Child Development-Community Policing: How One Local Health Department Joins Local Police on The Front Line in The War on ACEs

By Stacey Butler, LCSW, Child Development-Community Policing Director
and Gibbie Harris, Director

Mecklenburg County Public Health

Gunshots ring out at a Charlotte, North Carolina apartment complex, and a five-year-old girl is struck in the leg by a stray bullet. Charlotte-Mecklenburg Police (CMPD) arrive on scene.  Recognizing the potential psychological trauma for the child and her family, they call the Child Development-Community Policing (CD-CP) on-call clinician. She responds within minutes, providing acute trauma intervention alongside her officer partner, who is beginning the work of helping the child and her family feel safe again. This officer-clinician team continues to visit the family over the next few days and weeks to assess progress and needs, providing targeted interventions, and helping reestablish a sense of safety both inside and outside their home.

 Years ago, we didn’t know that events like these were the epicenter of one of our nation’s largest public health epidemics. We just knew we had to do something. Today we look at this problem through the lens of “Adverse Childhood Experiences,” or “ACEs,” and we know that this something is both lifesaving and important community building work.

In 1996 Charlotte county and city governments embarked on this new, innovative, and proactive partnership aimed at serving the area’s youngest and most vulnerable citizens: children exposed to violence (CEV) and their families. Modeled on a ground-breaking collaborative created several years ago between the Yale Medicine Child Studies Center and the New Haven Police Department, the Charlotte-Mecklenburg CD-CP Program began as a pilot project in five square miles of the city, and it has grown to become the nation’s largest program of its kind. We at Mecklenburg County Public Health manage the program. It now includes partnerships with several area police departments including the Charlotte-Mecklenburg PD, as well as the surrounding town departments of Huntersville and Cornelius. To date, over 50,000 families have been referred to the program by local police officers. Three hundred-sixty-five (365) days a year, nights, weekends, and holidays, the team of 17 child trauma clinicians head out with their police partners, ensuring that expert care is offered to every child, reducing barriers to their families such as cost, transportation, and system navigation.

The Charlotte CD-CP model allows for the earliest possible intervention by partnering mental health clinicians with the professionals most aware of acute child trauma: police officers. Clinicians employ immediate acute trauma assessment and targeted developmentally specific clinical interventions aimed at decreasing the earliest emerging symptoms, preventing potential long-term symptoms, and restoring emotional safety, while officer partners focus on physical safety and safety planning for families. This service model is designed to prevent the need for future long-term mental health services, disrupt the cycle of violence, and stabilize families. This effort echoes the resiliency movement’s aim to reduce the potential negative life outcomes that can impact individuals with high ACEs: decreased life expectancy, poor health and educational outcomes, poor social outcomes, etc. The partnership is supported and strengthened by regular classes for local police, co-taught by clinicians and officers. This helps to ensure a thorough understanding of the impact of trauma on a child’s brain, body, and functioning. Additionally, the ride-alongs for program clinicians allow them to develop an understanding of the challenges and vast scope of police work.

 CD-CP’s unofficial motto is “Every family matters, every moment counts,” highlighting the earnestly held belief that children have more successful short and long-term health, emotional, social, and educational outcomes when they receive immediate expert care, when caregivers are informed and supported in being their children’s best allies, when families are provided with needed referrals and assistance, and when follow-up care can include a variety of professionals or community resources depending upon each family’s individually expressed needs. We have changed the landscape of both mental health and policing in Charlotte-Mecklenburg. Clinicians no longer sit in offices, waiting for families to call days, weeks, or even years after a traumatic event, suffering needlessly before making an appointment. Police officers no longer drive away and wish there was more they could do for the vulnerable child in their rearview mirror.

Today we have a framework through which to address ACEs, and we know what every additional ACE could mean for a child, a family, a community. We also know what it takes to begin the process of building resiliency in each and every child, family, and community. While CD-CP has been on the front lines of that effort, we know the work is far greater than what they alone can do. The effort is one piece of the ACEs puzzle in a community. The solution must include healthcare systems, school systems, child welfare systems, legal systems and faith-based organizations, as well as so many others. Today we know that one more ACE for an individual child is one more ACE for all of us. We know that building up a child or family’s resiliency contributes to building up our community. We know that no child should ever have to wait, and that the work of combating an ACE should begin immediately and end only when the work is done.

