"When the day comes that we’re not able to respond in the way that we think we should, that there will be a price to pay."

The U.S. Centers for Disease Control and Prevention and the National Association of County and City Health Officials (NACCHO) are among the partners hosting this week’s 2013 Public Health Preparedness Summit, which provides a national forum for public health and health care professionals, emergency managers, and other leaders to collaborate, learn, and share best practices—especially as budget cuts threaten strides that have been made to better prepare communities for disasters.

Conferences sessions include presentations on catastrophic preparedness, community resilience, biosurveillance, volunteer management, mass prophylaxis, public health law, and crisis standards of care.

NewPublicHealth will be on the ground at the Preparedness Summit in Atlanta this week covering sessions, exploring new tools at the conference expo and talking with plenary speakers and other leaders. Follow the conversation on Twitter at #PHPS13 and follow our coverage here.

In advance of the conference NewPublicHealth spoke with Jack Herrmann, senior advisor for public health preparedness at NACCHO.

NewPublicHealth: How do disasters that happen during the course of the year—such as Superstorm Sandy and the past year’s mass shootings in Colorado and Connecticut—impact the sessions at the Summit?

Jack Herrmann: Unfortunately over the last number of years we’ve always had some kind of event that we’ve had to focus on during the summit, some disaster that has occurred, so this year really is not unique. Last year we also had hurricanes and major tornadoes, and so we found ourselves having to rally around major disasters and pointing out how poignant the Preparedness Summit is because of the events that unfolded. This year, the Aurora shooting, the Newtown shooting, Hurricane Sandy and other events that have occurred really define why we all come together each year for this summit.

It is an opportunity to reflect back and remember how important it is for us to be able to prepare for events every day. I suspect many of the people who have sat in the audience never expected a disaster to occur in their community. So, it is a lesson for all of us in that we never know when disaster is going to strike and that it’s critically important that we’re always on our toes and looking for ways that we can enhance and build the preparedness efforts across our communities and across our nation.

The most recent update on flu activity in the U.S. from the Centers for Disease Control and Prevention finds 47 states showing widespread activity, down from 48 states the week before. “Widespread” means that more than half of the counties in a state are reporting flu activity. While the Western part of the country will likely see more cases, flu seems to be slowing some in the South, Southeast, New England and the Midwest—though still packing a punch in terms of illness, deaths, emergency room visits and hospital admissions.

NewPublicHealth spoke with Paul Etkind, MPH, DrPH, MPH, DrPH, Senior Director of Infectious Diseases at the National Association of County and City Health Officials about the role local health departments play in educating communities about flu prevention and helping to facilitate treatment.

NewPublicHealth: What, if anything, is different about the flu this year?

Paul Etkind: The flu severity that’s being experienced, which we haven’t seen for several years now, has gotten the public’s attention and they’re really heeding the public health urgings, communication and education that’s been going on all along saying hey, get your flu shots, protect yourself. So now, within a relatively short period of time, there’s a very large demand for flu shots.

During the H1N1 outbreak of a few years ago, there was much greater funding for what the health departments were doing. I saw some magic happening then. They had the funds to hold clinics in very unusual places, such as local baseball stadiums and airports. They went to places where people are most comfortable.

Among the impacts of the East Coast’s Hurricane Sandy have been tens of thousands of uprooted trees, contaminated water and tons of compromised food. A recent article in the Journal of Environmental Health Natural recommends that environmental health become an integral part of emergency preparedness and that community stakeholders take a role in merging the two.

David Dyjack, DrPH, associate executive director of the National Association of County and City Health Officials, and a co-author of the study, spoke with NewPublicHealth about building momentum to include environmental health in disaster emergency preparedness.

NewPublicHealth: What does the article address?

David Dyjack: The article is the first step in a series of research steps looking at how best to integrate environmental health and emergency preparedness so that communities are more resilient and take greater responsibility for their own health and safety in the event of an environmental disaster.

NPH: What is distinct about environmental health emergency preparedness? 

At last month’s NACCHO 2012 conference, Susan Feinberg, MPH, communications specialist with the Cambridge Public Health Department in Massachusetts, led a discussion on the importance of a strong and reliable web presence for local health departments.

“Your site is the virtual face of your health department,” said Feinberg. “It’s your number one communications channel and anchor for everything you do.”

