NACCHO Annual 2013: NewPublicHealth Q&A with Robert Pestronk

Jul 10, 2013, 11:03 AM


NewPublicHealth is on the ground this week in Dallas at NACCHO Annual, the yearly meeting of the National Association of County and City Health Officials (NACCHO). The meeting theme this year is “Public Health by the Numbers” as city and county health departments face increased pressure for limited resources; an increased focus on both new and traditional public health roles; and government accountability and effectiveness.

NewPublicHealth spoke with Robert Pestronk, NACCHO’s executive director, in advance of the conference.

>> Be sure to follow our NACCHO conference coverage all week long, including stories from key sessions and interviews with speakers and thought leaders.

NACCHO CEO Robert Pestronk NACCHO CEO Robert Pestronk

NewPublicHealth: What are the key issues at this year’s NACCHO conference?

Robert Pestronk: We’re focused on a conference theme of public health by the numbers because the availability and use of data is integral to the performance and operations of local health departments. The use of data and metrics is important for quality improvement in health departments, and for the development and communication of messages about health status and disease status within local communities.

A couple of other things that are new for this year’s annual meeting is that we’re recognizing the role that large cities and metropolitan areas play in modeling and demonstrating public health policy and governmental public health practice work. We have a couple of sessions with presenters from big cities to talk about the work they’re doing. And because the Affordable Care Act is influencing the work and funding and future for local health departments, there are sessions to help local health departments consider the effects from the law. We’ve also got a plenary session on reducing health disparities, which is a line of work that is very important to NACCHO. In fact, NACCHO’s work in this area has stimulated work in other parts of the governmental public health structure at the state and federal level.

NPH: What is the role that local health departments will play when it comes to implementing the Affordable Care Act?

Pestronk: I think that the specific role that local health departments play, like in most situations, will depend upon the kinds of assets that are available in a local community and the extent to which their state is implementing provisions of the law. Local health departments can be helpful informing people about the start of enrollment and helping people understand where they can go to enroll. Part of what NACCHO has been doing over the past year is to share with local health departments the kinds of opportunities that are available for implementing and educating about the health law.

The other thing that NACCHO is doing is helping local health departments to identify documents that will help them think through whether to continue to offer clinical services, now that insurance plans will be open to so many more people; whether to and how to bill for those services if they continue them; and to help them think through what is going to happen to the tens of millions of people living in the United States who won’t gain access to insurance through the Affordable Care Act and how to figure out how clinical services can be made available to that population as well.

NPH: NACCHO has initiated a local health department of the year award this year. Tell us about that.

Pestronk: Well, who better than NACCHO to offer a local health department of the year award, since we are so familiar with their range of work? The theme of the award this year is also related to innovations on data and technology use in order both to recognize what health departments have done, generate a collection of ideas and document practices of local health departments in this area. One of the things that we recognized is that capacity of local health departments may differ based upon their size for a whole variety of reasons and so we’ve constructed the award to recognize a small department (one that’s serving fewer than than 50,000 people), a medium-size department (serving jurisdictions between 50,000 and half a million residents) and then large departments (serving populations of more than a million). This award also complements our award for distinguished service, so we are recognizing both individual leadership over time, as well as team effort or departmental excellence with the local health department of the year award. [Stay tuned to read about the winners of the local health department awards on NewPublicHealth.]

NPH: This has been a really severe weather year. What have you learned about local health departments and community resilience? How are they making a difference?

Pestronk: Well, I think first it’s especially important to highlight that financial assistance investments that the federal government made over the past 10 years have made a difference. They’ve made a difference because they provided specific support for local health departments to recognize their role and to respond during severe weather incidents as well as the complete range of disasters and emergencies that occur in communities nationwide. A specific targeted financial investment over time to allow capacity and relationships that develop in local communities makes a difference in the effectiveness of response. We’ve also seen an increasingly effective coordination across domains of response to make life after a disaster easier for community members. This kind of cross-sector coordination helps with the development of community resilience.

Those federal investments have allowed local health departments to participate in coordinating sheltering, feeding, and other human service needs for community members after a tornado or after a hurricane or after flooding or other severe weather. They’ve allowed local health departments to develop and improve their messaging to community members, both about sheltering in place and if necessary evacuation, and help them to understand the potential effects and the real effects of these events on the water they drink, on the food they eat, and on other kinds of environmental hazards. I think also that we’re seeing an increasing attention to the effect of climate change and the increasing likelihood of severe weather in many parts of the country, and local health departments have begun to factor this into their planning.

On the other hand funding cuts, which have been about 31 percent since 2004, are beginning to erode the capacity of local health departments to plan and to respond because a little under 60 percent of local health departments rely solely on federal funding for their preparedness activities. Further erosion of these funds is going to have consequences.

NPH: What is the next level of collaboration you’re seeing between public health departments and hospitals as hospitals refine their obligations under the Affordable Care Act to provide community benefit in order to retain their non-profit status?

Pestronk: I think these collaborations will demonstrate the growth of a health-in-all-policies approach within communities. There’s a critical need to reduce the expenditures that we’re making in clinical care and treating illness because they are simply unsustainable going out to the future. These partnerships will help demonstrate that these funds can be reinvested in activities that will prevent bad outcomes from happening in the first place by creating healthier places to live.

There’s so much more that we already know about how to prevent disease and injury and how to make people safer in communities than we put into practice. The “2.0” level of these partnerships will be about increasing the use of data and evidence on what we know works to protect people, make them safer, and reduce the likelihood of both disease and injury, which is what public health and much of local public health practice and theory has been about from the start.

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