December 15, 2015

Unifying the Assets of Our Communities to Strengthen Public Health

By LaMar Hasbrouck, MD, MPH, Executive Director, NACCHO

Building on the promise of public health means optimizing the health of our communities, and ultimately all of our nation’s residents, by creating the conditions people need to be healthy. This begins by understanding how our objectives, as public health professionals, differ from those of professionals in the healthcare system. In public health, instead of treating individual patients, we regard the whole population we serve as the patient. Although each person is important, we acknowledge that true impact occurs when we confront the contexts in which people become unhealthy. Instead of focusing on specific cases of injury and illness, we view individual ailments as symptomatic of larger environmental and systemic issues. Our interest lies in resolving or managing those larger issues, which will ultimately improve health outcomes for individuals, families, and communities.

As a result of the myriad of factors that affect health, building on the promise of public health demands collaboration. One of the most effective ways of collaborating involves leveraging the assets that exist in every community. This type of asset-based community development model works better than trying to create assets that don’t already exist. Local health departments, often conveners in their communities, can partner with a variety of different organizations to leverage their infrastructure and relationships to benefit the health of their jurisdictions. In service of their mission, some local health departments coordinate joint exercises with law enforcement agencies to prepare for emergencies; work with correctional facilities to educate inmates about family planning, and partner with hospitals to assess the health of their communities and develop plans for improving health.

Collaborating for Health
Retail pharmacies, such as Walgreens and CVS, provide an incredible and often underutilized benefit for communities. As it turns out, about 80% of distressed, low-income communities in this country have a retail pharmacy within five miles of them. Retail pharmacies, therefore, provide a great way for public health professionals to distribute vaccines and antivirals in the event of an epidemic. Instead of centralizing public health resources exclusively within the walls of a local health department’s facilities, retail pharmacies increase the accessibility of vital services.

As the Director of the Illinois Department of Public Health, I mediated tensions between retail pharmacies and local health departments. Retail pharmacists were offering their locations as places to provide immunization. Because immunizations can generate revenue for health departments, this resulted in tensions between the pharmacists and local public health workers.

Naturally, the question arose: Who ought to provide immunizations?

As the state’s health director, my priority was to ensure adequate coverage for the entire state. I didn’t care who provided the majority of that coverage as long as we were reaching our communities. However, for some local health departments struggling financially, immunizations provided a significant source of income. To optimize the efficacy of our public health system, we needed to address their concerns.

We facilitated a dialogue between retail pharmacists and local public health administrators. Sitting down with both groups at the table together, we heard from pharmacists about what they were and were not trying to do. From that exchange, we learned they weren’t trying to be a health home or take over the immunization business. They wanted to serve as an asset. They wanted to fill the gap in the availability of public health services—given their hours were often longer than that of public health departments, allowing community members to receive their immunizations in the evening, after work.

This conversation also allowed us to uncover opportunities for local health departments to work more closely with retail pharmacies. When a patient would come to a retail pharmacy to receive their medicine or immunization, the pharmacist could refer them to a local health department, which offered more comprehensive services.

The solution, as it often does, involved having the conversations, building the relationship, and finding how to align priorities in a way that ultimately benefited everyone.

In another example, the YMCA of America, a leading nonprofit for strengthening communities, implemented a diabetes prevention program, in which they work with at-risk individuals aged 60 and older to promote adjustments in lifestyle habits to reduce diabetes risk factors. The year-long program consists of multiple sessions in which a lifestyle coach leads discussion and exploration into various topics pertaining to weight loss, fitness, and healthy living. Local health departments have played an essential role in ensuring the success of the initiative. They have informed healthcare providers about the efficacy of the program and, by doing so, succeeded in attracting participants. Without the efforts of local health departments, many individuals may never have discovered the program, and may have gone on to develop diabetes or other negative health outcomes as a result.

When public health works in isolation, the community suffers. Public health must extend its reach beyond the walls of its facilities to truly promote wellness on the population level.

Engaging the Healthcare Sector
While many local health departments are successfully working with their local hospitals due to requirements in the Affordable Care Act, further collaboration between local health departments and healthcare is necessary. Ideally, doctors and nurses would become steadfast advocates for working across sectors; they’d realize patients can’t get well if they are sent back to contexts in which the healthy choice is the hard choice.

The healthcare and public health systems must work together to continue broadening the tent. Through multi-sector approaches, we can improve the ecosystem in which our patients live. To accomplish this, we must encourage collaboration by motivating healthcare workers to venture from the comfort of their facilities to work with other important sectors. We must also penalize redundancy. Redundancy is when healthcare workers resist collaborating with other sectors, when they fail to recognize the importance of addressing the systemic determinants of health. We must create a norm where public health works across sectors.

The Missing Link
Governmental spending for public health is declining and experts expect that trend to continue. As the public health umbrella expands to serve a larger number of individuals and address the environmental factors often contributing to negative health outcomes, the system will need resources. As we leverage the visible assets of our communities—retail pharmacies, law enforcement, hospitals, schools— one asset is less visible but just as important: philanthropists, both individuals and organizations. They have money and they want to give it away. But you need to know how to ask them and how to build a relationship with them. We have created The Foundation for the Public’s Health as a central hub for this type of expertise, dedicated to the flourishing of the public health sector. They are your ally in this uphill journey and they deserve your support.

By building on the promise of public health, we build communities. The Foundation helps energize this process of community-wide population-based health consciousness. The Foundation supports training and guidance for local health departments to become self-sustaining in their fundraising efforts. Additionally, The Foundation can identify donors in your community and throughout the country who share your passion. They can connect potential philanthropists to your health department and your vital programs. By stewarding your newfound relationship, The Foundation can cultivate relationships between donors and local health departments that can result in life-long partnerships. Together, we can create a culture of collaboration and build on the promise of public health.