With more Americans relying on the web as their means of accessing resources and information, it’s more important than ever for local health departments to create and maintain sites that provide real benefits to the public. Among the aspects Feinberg highlighted, a quality health department website should help users locate services, provide a place to share feedback, as well as discuss how the department is using grants and funding.

A well-built department website provides many benefits to public health practitioners, as well, including streamlining permitting and licensing procedures, amplifying the reach of local staff and promoting credibility for the department.

When building local health department websites, many communities seek to model their online presence after “big city” sites. However, Feinberg warns that this is not always attainable or appropriate. The best health department websites are not always the flashiest, but the ones that provide users with information that is current and concise, guide users to the resources they want and need and reflect the unique vision and values of the individual health department and its surrounding community.

It’s also important to consider that many of the same traits that make common commercial websites popular and easy to use translate well into the public health sector. The website should be easy to navigate, professional and consistant in appearance, include functional and thoughful use of images and graphics  and some manner of searchability, both internally and across the web via search engines to make the site easier to locate. Sites should also include links to other agencies, both local and Federal, that offer related  services and information and access to information in various languages, depending on community needs.

Feinberg also suggests local health departments make use of tracking and reporting tools, such as Google Analytics, to help monitor visits and growth trends, adding that the ultimate goal of a well-constructed health department website is to be “a trusted source for accurate and verifiable information.”

>>Follow the rest of our coverage from the NACCHO Annual Conference.

At last month’s NACCHO 2012 conference, Susan Feinberg, MPH, communications specialist with the Cambridge Public Health Department in Massachusetts, led a discussion on the importance of a strong and reliable web presence for local health departments.

“Your site is the virtual face of your health department,” said Feinberg. “It’s your number one communications channel and anchor for everything you do.”

With more Americans relying on the web as their means of accessing resources and information, it’s more important than ever for local health departments to create and maintain sites that provide real benefits to the public. Among the aspects Feinberg highlighted, a quality health department website should help users locate services, provide a place to share feedback, as well as discuss how the department is using grants and funding.

A well-built department website provides many benefits to public health practitioners, as well, including streamlining permitting and licensing procedures, amplifying the reach of local staff and promoting credibility for the department.

>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.

NewPublicHealth was on the ground at the National Association of County and City Health Officials Annual 2012 conference, providing the latest conference news and in­-depth interviews with conference speakers, as well as local success stories and a glimpse into the Los Angeles public health scene. Coverage highlights included:

• A discussion with Paul Kuehnert, new senior program officer for the Robert Wood Johnson Foundation and director of the Foundation’s Public Health Team, and former executive director for health for Kane County, Ill.
• A Q&A with Jonathan Fielding, MD, MPH, MA, MBA, director of the Los Angeles County Department of Public Health.
• Violence prevention discussions around the special screening of The Interrupters, including a talk with CeaseFire violence interrupter Ricardo “Cobe” Williams and a Q&A with Baltimore Health Commissioner Oxiris Barbot
• A photo tour of the L.A. City Emergency Operations Center, a model for collaboration around preparedness
• A site visit and photo tour of a corner store participating in the Long Beach Health Department’s healthy corner store initiative through the Healthy Eating Active Living Zone program.

At the conference, we also spoke with attendees about how local health departments are forging innovative new partnerships across sectors and across communities to meet shared goals and leverage resources. We asked: What’s the most creative, outside-the-box partner you’ve engaged with from a sector beyond public health? What did they add to the conversation and your joint efforts? What successes have you achieved as a result of partnerships? Who do you see as the most critical partners for public health?

A sampling of responses we heard from attendees are recapped below. Themes that emerged included the critical nature of partnerships between health departments and hospitals, Community Health Assessments and Improvement Plans as a catalyst for partnerships and sustained community health changes, and diverse partnerships across the community that each bring something valuable to the table.

>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.