Ten lessons we learned about how to deploy teams into post-hurricane settings

By Mitch Stripling, MPA, Assistant Commissioner, Bureau of Agency Preparedness and Response; Colin Stimmler, MA, Senior Director for Agency Preparedness and Response at the New York City Department of Health and Mental Hygiene

This blog contains highlights from a new article we wrote for the latest edition of the public health journal, Health Security’s “From the Field” column. Entitled, The NYC Health Department’s Reflections on First-Ever Public Health Deployments in Support of Puerto Rico and the US Virgin Islands After the 2017 Hurricane Season, the article breaks down exactly how experts from our city’s health department deployed teams to storm ravaged Puerto Rico. This sort of content is usually placed behind a paywall, but it will temporarily remain open for public use until November 5, 2018. 

Puerto Rico Blog.png

Disasters like Hurricane Michael show how severe the public health impacts from a coastal storm can be.  When disasters like this strike, many local and state health workers are often willing to help in another jurisdiction, but they aren’t quite sure how.  

The New York City Department of Health and Mental Hygiene took on the unique challenge of serving communities located thousands of miles from our own. In late 2017 and early 2018, the agency deployed multiple teams to Puerto Rico and the U.S. Virgin Islands to support public health. This was an unprecedented mission for our agency.

We wrote the Health Security journal article to reflect on what worked and what didn’t work for our team. It is our hope that other jurisdictions can use this information to organize and execute similar missions in the future, and collectively we can continue to advance the field of public health preparedness and response.

Here is our top ten list of lessons we learned about deploying teams for emergency response:

  1. Leadership skills for your team leaders are more important than any particular subject matter expertise. 

  2. Choose these leaders first and let them help form their teams.

  3. Don't forget that every team needs support personnel for issues like planning and logistics.

  4. Trust the Emergency Management Assistance Compact (EMAC) process, and only deploy in coordination with your emergency management partners.

  5. Make sure you research the situation, continuously using local and national media resources and official situational reports. Brief your team well as you gather more information, since events will change constantly. 

  6. Adaptability and creative problem-solving are key traits for any staff you send, since the mission will change on site. 

  7. Train staff in humility and consensus building. Remember, your team is there to help the real heroes: the survivors.

  8. Team building exercises before you go improve your success rates in the field.

  9. Once the team deploys, trust them to run their mission. Stand by to help them, but don't bother them for excessive updates. 

  10. When a team returns, try to create a clear debrief process with all administrative issues and hotwashes. Make it easy on them, and give them time to adjust back to regular work. 

In order to fully understand why we felt required to take on this mission, remember that the 2017 coastal storm season was historic by almost every measure. Three major hurricanes, Harvey, Maria and Irma, made landfall from mid-August to late September just weeks apart on American soil. These storms collectively caused more than $200 billion in damages, making 2017 the most expensive storm season ever.

The storm season was also deadly. In Puerto Rico, officials estimate the death toll to be more than 2,975.

A year later, now that the lives lost and dollars spent have been tallied, the current storm season presents a moment of reckoning for policymakers at the federal, state and local level, who allocate resources for response.

In the wake of the hurricanes, New York City sent multiple teams from a broad range of agencies and disciplines to help support the response (for example, first responders to assist with search and rescue) and, later, to aid the recovery efforts – including debris removal and emergency management support for coordination centers.

But this was the first time our agency sent public health teams to support a community.

In Puerto Rico and the U.S. Virgin Islands, health care systems were devastated, and millions lost access to both emergency and routine medical care. New dangers surfaced when safe water and food were not available, resulting in sanitation issues that enabled diseases to spread and desperate families searching for basic necessities. Telecommunications failures made the most vulnerable patients difficult to find. The infrastructure damage released toxic chemicals that caused contamination.

These traumas inflicted on the wider population meant that post-storm suicide rates surged, resulting in the number of people taking their own lives rising by almost a third.

Our health department responded by dispatching mental health trainers to the island in teams. They leveraged curriculum and lessons learned from our own experiences following Superstorm Sandy, adopting it to the local context. 

The department completed multiple missions to the embattled island. Our Acting Health Commissioner, Dr. Oxiris Barbot, who is of Puerto Rican descent, described these missions as such: “Our fellow Americans in Puerto Rico needed our help as they coped with the trauma from the hurricanes. We saw the urgent need for mental health resources on the island, especially among children.”

