased investment in STD prevention, millions of lives will continue to be affected and babies will continue to get sick. These are not outcomes we can accept.”says David C. Harvey, executive director of the National Coalition of STD Directors (NCSD). “We call on Congress to recognize this growing threat and invest in STD prevention. Specifically, we call for a $70 million increase to the federal STD prevention line at CDC is needed to kickstart a response against the rise in STDs, part of the national 22 by 22 campaign to increase CDC’s budget and support for state and local programs.”

CDC Media Update: Lung Disease Associated with E-cigarette Use or Vaping

By Kim Rodgers, Communications Manager, NACCHO

This story originally ran in NACCHO’s Preparedness Brief

In response to the multistate outbreak of lung injury associated with e-cigarette product use (e.g., devices, liquids, refill pods, and/or cartridges), the Centers for Disease Control and Prevention (CDC) along with other federal, state, and local partners are involved in an on-going investigation. CDC has released a media advisory concerning the situation, and the Lung Injury Response Website has various available resources to educate the publichealthcare providers, and state and local health departments on key facts and recommendations.

At this time, 805 cases of lung injury have been reported from 46 states and the U.S. Virgin Islands, and 10 states have reported 12 confirmed deaths. All reported cases have been linked to a history of e-cigarette product use or vaping.

Healthcare providers are urged to support response efforts by continuing to report both suspected and confirmed cases of lung injury to their state or local health department. Specimen collection, storage, and submission guidance is available. Collaboration with states, local health departments, and additional relevant partners is also critical. State public health officials should contact CDC at eocevent101@cdc.gov regarding possible cases of e-cigarette- or vaping-associated lung injury.

For information on technical assistance with epidemiologic investigation, laboratory testing, and/or data collection tools, please contact CDC at eocevent101@cdc.gov. Questions on the submission of non-tissue samples should be directed to NCEHSampleLogistics@cdc.gov.

On September 25, 2019, NACCHO sent a letter to Congress highlighting the role of local health departments in addressing youth use of e-cigarettes and the need for action to curb youth use of these products. The letter further explained how NACCHO supports the U.S. Food and Drug Administration’s plan to ban flavored e-cigarettes.

NACCHO has a liaison officer within the CDC Emergency Operations Center and is participating in national calls. For any questions, comments, and/or technical resource needs, please contact the NACCHO Preparedness Program at preparedness@naccho.org.

Dialogue with Indigent Communities: How the Voice of Public Health Makes an Impact that Matters

Erika S. Corle, MPH, Executive Assistant, Providence St. Joseph Health/St. Mary Medical Center

While finishing this blog post, two major earthquakes struck the very area that I am writing about. These earthquakes were the largest to hit Southern California in the past 20 years, striking Kern and San Bernardino counties. Being a member of the affected community, I can attest to the fear, the unknowing, and the hope that the areas hardest hit would not be left behind or forgotten while larger, more able areas were addressed. Continue reading

NACCHO Book Club: Dreamland—The True Tale of America’s Opioid Epidemic

By Emily Yox, MPH, Global Health Program Analyst, NACCHO

Each month, NACCHO will bring you a new public health book, read and reviewed by NACCHO staff. We hope to provide a well-rounded reading list that you will find enjoyable as well as informative.

Our first recommendation, Dreamland: The True Tale of America’s Opioid Epidemic, by Sam Quinones, was published in 2015 and received many accolades for the way in which the author intertwines the multiple narratives that fit into the U.S. opioid overdose epidemic. He tells stories of epidemiologists, big pharma, entrepreneurial drug dealers, and people in recovery to showcase the different perspectives of the addiction crisis in the United States. It is clear that the book was painstakingly researched but is very well written and hard to put down. Continue reading

From the Field: Strategies to Increase Hepatitis C Screening and Linkage to Care through SSPs

By Nicole Miller, MSN, RN; Lela Riherd, BSN, RN, CIC; Zac Doobovsky, BSN, RN, CIC; and Harp Cheema, BSN, RN, Whatcom County Health Department (WA)

This post originally ran in NACCHO’s Healthy People, Healthy Places Blog.