The Robert Wood Johnson Foundation (RWJF) and Cure Violence (formerly called CeaseFire), a program that takes a unique public health approach to stopping gun violence in communities, hosted a screening of the award-winning documentary, The Interrupters, in Los Angeles at the 2012 Annual Meeting of the National Association of County and City Health Officials. The screening featured a discussion panel including Ricardo “Cobe” Williams, one of the movie’s lead characters and Cure Violence violence interrupter and national trainer; Sheila Regan, director of hospital partnerships for Cure Violence; and Commissioner Oxiris Barbot of the Baltimore City Health Department, where the Cure Violence model was replicated and found to statistically lower either homicides or nonfatal shootings or both in all four of the historically violent neighborhoods in which it worked. Violence interrupters and outreach workers succeeded at cutting homicides by more than half in the Cherry Hill neighborhood.

Cure Violence pursues a singular, relentless focus on stopping shootings and killings. Maintaining that violence spreads fundamentally like a disease, and that it is possible to interrupt the transmission of violence much like a disease by changing the behaviors and norms that drive violent acts, Cure VIolence employs former gang members and ex-offenders who have the unique credibility with community members to effectively get people to rethink the impulse to resolve disputes using guns.

The program, begun in Chicago in 2000 by epidemiologist Dr. Gary Slutkin and funded in part by RWJF, has spread to other cities where violence is an acute health problem, including Baltimore, Md., Crown Heights, N.Y., Kansas City, Mo., and New Orleans, La. At the recent U.S. Conference of Mayors annual meeting, New Orleans Mayor Mitchell Landrieu stated, Violence is a deeply rooted problem that can only be dealt with as a public health epidemic. The Cure Violence model is built on an idea that is exactly right. It is one of many tools that we have to use to get to the problem.”

The Interrupters tells the story of three Cure Violence Chicago “violence interrupters” who work to protect communities from the violence in which they themselves once were involved.

NewPublicHealth caught up with Williams before the Los Angeles conference to ask about his experience as a violence interrupter for Cure Violence. “Before you do anything to intervene, you have to build relationships. That’s when community members open up to you,” says Williams, who at age 11 lost his own father to homicide. “We’re trying to stop people from retaliation, which is often the mindset they grew up with; it’s the mindset I grew up with,” Williams says.

Williams says it’s his job to “mediate the conflict, to put out the fire—to change their mindset and their thinking.” By establishing trust in the community, says Williams, “people will call me when they see a problem going on and I’m able to talk to people on both sides to work it out without shooting and killing. Once you build those relationships, it’s the fathers, the grandmothers, the brothers who start calling us to help work it out,” Williams says.

While Chicago has seen a dramatic increase in homicides this year over last year, Williams says many of those killings have not been in the communities where Cure Violence operates.

The message is simple, even if the work isn’t, says Williams: Violence is not acceptable, and to achieve new social norms that don’t accept violence as a commonplace, tolerable means of behavior, it’s important for everyone to get involved and build the community. “I grew up in a community where if I’m mad at you, all my friends are mad at you. That’s how I was raised. I lost a lot of friends to shootings. I wanted to be part of the solution.”

>>Bonus Link: Read a NewPublicHealth interview with Cure Violence founder Gary Slutkin.

Local health officials will be meeting in Los Angeles later this week at the NACCHO Annual 2012, the annual meeting of the National Association of County and City Health Officials. Key conference topics this year include:

• Affordable Care Act and its impact on local health departments and service delivery
• Chronic Disease Prevention and Control
• Transforming and Supporting the Local Public Health Workforce
• Building a Disaster Resilient Community
• Public Health Research

NewPublicHealth will be on the ground conducting speaker and attendee interviews, featuring session coverage and capturing the stories of public health departments across the country. Follow our coverage here.

In advance of the meeting, NewPublicHealth spoke with Robert Pestronk, MPH, executive director of NACCHO.

NewPublicHealth: How difficult is it to cull to the final session list for the meeting this week?

Robert Pestronk: The conference committee has once again done their wonderful job of selecting from among hundreds of potential sessions. I think the tracks selected are in areas that speak to the issues local health departments are confronting. They’re looking at transition into chronic disease prevention and control. They’re looking into and acting in many areas on the policy, system and environment and organizational change spectrum. There are big questions about the local public health department workforce and how that needs to change in light of both the reductions in funding and the increasing emphasis on new areas of work. And certainly, the need to have a resilient community and to have the health department play an important role in planning for disasters. The departments also need to do the best job that can be done to communicate to policymakers, to community members, to governing boards, the case for local health departments. These are timely, essential issues, and those attending the conference will hear from local health department officials and others who are grappling with these issues and coming up with ways to address them successfully.