A unique partnership between our city and Puerto Rico was formed. Last March, Mayor Bill de Blasio announced the deployment of a 12-person team of mental and behavioral health experts from the Health Department to train school staff across Puerto Rico on warning signs for their students, and how to take care of themselves in this post disaster setting, as the recovery operations dragged on for months on end. Coupled with the commitment of personnel, the Mayor’s Fund to Advance New York City provided a grant of $100,000 to the Hispanic Federation’s UNIDOS Program to increase mental health services on the island.

The Hispanic Federation’s UNIDOS Disaster Relief & Recovery Program matched the Mayor’s grant of $100,000, bringing the total new support for community health centers in Puerto Rico to $200,000.

We are grateful to have participated in an effort that marshaled resources in such a unique way. Although this storm was historic, we know the public health field should prepare to see more like it.  

Global warming means that storms like Harvey, Maria and Irma are getting stronger and more frequent. Climate change is creating storms of higher intensity, with greater wind speeds. Experts estimate that since the turn of the century, the likelihood of a storm’s rainfall reaching Hurricane Harvey levels has risen from once every 100 years to once every 16 years.

These hard truths are coupled with the fact that our country has not made the investments needed to sustain the capabilities of first responders and to further build these capabilities in preparation for future emergencies. Health preparedness funds have been slashed by 31 percent for public health and 50 percent for health care preparedness over the past decade.

Local health professionals have a special role in helping communities survive and come back from disasters. Federal response assets are powerful, but limited. The federal government is better at focusing on the immediate impacts of an incident and standing up short-term teams of responders, rather than rebuilding the underlying infrastructure or supporting long-term recovery. Local health departments are often better at understanding local needs, making them better suited to provide the sort of front line tactical assistance that survivors need.

We hope that the lessons learned from our experience can advance the field and help save lives. To read more about the teams we created, and how we designed our response, read our full account here.  

New Report: Shortage of “Disease Detectives” in Local Health Departments Puts Cities at Risk

By Big Cities Health Coalition and Council of State and Territorial Epidemiologists staff

Epidemiologist, noun
epidemiologist \ˌe-pə-ˌdē-mē-ˈä-lə-jist
An expert scientist who studies, detects and tracks injuries and disease in our communities.

Epidemiologists serve on the front lines of public health, protecting Americans and the global community. When health threats emerge, these “disease detectives” investigate. They identify the causes, factors and patterns associated with illness, determine who is at risk, collect evidence to recommend preventive actions, and rapidly implement control measures. Epidemiologists also respond to major health hazards including emerging threats such as Zika and Ebola, as well as natural disasters such as floods and hurricanes. They also work on chronic issues facing communities including obesity, diabetes, cancer, HIV/AIDS and motor vehicle crashes.

Looking Under the Hood in City Health Departments

 Click here to join a webinar presenting the findings of the report on Thursday, October 24 at 2:00 pm ET.

Click here to join a webinar presenting the findings of the report on Thursday, October 24 at 2:00 pm ET.

A new study of Big Cities Health Coalition (BCHC) member departments just released by BCHC and the Council of State and Territorial Epidemiologists (CSTE), done in partnership with 27 of our members, finds that big city health departments contribute substantially to our national epidemiology capacity. Epidemiologists often receive increased attention when a major infectious disease outbreak hits the country, such as with the Ebola or Zika viruses. Media and public officials look to these experts to find out how and to whom a disease  spreads in communities, and what can be done to stop it. The work of these experts is vitally important to our nation’s health and security even when not making headlines, and they serve a wide variety of functions beyond stopping disease outbreaks, from fighting the opioid epidemic to measuring childhood asthma or other chronic disease rates. In fact, epidemiologists work every day to help make the difference between a healthy community and one overburdened with disease. 

According to research from the 2017 BCHC/CSTE Epidemiology Capacity Assessment, local health departments have broad capabilities, but there are three key areas where local officials say the need for additional disease trackers outpaces current capacity: chronic disease, substance abuse, and infectious disease.

CSTE’s state Epidemiology Capacity Assessment, has been conducted six times since 2001. The report quantifies what we’ve known anecdotally - a gap exists between the number of epidemiologists on staff in many public health departments and what is needed. It estimates the number of experts required to be able to adequately protect the health of so many Americans. It also reveals that local health departments aren’t getting the full support of state and federal governments and must spend scarce local funds on this core function.

