Opinion: Local public health departments can lead a future of health and equity

Last month, I assumed the role of president of the National Association of County and City Health Officials (NACCHO), representing over 3,000 local health departments across the United States.

Our mission at the association is to promote and protect the health and well-being of communities throughout this beautiful nation of ours.

Taking on this significant national role as an immigrant and a person of color, and now an American with a family, fills me with both pride and humility.

I identify as a public health professional and scientist.

As I stood before the largest gathering in the history of the association's annual meeting, in Denver, I felt it necessary to acknowledge the territories and ancestral homelands of the Cheyenne and Arapahoe nations on which we convened. The space was also vital to many other Native Nations, including the Lakota, Ute, Kiowa, Comanche, Apache, Shoshone, and others. Recognizing the Indigenous peoples as the original custodians of the land, water, plants, and animals is crucial, as is acknowledging the painful history of genocide and forced removal of tribes from this territory.

I also felt it important to acknowledge the labor of enslaved Africans and their descendants who worked the stolen land for the colonists, and who continue to disproportionately face economic oppression, racism, violence and exploitation.

Public health systems need investment to face myriad challenges

Our nation faces unprecedented challenges, brought to the forefront by the COVID-19 pandemic, exposing vulnerabilities in our public health infrastructure. We must address decades of disinvestment that have crippled governmental public health systems. Local health departments are on the front lines during public health emergencies, yet they often find themselves at the back of the line when it comes to resources. This must change, and we, the public health community, must reclaim our rightful place in public discourse and strive for an equitable and inclusive system.

Health disparities and inequities have plagued our communities for too long, disproportionately affecting people of color, low-income individuals, and rural communities. To achieve health equity, we must address systemic racism, poverty, and discrimination — the root causes of these disparities.

Additionally, climate change poses a significant public health emergency, impacting marginalized communities, such as Black, Indigenous, and people of color, disproportionately.

We cannot overlook the urgent issue of gun violence, which claims far too many lives daily. A comprehensive public health approach is essential, including policies such as universal background checks, red flag laws, and firearm licensing requirements.

As a society, we must ensure that women have the right to make informed decisions regarding their health and health care. I am proud that NACCHO policy supports unrestricted access to information, enabling them to make informed decisions regarding their health and health care.  This means guaranteeing that information is not limited by regulations, laws, or the personal beliefs of health care providers.

It is crucial to prioritize the health of individuals throughout their lives, recognizing the unique needs and challenges faced by adolescents during their transition to young adulthood. Thus, a comprehensive approach to adolescent health should be supported.

There is a pressing need to invest in early childhood initiatives and address the impact of adverse childhood experiences, including their connection to mental health, substance use disorders, and chronic diseases.

Together we can use our collective power to create a space where every individual, regardless of their sexual orientation or gender identity, can thrive and contribute to the health and vitality of our communities.

To effectively address substance use and its associated risks, we require a comprehensive, evidence-based approach that prioritizes harm reduction and equity.  This approach aims to reduce the transmission of HIV, viral hepatitis, and other blood-borne diseases, prevent overdoses, and ultimately promote the health and well-being of individuals who use drugs.

Investment in prevention of opioid-related deaths is paramount. And we must use opioid settlement dollars to stop the carnage.

Mental health has also become a pressing concern, and we must prioritize self-care and support our neighbors and public health workforce in their well-being.

Racism perpetuates inequities and injustices that severely affect the health and well-being of individuals and communities. As public health leaders, we must confront racism head-on, dismantle systemic barriers, and promote inclusivity to create a healthy and just society.

Advocacy supports health workforce and better outcomes for the public

Through our advisory workgroups, our local health department members continuously develop and review policy statements that guide our work. I encourage you to explore these policy statements on the NACCHO website, particularly those related to health equity and social justice, environmental justice, mass incarceration, policing and racism, climate change, women’s health and injury and violence prevention, including firearms.

In terms of advocacy, NACCHO made significant strides, including the inclusion of the public health student loan repayment program in the December 2022 omnibus, which is now law. This program aims to not only build a diverse workforce but also attract young professionals to public health by offering loan repayment in exchange for working in local or state health departments.

On public health workforce development, NACCHO will continue to garner resources through its advocacy.  And, as President, I have asked each Board member to work toward this goal.  Workforce is our biggest asset, our biggest infrastructure, and we must do everything to build a strong, equitable, fun-loving, and culturally sensitive workforce and, and a public health system which can sustain it.

Let’s also make sure our workforce does not leave the public health field.

We want to continue to encourage new views toward direct funding to local health departments where and when it makes sense, and strengthening our communication linkages between the federal and local governments.

A few years ago, the CDC initiated the Ending the HIV Epidemic, which provided direct funding to local health departments targeted on communities with the highest prevalence of HIV spread and infections. At the time this was a landmark change in targeting funding directly to local health departments based on data and outcomes. This year, NACCHO continued to work hard to push more money into the hands of our county and city health departments. As a result, the CDC directly funded 47 health departments with workforce dollars. We worked to ensure the introduction of language in notices of awards for states to allocate 40% of workforce dollars to all local health departments not directly funded. This is progress and NACCHO will continue to advocate for local health departments to receive funding.

NACCHO remains committed to striving for local health departments across the nation to develop strong foundational capabilities before another public health emergency reaches our doorsteps.

And, programmatically, we continue to grow our work to provide resources, programs, reports, and technical assistance to local health departments across the country.

As an Iowan I am humbled and honored to receive this grave responsibility. My commitment as president is to work collaboratively with all stakeholders in government, academia, and the private sector to build a stronger, equitable, and sustainable public health infrastructure. Public health is a team sport, and together, we will leave no stone unturned in our pursuit of a healthier, more equitable and joyous future for our communities in Iowa and the United States.

Dr. Pramod Dwivedi is health director at Linn County Public Health in Cedar Rapids and president of the National Association of County and City Health Officials. X (Twitter): @pdwivedi9.

This article originally appeared on Des Moines Register: Opinion: Local health departments can lead a future of health, equity