NewPublicHealth Q&A: Linda Langston, National Association of Counties

Jan 29, 2014, 11:37 AM

This week the National Association of Counties (NACo) will hold the fourth Healthy Communities Initiative Forum, in San Diego, bringing together county health directors and staff to share best practices to improve community health. The NACo Healthy Counties Initiative supports innovative public-private partnerships to enhance community health.

Ahead of the conference, NewPublicHealth spoke with Linda Langston, president of NACo and Supervisor of Linn County, Iowa, who will be attending and presenting at the conference.

NewPublicHealth: Tell us about the Healthy Counties Initiative.

Linda Langston: I was the first chair of the initiative when it came into being four years ago. We modeled it after what we had done with our Green Government initiative—we had local government elected officials and staff connected to various areas of health, and then we also populated the committee with some of our corporate sponsors that were ultimately working toward very similar kinds of goals and trying to figure out how we could work affectively together.

We're also helping people understand upcoming issues and ideas they may know about.

NPH: What are the key health issues that counties face in 2014 and how is NACo generally helping counties with those issues?

Langston: Many counties are responsible for safety-net services and virtually every county in the nation has a jail. We’ve learned that many people, including many federal legislators, don’t understand the difference between jails and prisons. Jails are unique to local government, at the county level, and are often where people who have been arrested but can’t afford bail wait until their trial dates. Our challenges include providing health care in the jails, as well as connecting those released to health services in the community, with a goal of continuity for such services as mental health care and treatment for substance abuse.

We are also employers and very often, particularly in small-to-medium-sized counties, we are the largest employer in the area. So we have a lot of employees who need our best efforts, such as looking at how to incentivize people to make good decisions about their own health. And, of course, we also have the community public health responsibility. So we're pretty effectively placed to deal with all things related to health.

NPH: Who are counties partnering with to improve population health?

Langston: As counties, we can’t do it all. There are not enough of us to go around. But what we can do, by virtue of the roles we play in the community, is help educate and convene people. When we focus on health, we also focus on community. This is about driving the concept of the county as a community and what we can do to enhance the health, the vitality, the vibrancy, the resiliency of a county

For example, we know that in many counties, because of the economy, there’s a really expanding need for food access. If people aren’t able to afford food, then in all likelihood their health isn’t good either. I have a particular focus on resiliency, which is about understanding the broad interdependencies that exist and putting them in context so that people can take action and understand that if the dial is moved a little bit, it’s going to be able to impact other areas.

By focusing resiliency on health of the community and what we can do about that, then if bad things happen, God forbid, you've got the ability to pull the resources together and you have partnerships that can respond.

NPH: Are counties set up well to replicate best practices?

Langston: Yes and no. We often say if you've seen one county then you've seen one county. So, it is important to look at the range of best practices and the programs that are out there that have worked, and also to understand your own community because what works in San Diego may not work as effectively in Cedar Rapids.

I get frustrated by the fact that you do the program that has the funding and then you move to the next program because now there’s funding there. My contention is counties need to take the time to do their own assessments of their own communities, and then look at the really broad range of programs that are available and how they might implement them in their county

Within NACo we have two caucuses; the Large Urban County Caucus and the Rural Action Caucus. That often can help sort things out because what has worked really effectively in a large county may have absolutely no application in a smaller community of say 50,000 people, as opposed to 5 million people. It’s great to have a bookshelf of programs that have worked, but also understanding how they fit. Was it a large county that implemented it? What were the key intractable problems they were facing at the time? Because you might think that another county looks just like your community and you’d be able to make a program work. Critical to making those programs work is having the kinds of partnerships throughout the community that can help strategize, tailor and implement—which is why it’s so important for county leaders to be conveners to build the partnerships that lead to change.

>>Bonus Link: Read more about NACo’s “Resilient Counties” initiative.

This commentary originally appeared on the RWJF New Public Health blog.