Key Findings from 27 BCHC Health Departments

  • Nearly 1,100 epidemiologists work in big cities protecting over 55 million Americans.

  • In most city health departments, epidemiologists work on infectious disease, maternal and child health, disaster preparedness, chronic disease, vital statistics, and environmental health.

  • Fewer departments have epidemiologists working on: mental health, substance abuse and injury prevention

  • To reach full capacity, big city health departments need:

    • 40% increase in epidemiologists overall, or an additional 434 epidemiologists.

    • 121% increase in injury/violence epidemiologists

    • 86% increase in maternal and child health epidemiologists

    • 72% increase in chronic disease epidemiologists

    • 66% increase in disaster preparedness epidemiologists

    • 51% increase in substance abuse epidemiologists

BCHC and CSTE will co-host a webinar on Wednesday, October 24, 2018 at 2:00 pm EDT to review the findings of the report and answer questions. To join the webinar, please register HERE.

Big Tobacco is marketing vapes to our kids, so our city took them on and won — it’s the FDA’s turn now

By Tomás Aragón, MD, DrPH, Health Officer and Director, Population Health Division, Derek Smith, MSW, MPH, Tobacco Free Project Director, San Francisco Department of Health

This blog originally appeared here in the Hill.

The FDA recently announced that it considers a new surge in teen e-cigarette use to be an epidemic, and will give e-cigarette manufacturers 60 days to prove that they are not marketing to kids. This is a very welcome move for those of us who have been pushing to prevent teen tobacco use. Our city recently took on the makers of e-cigarettes and won. The FDA should take San Francisco's lead and do everything it can to protect kids from Big Tobacco.

"Big tobacco sees vaping as their future," these are the words of Patrick Reynolds, an anti-tobacco activist and executive director of Foundation for Smokefree America. He is the grandson of R.J. Reynolds, the man behind a namesake tobacco company largely responsible for the fact that millions of Americans continue to be hooked on cigarettes.

Reynolds, like many local health departments, sees that a new generation is consuming new and different tobacco products at alarming rates. Electronic cigarettes (e-cigarettes), are the main driver of this trend. They contain nicotine and harmful toxins, making them especially dangerous to youth, who are more susceptible to addiction because their brains are still developing. Cities like mine are taking action, because federal authorities have thus far failed to do so, leaving children and teenagers vulnerable to the effects of these deadly products.

“Vaping” is a new mode of nicotine delivery that includes e-cigarettes, e-pens, e-pipes, e-hookah, and e-cigars. “Vape” is a misnomer, as many assume the resulting product contains water vapor, when it indeed is an aerosol much like smog, and contains propylene glycol, a chemical base used in theater fog machines.

These e-products are easy to consume and simple to conceal, making them especially attractive to teens, which the industry is banking on. Juul, an extremely youth-popular San Francisco-based nicotine delivery device, in particular, is rising in popularity because it is arguably the most discreet e-cigarette product on the market, which comes in enticing flavors. The tobacco industry is again luring youth with flavors such as Gummi Bear and Cherry Crush, with the goal of creating a new generation of smokers — just in a different product.

The battle against vapes is like déjà vu for many of us in the public health community, who successfully fought to eliminate youth-attracting marketing tricks like colorful packaging and candy flavors in cigarettes decades ago. Much of the danger is fueled by the product’s seemingly innocuous presentation. Despite their sleek packaging, e-cigarettes still contain cancer-causing chemicals and highly addictive nicotine.

However, the aerosol emitted doesn’t smell like traditional cigarette smoke does, and resembles water boiled from a teapot. The aerosol inside has ultra-fine particles that contain heavy metals and other substances that are inhaled deep into the lungs. While originally thought to be a “harm reduction” mechanism, i.e. better for people than smoking traditional cigarettes, little is known about their long term effects, and many studies show dual use with cigarettes and reduced likelihood of quitting. Further, vaping may be an entry point to other drug/tobacco use.

Research shows that these sorts of features are devastatingly effective in attracting children, and Big Tobacco knows it. The ease of concealing e-cigarettes doubles their appeal. It’s no wonder new surveys show that the number of kids lighting up is spiking across America.

In the last year, San Francisco stood up to these tactics, enacting a ban on the sale of menthol cigarettes and all flavors in e-cigarettes and other tobacco products. Initially the local public health community worked with elected officials who unanimously adopted the ban.