NPH: Recent public health meetings have addressed the importance of both quantitative and qualitative research to improve public health. Are you seeing that at NACCHO as well?

Robert Pestronk: Both quantitative and qualitative research are becoming increasingly important. On the research side, I think that perhaps not just in the field of public health but in the human services or social services field generally the qualitative research has been seen as a poor step child to the quantitative that has been done at the medical or the research bench, and I think part of what’s happening is we’re coming to understand the importance of both styles and types of research. Researchers are coming to grips with the need for both types and also becoming more sophisticated in terms of the methodologies that they’re using. I think this convergence is a good thing, and I think that the recognition of the importance of both types of research by people and researchers in both areas is a very important development.

NPH: How important will the topic of Affordable Care Act be, now that the Supreme Court has ruled, at this year’s NACCHO meeting?

Robert Pestronk: We do have a couple of sessions on the Affordable Care Act, and I think that there’s going to be a lot of conversation among participants at the meeting about how the Supreme Court’s decision will play out in their state and play out across the country. Certainly, the changes in IRS rules for non-profit hospitals has opened up lines of conversation both at the member organization level as well as in local communities, either opened it up or enhanced that conversation, and I think that Medicaid and the way in which states either adjust or not adjust their programs to limit coverage are going to be conversations because those decisions have implications for the kinds of services that local health departments may need to continue to provide or not.

I think that other areas that will get discussed are the evidence that’s been generated from the funding that has been out there already. It’s going to be necessary to bring those stories forward to communicate why these changes are important for the health of their communities.

NPH: How does the Affordable Care Act help local health departments?

Robert Pestronk: It continues the nation down a road of assuring that people in communities have insurance coverage and have access to healthcare services regardless of whether their place of employment provides that as a benefit. So it will continue the conversation in local health departments across the country about the role that they should or shouldn’t and can or can’t play with respect to clinical care. I think that what we’ve learned is that some health departments will, because of the nature of the clinical resources available in their communities, need to continue to provide these services. I think that local health departments will hope that the expansion in dollars that are available through the Public Health and Prevention Fund continues over the next couple of years and that expansion will result in more opportunities for local health departments to become more active in the policy system in environmental and organizational change area. I think that the resources that are available through the Fund present opportunities for enhanced relationship-building within communities.

NPH: Collaboration is becoming a very important part of improving public health services delivery. Are we seeing both more in terms of recognizing how vital these partnerships can be as well as the actual collaborations at the local health department level?

Robert Pestronk:I think that in most cases local health departments have always been in a collaborative mode. They’ve always known that the resources that they have aren’t big enough and large enough in most communities to make a difference all by themselves. Those who are practicing in local health departments understand that to move the needle; to make a change to create the conditions in which people can be healthy requires collaborations around individual projects and programs as well as collaboration on the vision for healthier communities.

NPH: Shared services is also a topic of current important for local health departments—can you talk about its importance for local health departments?

Robert Pestronk: We have some sessions on that topic. I think that people will be interested in it. In some parts of the country, local health department districts or regions or two or more counties or communities have long been joined despite a law which might allow all individual counties or communities to have a local health department. And it’s not just shared services between local health departments; I think the conversations are underway about whether health departments are helped by collaboration or shared service arrangements with other service providers in communities as well. It’s the recognition that shared services among the public and private and non-profit sectors within a community are aimed at common goals. That includes between the media and local health departments, between the clergy and the local health departments, between businesses and local health departments—the notion of everybody on the same team rowing in the same direction, having the same vision for the community and sharing aspects of their resources with one another because some members or organizations in a community have expertise that others don’t. By combining those different assets with one another, health is more likely.

NPH: What’s your hope this year for some of the hallway conversations among meeting attendees?

Robert Pestronk: One of the major outcomes that we seek from the Annual Meeting each year is to have presented an opportunity where people around the country who face similar challenges can talk with one another about the work that they are doing and to gain enthusiasm and support and recognize the importance of persistence around difficult issues, and to recognize the importance of partnerships. It’s to give people opportunities to see what others are doing and to see how their success or what they’ve learned from failure can be adapted within their own communities. I think at a 10,000 foot level people may be grappling with the same kinds of issues. Here they can attend sessions that are of practical interest to them that will open up their eyes to the ways in which their peers are addressing an issue or have confronted an issue which they themselves may confront.