The Centers for Disease Control and Prevention (CDC) estimates nearly 2.4 million Americans are living with the hepatitis C virus (HCV), with transmission via injection drug use being the most common mode of HCV acquisition. In Washington State, there has been a 126% increase in newly acquired HCV infections between 2013 and 2017 that is linked to the opioid crisis. In 2018, Whatcom County had approximately 13 acute HCV cases and 306 chronic HCV cases, an increase from 4 acute and 241 chronic in 2017. On July 26, 2019, in response to these increasing numbers, Washington Governor Jay Inslee launched the Hep C Free Washington Plan to Eliminate Hepatitis C in Washington State by 2030, expanding upon a 2018 proclamation calling for a coordinated strategy between state and local public health agencies, tribal governments, and other partners to eliminate hepatitis C.

Expanding prevention and screening services and increasing access to treatment are critical to Washington’s efforts to eliminate hepatitis C, yet many barriers exist for people who inject drugs (PWID) when trying to access care and needed services. Opioid misuse is a complex issue that requires a multifaceted, collaborative approach across disciplines and agencies. The Whatcom County Health Department (WCHD) is working to expand its Syringe Services Program (SSP) and Adult Health Clinic services to address the hepatitis C challenges. By expanding our services, we hope to provide our clients with the resources they need to make informed decisions regarding their health and to encourage testing and treatment for people who are living with hepatitis C.

Syringe Services Program

SSPs are shown to be safe, effective, and play an important role in reducing the transmission of viral hepatitis and other infections. The WCHD SSP is a community-based prevention program that can provide a range of services, including access to clean syringes, safe disposal of syringes, testing for infectious diseases, and linkage to treatment services. Hepatitis A and B vaccines are also available.

The WCHD started its SSP to combat the disease transmission of HCV, HIV, and other infectious diseases among PWID. The number of participants served has increased fourfold since 2009, from 219 unique participants to 881 in 2018.

Participants in our SSP reported stigma as the most common reason for avoiding medical care. We work towards a no-judgment approach to help build a trusting relationship with our clients, which is crucial in the participant’s road to change and healthy outcomes.

The increasing number of unique participants has forced our SSP to change what we ask our clients, how we test, when we test, clinic flow, and how we provide follow up services and referrals. We made changes to our dialogue with clients to facilitate a more engaging conversation and achieve a positive rapport. Our clinic flow is set up to create a safe comfortable space that allows for point of care testing in all of our exchange rooms. Clients often reported time restrictions as a barrier to testing and this change has helped us to provide testing and results in a more timely manner to meet client needs.

A standing order was approved to draw confirmatory HCV RNA testing for any of our clients that are reactive for the point of care HCV antibody test or who have received a reactive test with us in the past with no additional follow up or linkage to care. By providing confirmatory testing we can help clients document chronic HCV and initiate treatment sooner. Clients are more likely to be compliant with care if services can be provided in one centralized location.

SSPs are a tool that can help reduce transmission of viral hepatitis and other infections as well as serve as a bridge to other healthcare or treatment services. Program participants have reported that our services decrease needle reuse and sharing. This in turn helps to reduce disease transmission in our community.

Linkage to Care

Follow-up testing and linkage to care is essential for clients with a new diagnosis, but understanding the next steps for follow-up can be challenging. Our SSP program staff met with a local community health clinic about the potential to expedite referrals that screen reactive to HCV at our SSP. We worked on creating a process that ensured the appropriate testing and linkage to care happened in a timely manner. The community health clinic created a flow sheet, standing orders for HCV testing, and signed a Memorandum of Understanding (MOU) for this process. This MOU allows expedited referrals for better client outcomes.

Continue reading

CHOICES Learning Collaborative Partnership Announces New Opportunity to Develop Effective Strategies to Prevent Childhood Obesity

The CHOICES Project at the Prevention Research Center on Nutrition and Physical Activity at the Harvard T.H. Chan School of Public Health will be accepting applications beginning on August 1 for state and local health agencies to apply to participate in the CHOICES Learning Collaborative Partnership (LCP).

Over the past four years, the CHOICES team has fostered Learning Collaborative Partnerships with 15 state and local health agencies throughout the United States, with Philadelphia, Denver, San Antonio, Salt Lake County, Allegheny County, Detroit, and Houston taking part. The CHOICES LCP presents an opportunity for health agencies representing populations of 500,000 or more to receive funding, training, technical assistance, and locally tailored data to help decision-makers understand and use data on health and cost impact to identify best value for money strategies to prevent childhood obesity. Continue reading