Big Tobacco quickly challenged the local law with a signature-collecting campaign and referendum, which voters approved by a 2-to-1 margin in June 2018. San Franciscans effectively finished work that the U.S. Food and Drug Administration (FDA) and U.S. Congress left undone when flavors in traditional cigarettes were banned just a few years ago. The tobacco industry did not go down without a fight, however, as R.J Reynolds spent almost $12 million to defeat the city’s measure.

These corporations are fighting so hard to protect these products because their marketing is working, with devastating effects. E-cigarettes entered the market over a decade ago, and since then we’ve seen their popularity rise dramatically, especially among kids.

We conduct the California Healthy Kids Survey, and between 2013-2015 the study included questions about smoking electronic cigarettes or other vaping devices for the first time. Researchers found that students were significantly more likely to consume tobacco with this new method than to smoke cigarettes, especially among younger adolescents.

  • Among 7th graders, 13 percent identified themselves as lifetime users of e-cigarettes

  • Among 9th graders, 26 percent smoked e-cigarettes

  • Among 11th graders, 32 percent use these products

These rates were three times higher than for traditional cigarettes in 7th grade, twice as high in 9th, and 1.5 times higher in 11th. Students in all grades are also twice as likely to vape on school property (4 percent to 5 percent) than smoke cigarettes.

These rates of tobacco use are simply not acceptable, and right now, the tobacco industry is winning, continuing to grow their youth customer base almost unchecked.

Because the FDA and Congress have not acted to ban the flavors that help to lure a new generation of smokers, cities are left to fight Big Tobacco on their own to protect kids in their communities. Policymakers in Washington, must act now to ensure every kid in America, no matter where they live, is protected from the tobacco industry’s billions of dollars in marketing targeted to youth.

Hurricane Harvey: In the Eye of the Storm

By Big Cities Health Coalition Staff

It’s been one year since Hurricane Harvey hit Houston and the surrounding area with record-breaking rain and devastating floods which inflicted injuries, infectious diseases, chemical exposures and mental trauma on residents. Public health officials from the Houston Health Department, a member of the Big Cities Health Coalition, were on the front lines in the lead up to the hurricane and its aftermath. Today, many are reflecting on the events of those four historic days in August 2017 and what lessons were learned, and can still be learned, from the disaster.

Let schools be places for learning—not “JUULing”

By Brian A. King, PhD, MPH, Deputy Director for Research Translation, Office on Smoking and Health, Centers for Disease Control and Prevention

Remember your high school bathroom? If it was anything like mine, the bathroom was a fairly foul-smelling place that you wanted to leave as quickly as possible.

But things are changing. Kids are flocking to school bathrooms across the country faster than the cafeteria on pizza day. School bathrooms have become places where students gather to socialize and use e-cigarettes—in particular, e-cigarettes shaped like USB flash drives that deliver a high level of nicotine.

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 blog originally appeared here on The National Association of County & City Health Officials (NACCHO) 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.

Recently, his business came to the attention of local officials when someone complained that he did not have official permits.

To make sure people are safe from food-borne illnesses, all events that serve food to the public in Minneapolis must be permitted, and violators are subject to an immediate shutdown.

Our Top Takeaways from NACCHO Annual 2018

By Big Cities Health Coalition Staff

We just returned to D.C. from the NACCHO Annual Conference, a summer pilgrimage for public health enthusiasts, which took place this year in New Orleans. The theme of this year’s conference was Unleashing the Power of Public Health. Our time in The Big Easy was especially frenetic this year, with lots and lots of sessions that we found fascinating. Below is a collection of our top takeaways from some of the most engaging sessions we participated in. Tell us which moments you thought were most important in the comment box below, or on Twitter at @BigCitiesHealth.

Public Health and Medical Community Pledge to Decrease Gun Violence

By Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County

This blog originally appeared here in the Public Health - Seattle & King County blog Public Health Insider

Firearm-related injury and death, from suicide to accidental injury and homicide – is a major public health problem and a leading cause of premature death in King County and nationally. In 2016, 663 adults and 20 children died from a firearm injury in Washington state, including 144 adults and 7 children from King County.

