Category Archives: environmental health

Earth Day 2016: Addressing the Health Effects of Climate Change at the Local Level

By LaMar Hasbrouck, MD, MPH, Executive Director, NACCHO

Celebrating Earth Day provides an opportunity for local health department (LHD) leaders and staff to reflect on and plan for the health effects of climate change. Climate change is already having global impacts; LHDs are on the front lines of ensuring the health and safety of their communities and will face a plethora of local-level challenges brought on by climate change in the future.

Climate change will significantly impact the health of communities. The World Health Organization estimates that between 2030 and 2050, climate change will cause approximately 250,000 additional deaths per year.1 Climate change is predicted to bring about an increase in heat-related illnesses; poorer air quality; an increase in droughts, forest fires, and brush fires; and more frequent and intense storms and floods. It will also affect issues such as food security and water-, food-, and insect-borne diseases. Continue reading

DOH-Orange Partners with Hospitals to Conduct Specimen Collection and Testing for Zika Virus

zikaThe following post was originally published on NACCHO’s Healthy People, Healthy Places blog. For more information about environmental health and infectious disease, visit

As local health departments prepare for cases of Zika in their communities, creative solutions and partnerships are necessary to control the spread of the virus. With recent outbreaks of Zika in the Americas, the number of Zika cases will increase and imported cases could result in local spread of the virus in some areas of the United States.

In the following interview, Sarah D. Matthews, MPH, Epidemiology Department Program Manager at the Florida Department of Health in Orange County (DOH-Orange), shares how her health department is engaging in a public-private partnership to test for suspected Zika virus cases. Thanks to existing partnerships with Florida Hospital and Orlando Health Systems, DOH-Orange has been able to build the capability to support medical providers with resources to facilitate the collection and shipping of appropriate specimens to the state’s lab for Zika virus testing.

Q: How does DOH-Orange collaborate with hospitals during the specimen collection and testing process for Zika?

A: Since Florida receives a lot of travelers from Zika-affected countries, on Feb. 3 our Governor Rick Scott directed the State Surgeon General to declare a public health emergency for the counties of residents with travel-associated cases of Zika. Continue reading

The Lead Contamination Crisis in Flint, Michigan: A Joint Statement from NACCHO and ASTHO

The lead poisoning crisis in Flint, Michigan touches on almost every aspect in the daily life of a health department: lead poisoning, water quality, health equity, reproductive health, and other social, political, and environmental impacts. This crisis underscores the basic fundamental need to have safe food, air, and water.

As always, the role of our health departments is to promote and protect the health and well-being of all people in their communities. The National Association of County & City Health Officials and the Association of State and Territorial Health Officials, alongside our federal partners, support our colleagues in Genesee County and the state of Michigan.  We will continue to update our members about further developments and opportunities to assist with the ongoing crisis and help Flint emerge as a strong and resilient community. Together we are working to immediately learn the lessons from this crisis to better inform public health at the local, state, and national level.

Both NACCHO and ASTHO have a history of responding to emerging issues by leveraging our resources, networks, and members to support the needs of local and state public health departments. Both organizations have been actively communicating with local, state, and federal stakeholders. We will coordinate with all of our partners to assist with needed capacity and resources in this crisis, including epidemiology, surveillance, screening, risk communication, education, remediation, long-term recovery, and policy.

Stories from the Field: Food Safety Calendar Educates Entire Community

food-safety-calendar-storyThe following story was submitted to NACCHO’s Stories from the Field website by Jeanne Garbarino from Vineland City (NJ) Health Department on Sept. 17. NACCHO’s Stories from the Field website provides a means for local health departments (LHDs) to share their experiences and demonstrate the value of public health. Stories from the Field can be used to support advocacy, peer learning, and collaboration with state and federal partners. Share your story at

When the Vineland City Health Department (VCHD) in Vineland, NJ, discovered that a lack of education around proper hand washing was the number one public health offense in the city’s retail food establishments, local health department (LHD) and Food Safety Council staff thought up an unusual solution: let students do the teaching. Through a contest with cash prizes, the department tasked K-12 students to contribute drawings illustrating best practices related to hand washing; the winning art was then published in the VCHD’s inaugural “Serving Safe Food Calendar,” distributed to every retail food establishment in the city.

The calendar project began in 2005, after the VCHD conducted its first risk-factor study with the U.S. Food and Drug Administration’s voluntary standards program and identified poor personal hygiene as the biggest health issue present in the city’s restaurants. A lack of hand washing spreads the viruses and bacteria that can lead to a number of foodborne illnesses, such as norovirus and salmonella. The LHD wanted to combat this issue in a creative, original way in hopes of gaining more attention from the food service community, and raising a higher level of awareness surrounding hygiene issues. Along with the Food Safety Council, the VCHD began brainstorming education campaigns and someone suggested enlisting local students to draw posters; the idea quickly evolved into a calendar.