That was always as a local health department practitioner why I valued the NACCHO Annual Meeting so much was because it was a source of stimulation for me, it introduced me to my peers around the country. I always discovered that there was somebody doing something better than I or who had attempted to do something that I was interested in doing and the conference provided an opportunity for me to learn from them both there and then to establish a personal relationship with them so that if later I called them on the phone they would have a face to attach to the person on the other end of the line.

NPH: The intersection of public health and health care is at a critical juncture. What’s ahead at NACCHO on this issue?

Robert Pestronk: I think that one of the things that we’re going to be focusing on at NACCHO over the next year is what does the health department of the future look like? And clearly, again, based upon the resources that individual communities have this intersection between the clinical domain and the governmental public health practice domain is going to be an important conversation. I think that it’s going to play out differently in different communities because the resources that are available are different in different communities. I don’t think there’s going to be a one size fits all. I don’t think we’re close to having a national system in which these two separate domains are appropriately and proportionately resourced and appropriately and genuinely linked together in the ways that they might be. I think that we’re going to be on a long road in that direction over time.

NPH: Any sessions in particular you’d like to note?

Robert Pestronk: That’s like picking a favorite child! I’d say look carefully at the program ahead of time, pick sessions that are in areas that are familiar and pick sessions that are in areas that one knows nothing about because that’s a way of both discovering what’s immediately useful in terms of one’s own work in the community and it’s also useful in the long term because it often is the case that although one isn’t confronting a particular challenge at this time, one very well may be confronting it soon after. And also take time to have informal conversation with others because it’s often in that space where very interesting observations and relationships are made and joined, and those are ones that can last a lifetime.

>>Follow NewPublicHealth coverage of NACCHO Annual 2012.

NewPublicHealth will be once again be covering the upcoming NACCHO Annual 2012 conference, providing the latest conference news and in­-depth interviews with conference speakers, including Jonathan Fielding, MD, MPH, MA, MBA, director of the Los Angeles County Department of Public Health, as well as other key leaders and decision makers, as well as profiles of on-the-ground success stories. The conference will take place July 11 through 13, and this year is headed to Los Angeles, Calif.

We will also be collecting stories on how local health departments are forging innovative new partnerships across sectors and across communities to meet shared goals and leverage resources. One area we’ll be exploring – in connection with a screening of The Interrupters taking place at the meeting, on July 11 at 7 p.m. – is the issue of violence prevention and what public health departments are doing to reduce violence in communities. Also new this year – we'll be on the lookout for opportunities to showcase innovative public health efforts in the greater Los Angeles County area.

Some questions to get you started:

• What's the most creative, outside-the-box partner you've engaged with from a sector beyond public health? What did they add to the conversation and your joint efforts?
• Who do you see as the most critical partners for public health?
• Who do you see as the partners with the most untapped potential?
• What successes have you achieved as a result of partnerships?
• What successes have you had specifically in violence prevention, and who were your partners?

>>In the coming weeks, follow NewPublicHealth.org coverage of NACCHO Annual 2012 and tell us about your critical partners for success.

>>Add YOUR ideas and stories by adding them to the comments below, visiting us at booth #7, or joining the conversation on Twitter by messaging @RWJF_PubHealth (don't forget the conference hashtag, #NA12).

Public health and health care preparedness experts met together at the 2012 Joint Preparedness Conference, where a major focus was greater collaboration between agencies and partners throughout the federal government to achieve maximum public benefit. The conference was sponsored by the Centers for Disease Control and Prevention Office of Public Health Preparedness and Response (OPHPR) and the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response.

Both offices award annual preparedness grants to all fifty states, several large cities and all U.S. territories, but previously required grantees to apply and report separately. The conference, which also included representatives from the Association of State and Territorial Health Officers (ASTHO), the National Association of County and City Health Officials (NACCHO) and other partners, brought the experts from both funding streams into the same room along with the project managers who handle both health care and public health.

“The emphasis is on aligning the efforts between public health and heath care,” says Steven F. Boedigheimer, CDC Deputy Director of OPHPR’s Division of State and Local Readiness, who led the conference.