Firearm-related injuries have very high personal and financial costs to individuals, families and society – and that’s why prevention is essential.  In 2015, the cost of firearm fatalities alone (not counting non-fatal injuries) in King County was almost $200 million from medical costs and lost productivity, and nationally the cost is in the hundreds of billions of dollars each year.

LGBTQ Pride and Public Health

By Ginger Lee, MPH, Bureau Manager, Collective Impact & Operations,
Long Beach Department of Health and Human Services

June is LGBTQ Pride month.  Pride is a time when lesbian, gay, bisexual, transgender, queer and questioning people join together to further strengthen community by celebrating joyously, with parades and other events.  Pride is also a time when the LGBTQ community remembers its history. And for public health professionals, Pride is a time to reflect on what we can do to address social conditions that negatively affect the health of LGBT people, and to strengthen conditions that support health within our LGBTQ communities.

Hepatitis Awareness Month 2018: Addressing Hepatitis A

By Meghan McGinty, PhD, MPH, MBA, Deputy Director of the Big Cities Health Coalition, and Michelle Cantu, MPH, Director of Infectious Diseases and Immunization, NACCHO

This blog originally appeared here on The National Association of County & City Health Officials (NACCHO) Essential Elements Blog.

The month of May is designated as Hepatitis Awareness Month in the United States and May 19th is Hepatitis Testing Day. During this month, NACCHO will highlight the role of local health departments (LHDs) in responding to this silent epidemic and work to bring increased attention to viral hepatitis. Through a series of three blog posts, NACCHO will focus on the most common types of viral hepatitis, which are hepatitis A, hepatitis B, and hepatitis C. This series seeks to raise awareness of the importance of vaccination for hepatitis A and B, testing for hepatitis B and C, and the availability of effective care and treatments that, in the case of hepatitis C, result in a cure for most people. Additionally, the series will highlight current events related to viral hepatitis – such as outbreaks of hepatitis A in jurisdictions across the country and soaring rates of hepatitis B and C associated with increased injection drug use that is being fueled by the opioid epidemic – and how LHDs are on the frontlines of responding to these worrying trends.

Chicago health commissioner: Big Tobacco is targeting our youth and we must stop them

By Dr. Julie Morita, Commissioner, Chicago Department of Public Health

The U.S. Food and Drug Administration recently announced a crackdown on e-cigarette sales to minors, but before then, the city of Chicago had already taken matters into its own hands. The City Council passed an ordinance to require tobacco dealers to post warning signs at their doors about the health risks of e-cigarettes and other tobacco products. These signs, once designed and distributed, will also contain quit-line numbers to help our residents beat a nicotine addiction. 

Give Women the Gift of Good Health

By Mysheika W. Roberts, MD, MPH, Health Commissioner, Columbus Public Health

As we celebrate all the women in our lives for Mother’s Day and National Women’s Health Month, we are reminded that despite the advances women have made in many areas, great disparities still exist when it comes to their health. 

Women make the majority of health care decisions for their families and are powerful partners by advocating and modeling healthy lifestyles and behaviors for their children, colleagues and friends. But when it comes to their own health, they are often left behind.

Supporting Older Adults in Houston: Ramps, Rails and Toilets

By Deborah A. Moore, Assistant Director, Human Services Division, Houston Health Department and Scott Packard, Chief Communications and Public Affairs Officer, Houston Health Department

When you think of Older Americans Month, toilets probably aren’t the first thing to come to mind. But at the Houston Health Department, commodes are a major component of one of the Harris County Area Agency on Aging’s most gratifying programs.

Allow me to take a step back to explain.

Multnomah County’s Community Powered Change

By Rachael Banks, Public Health Director, Multnomah County Health Department

After years of unacceptable disparities data, we knew we had to do something different.  In the summer of 2015, Multnomah County Health Department (MCHD), set out to create a community health improvement plan (CHIP) centered on things that are largely outside of the control of the individual. In response, MCHD released a request for proposals (RFP) for the coordination of a CHIP that was created in partnership with communities of color. Oregon Health Equity Alliance (OHEA) was selected as the contractor to lead the development and implementation process for the CHIP.

Throughout 2016 OHEA, with the support of MCHD’s Health Equity Initiative (HEI), intensive community engagement and outreach (forums and interviews) were conducted to gather input from a variety of communities including: African-American, Asian, Immigrant/Refugee, Latino, Native American, Pacific Islanders, and youth and elders of color. The outreach and engagement was followed by a tremendous amount of planning, analyzing and prioritizing areas over the next year. Through these engagement efforts, a framework was developed outlining 23 goals and over 150 strategies.