The original production focused only on hand washing, but in subsequent years, the VCHD has expanded its focus to also cover proper food temperatures and foodborne illnesses. It isn’t a regular series – in total, the project costs about $4,000, so the department only produces them when funds are available – but when the opportunity arises students, parents, teachers and food service industry workers jump at the chance to take part, whether that means contributing a drawing or just pinning a calendar on a wall. Calendars have since been produced in 2009, 2011, 2012, and 2014. Artwork is selected through a contest that offers 12 winners a $50 Visa gift card and the opportunity to receive their prize during a televised city council meeting. Surprisingly, it’s the brief TV appearance that really drives kids to participate, and not the cash.

To garner enough submissions, the VCHD reached out to local teachers – a challenge in itself, as catching teachers when they weren’t busy was not always achievable – and asked that they promote the contest to their students. Some biology teachers even turned contest participation into a graded classroom assignment; they studied the various foodborne illness that can arise due to improper hand washing or refrigeration and students incorporated their lessons into their drawings. Simple outreach efforts expanded the scope of the VCHD’s original project; students and teachers were able to engage with public health education in a more meaningful way, and came away from the project with a strong personal understanding of the issues.

Once published, every licensed retail food establishment in the city, from top-tier restaurants to coffee carts, receives a copy of the calendar. The VCHD even provides them to the supermarket departments that handle and prepare raw foods. And though there are no established, direct links between calendar production and changed habits, risk factor studies conducted in the nine years since the project began have shown an improvement in personal hygiene practices among the city’s food service professionals. Additionally, VCHD staff have heard anecdotal evidence about community members whose children have taken to monitoring their family’s hand washing habits, or contest winners who now manage restaurants. And, perhaps most poignantly, retail food establishments sing the praises of the calendars and greatly appreciate the educational opportunity they provide.

Despite the clear successes, the calendar project has not been without struggles. Every new production cycle the VCHD undertook illuminated new strategies they needed to follow in order to ensure a useful product. For instance, one of the biggest challenges was timing their initial outreach campaign with a break in teachers’ schedules. If teachers were too busy to deviate from their planned curriculum, the calendars didn’t receive the classroom promotion the VCHD relied on for success. The department has since identified May as the best month to solicit artwork from students and teachers. Another important step was ensuring students had quality information to inform their projects. The VCHD found that it was often necessary to provide resources directly to the teachers; as schools do not typically teach food safety, classrooms really relied on the health department to educate them about proper behaviors.

Any LHDs interested in replicating Vineland’s calendar project, or initiating their own food safety education campaign, should remember the importance of including the whole community in the process. By involving students in the calendar, the VCHD was able to educate children, parents, and teachers in addition to the food service establishments originally targeted. Food safety became education became the whole city’s mission, not just the health department’s.

Read more LHD stories from the field at

Resources and Information for National Food Safety Month

meat thermometerLocal health departments (LHDs) are on the front lines of foodborne illness prevention and response. According to the 2013 National Profile of Local Health Departments, 78% of LHDs provide food service establishment inspections and 72% of LHDs provide food safety education in their jurisdictions.

September marks the 20th anniversary of National Food Safety Month (NFSM), an initiative by the National Restaurant Association designed to heighten the importance of food safety education. Each week highlights a different food safety issue—such as cleaning and sanitizing, cross-contamination, and personal hygiene—with educational activities and posters. Visit the NFSM website for more information.

NACCHO and its public health partners have also developed a variety of resources to help LHDs provide food safety services.

The Centers for Disease Control and Prevention (CDC) has released two eLearning tools to assist LHDs in their food safety work. Environmental Assessment of Foodborne Illness Outbreaks is a free interactive course that teaches participants how to (1) investigate foodborne illness outbreaks as part of a larger team; (2) identify the environmental causes of an outbreak; and (3) recommend control measures.

The second CDC tool is the National Voluntary Environmental Assessment Information System, which fosters information-sharing between LHDs to improve response to, and prevention of, future outbreaks. CDC encourages LHDs to register and provide data about their foodborne illness investigations.

NACCHO works with the Food and Drug Administration (FDA) to increase the use of the FDA Voluntary National Retail Food Regulatory Program Standards (Retail Program Standards), a continuous quality improvement and quality assurance program that helps LHDs achieve optimal performance in food safety programs, services, and processes. NACCHO’s Retail Program Standards mentorship program partners LHDs together to implement the Retail Program Standards. Participating LHDs benefit from the experience of other LHDs in best applying the Retail Program Standards to their food protection programs. NACCHO has also collaborated with FDA to develop a crosswalk that outlines the areas of alignment between the Retail Program Standards and the Public Health Accreditation Board’s Standards and Measures.

NACCHO co-chairs the Council to Improve Foodborne Outbreak Response (CIFOR), a multidisciplinary working group that aims to reduce the burden of foodborne illness. The council publishes the CIFOR Guidelines for Foodborne Disease Outbreak Response, which guides LHDs on how to prepare for, detect, investigate, and control a foodborne illness outbreak. Find additional CIFOR resources.

NACCHO also works closely with LHDs through its Food Safety Workgroup and the Food Safety Toolkit. NACCHO staff participate in national initiatives including the Partnership for Food Protection, the National School Safety Coalition, the Food Safety Modernization Act Working Group, and Government Coordinating Council Food and Agriculture Sector.