Sexually Transmitted Diseases (STDs) are Making a Comeback – Recognizing April as STD Awareness Month, We Highlight BCHC Activities to Address Vast Increases in (STDs)

By Chrissie Juliano, Director, Big Cities Health Coalition

STD Awareness Month is an opportunity to focus on raising awareness of a problem that affects millions of Americans every year. STDs in the United States are at record highs, despite years of dropping rates, with the latest CDC data showing chlamydia, gonorrhea, and syphilis infections rising to exceed 2 million reported cases nationwide.  The increases are dramatic - 4.7% for chlamydia, 17.6% for syphilis, and a whopping 18.5% for gonorrhea. In short, we’ve lost ground in this fight. Left undiagnosed or untreated, STDs can cause serious long-term problems. Importantly, they are largely preventable and treatable.

On Earth Day: Local efforts are making a difference on climate change

The world-wide scientific consensus is clear: climate change is real, it is being driven by human causes, and we must act now to avoid its worst effects. However, it also clear that leadership in the fight against climate change will not come from Washington, D.C. anytime soon. The EPA is being targeted for huge budget cuts, and the U.S. withdrew from the Paris Climate Accord. In a heartening trend, businesses, community organizations, non-profits, states, counties and cities are stepping up to fill this leadership vacuum. Within this growing coalition there is one player that is often overlooked: local Health Departments. We have a unique perspective and the community connections to play a significant role in helping our communities adapt to the effects of climate change while also fighting against its causes.

Making Public Health Visible

By Narintohn Luangrath, Special Assistant to the  Baltimore City Health Commissioner and
Dr. Leana S. Wen, MD, MSc, FAAEM, Baltimore City Health Commissioner

At a commencement ceremony several years ago, Dr. Linda Rae Murray, then-president of the American Public Health Association, recounted a famous saying: “When public health works, we’re invisible.” She followed that by urging the graduates to “refuse to be invisible, because […] we need to lend our strength and our science to broad social movements whose goal is to make things better.”

When public health is invisible, we only end up talking about it when things go wrong; people tend to think about public health agencies as entities that respond to infectious disease outbreaks or shut down a restaurant due to health code violations. We frequently think about health as healthcare, but what determines how long and how well we live is less about what happens in the doctor’s office and more about where we live, the air we breathe, and the availability of other resources in our communities. At the Baltimore City Health Department (BCHD), we believe that all issues – education, housing, employment, public safety, and beyond – can and should be tied back to health. We are committed to making the progress earned through public health visible, and to make the case for incorporating health-in-all policies across the City.

Wanted: Leaders for a TB-Free United States

By Joseph Iser, MD, DrPH, MSc, Chief Health Officer, Southern Nevada Health District

This blog originally appeared in County Line Magazine


Every year on March 24 the health care community commemorates World TB Day to bring attention to a preventable disease that still impacts many people in the United States and around the world. This year’s theme is “Wanted: Leaders for a TB-Free United States. We can make history. End TB.” It is a call for health care partners to work together on a local, national, and international scale to eliminate the disease.

Health care providers are instrumental in this process. For many patients, TB can present as a bad cold or respiratory infection that won’t go away. Physicians should always consider the possibility of TB when examining a patient with an ongoing respiratory infection, especially if it is accompanied by a persistent cough, night sweats, loss of appetite, and fatigue.

Seattle's Food Safety Rating System is One Year Old

In 2017, King County launched our new food safety rating system with the goal of making it the best rating system in the country. With a year under our belt, Public Health – Seattle & King County’s food safety team is proud to say that the new system has achieved measurable success.

  • Over 75 percent of all restaurants in King County now have easy to understand food safety rating signs in their front windows. This has greatly improved the ability for consumers to quickly assess the food safety practices at each restaurant.
  • Anecdotally, our food safety investigators report an increased interest from restaurant owners in improving their food safety practices, which means that the placards are motivating restaurants to do better. The number of perfect scores from all restaurants across King County increased 3 percent in 2017 from 52 percent to 55 percent.
  • The ratings provide a more complete picture of food safety than any other rating system across the country. Ratings reflect the trend of critical food safety practices over time in each restaurant and take inspector differences into account to make sure the playing field is level.