NACCHO, in collaboration with the National Center for Environmental Health at CDC, selected 12 LHDs to implement innovative programs in food safety within their health departments and communities. The projects focused on infrastructure, marketing, training, and program assessment. Read the report.

For more information, visit NACCHO’s food safety webpage.

Chikungunya: Time to Prepare for a New Mosquito-Borne Virus in the United States

On July 17, the Centers for Disease Control and Prevention announced that the first locally acquired case of the chikungunya disease has surfaced in the continental United States. The post below shares how LHDs can prepare for chikungunya.

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The chikungunya (pronounced “chik-en-gun-ya”) virus has expanded its range into the Western Hemisphere as of late 2013. The virus, which has been known throughout Africa and Asia since the 1950s, causes a disease that has been compared to having a terrible case of the flu combined with an abrupt case of arthritis. It is most commonly characterized by fever and joint pain and could include headache, muscle pain, joint swelling, and/or a rash. The disease is spread via bites of two species of mosquitoes that are present and abundant in the United States: Aedes aegypti and Aedes albopictus, the latter is an alien species that has established itself in our country.

Chikungunya disease has been rapidly spreading since its introduction. It has spread in a matter of months throughout the Caribbean and Central America and into the eastern coast of the South American continent. More than 50,000 cases of human disease have been reported through the end of May 2014. Will it reach and become established in the United States? It is virtually certain that it will. We have already seen this happen with West Nile Virus, which entered the United States in 1999 and  spread throughout almost the entire country within five years. In fact, at least four cases of chikungunya in U.S. citizens who became ill with after returning from trips to Caribbean islands were recently documented in Florida and Tennessee. Local health departments should expect to see more of these cases as travel to the Caribbean for business and pleasure purposes increases over time. In addition, hundreds of thousands of soccer fans, many from the United States, are expected to travel to Brazil in July for the World Cup. The opportunities for introduction of the virus via infected fans returning from the games will be many.

Local health departments are on the front lines to prevent and control the expected introduction and spread of this virus and disease. This is the time for assuring that we as a profession and as a nation are prepared for this new disease. Treatments might only diminish the symptoms; there are no cures. There are also no vaccines to prevent infection. Local health departments will need to rely on traditional public health measures of surveillance, response, and education.

NACCHO recommends that local health departments take the following steps to prepare for chikungunya:

  1. Review mosquito surveillance capacities and ability to monitor the mosquito populations, measure for the presence and extent of the virus, and identify human cases.
  2. Review and update mosquito control plans and assure that all participants in that plan are capable of responding to findings that would be a trigger for use of control measures.
  3. Review vector control education plans for the public, medical providers, and laboratories serving the community. Awareness of the virus and disease, recognition of symptoms, personal measures for preventing mosquito bites, and community measures for eliminating Aedes mosquitoes and their breeding sites are all parts of a comprehensive vector disease prevention and control educational campaign.

This post originally ran on NACCHO’s Preparedness Brief blog. For more preparedness news and resources, visit

Improving the Quality of Public Health Practice through PHAB’s Accreditation Program and the FDA Retail Program Standards

By Stephen Hughes, Consumer Safety Officer, Food and Drug Administration, and Amy Chang, Program Assistant, Environmental Health, NACCHO

For the past 15 years, the Voluntary National Retail Food Regulatory Program Standards (Retail Program Standards) have served as a model for the continuous improvement of retail food regulatory programs throughout the United States. Many of the retail food regulatory programs enrolled in the Retail Program Standards operate within a larger public health agency with a broad public health mission. As public health accreditation becomes more common for public health agencies, it is becoming more important for retail food regulatory programs to understand the relationships between the Retail Program Standards and the standards used for public health accreditation.

The Public Health Accreditation Board’s (PHAB’s) accreditation program defines the expectations for health departments that seek to become accredited and document the capacity of the health department to deliver the three core functions of public health and the Ten Essential Public Health Services. Similarly, the Retail Program Standards serve as a guide to regulatory retail food program managers in the design and administration of a retail food program and provide a means to recognize a program’s accomplishments.

Although each initiative targets different parts of a public health agency, they share many similarities, such as an emphasis on specific, measurable performance metrics and continuous quality improvement. Specific, measurable performance metrics, coupled with continuous quality improvement, will help public health agencies to improve the quality of public health practices.

To assist health departments in understanding that both initiatives complement each other and are not mutually exclusive processes, NACCHO and the Food and Drug Administration created the Crosswalk on Public Health Accreditation and Retail Program Standards. The document provides an overview of the two initiatives, areas of alignment, and examples of how specific documents generated during the Retail Program Standards process might be used to meet certain required documentation examples for the PHAB measures. The table below gives a broad overview of how PHAB’s accreditation program and the Retail Program Standards have many similarities. Access the full crosswalk in NACCHO’s Bookstore.

Broad Overview of Similarities between PHAB Standards and the Retail Program Standards