Visit the NALBOH website at www.nalboh.org to view the full conference brochure and to register today!

Keynote Speakers At-A-Glace

Thursday, August 6 • 9:00-10:00 a.m. Harness the Power of Healthy People 2020: Translating National Goals to Local Action Carter R. Blakey is the Deputy Director of the Office of Disease Prevention and Health Promotion (ODPHP), US Department of Health and Human Services. ODPHP plays a key role in developing and coordinating disease prevention and health promotion policy for the nation. Carter also leads ODPHP’’s Community Strategies Team, which oversees Healthy People 2020 initiative on behalf of HHS and the Administration. Since the late 1990’’s, she has worked on the myriad aspects of the Healthy People initiative, ranging from the development of the specific 10-

year health objectives to implementation strategies across multiple sectors - Federal and non-Federal. Before joining ODPHP, her 13-year consulting career encompassed numerous activities in the health and biomedical arenas, including projects for the National Institutes of Health, the Congressional Office of Technology Assessment, the Council for Responsible Nutrition, the HHS Office of Public Health and Science, ODPHP, and the National Center for Health Statistics.

Friday, August 7 • 8:15-9:15 a.m. “Top 10” of Modern Local Public Health Legal Innovations Through scholarly and applied work, James G. Hodge, Jr., J.D., LL.M., delves into multiple areas of public health law, global health law, ethics and human rights. James teaches Health Law, Ethics and Policy; Public Health Law and Ethics; and Global Health Law and Policy at the Sandra Day O’Connor College of Law. He is also an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and Georgetown University Law Center, and a

senior scholar at the Centers for Law and the Public’s Health: A Collaborative at Johns Hopkins and Georgetown Universities. The recipient of the 2006 Henrik L. Blum Award for Excellence in Health Policy from the American Public Health Association, James has drafted (with others) several public health law reform initiatives including the Model State Emergency Health Powers Act in 2001. His diverse, funded projects include work on (1) emergency legal preparedness; (2) the legal framework underlying the use of volunteer health professionals during emergencies; (3) historical and legal bases underlying school vaccination programs; (4) legal and ethical distinctions between public health practice and research; (5) legal underpinnings of partner notification and expedited partner therapies; (6) public health information privacy law and policy; and (7) legal support for health impact assessments (HIAs).

Friday, August 7 • 12:30-1:30 p.m. Putting the Global in Local Boards of Health Ali S. Khan, MD, MPH is a former Assistant Surgeon General and current Dean of the College of Public Health at the University of Nebraska Medical Center. Dr. Khan’s professional career has focused on health security, global health and emerging infectious diseases. He completed a 23-year career as a senior Director at the Centers of Disease Control which he joined as a disease detective. At CDC, Dr. Khan led and responded to numerous high profile domestic and international public health emergencies, including hantavirus pulmonary syndrome, Ebola

NewsBrief

In This Issue:Annual Conference.......................1

President’s Message.......................2

PHL Webinar Series ....................3

State News................................4-7

2015 Conference Snapshots ........8

NALBOH 2015 Annual ConferenceLeading the Race in Board GovernanceLouisville, KY • August 5-7, 2015

Continued on page 2...

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Ali S. Khan, MD, MPH Bio Continued from page 1.....

hemorrhagic fever, monkeypox, avian influenza, Rift Valley fever, severe acute respiratory syndrome, the Asian Tsunami in 2004 Ali and Hurricane Katrina in New Orleans. Khan was also one of the main architects of its public health bioterrorism preparedness program and provided scientific and strategic oversight of CDC’s malaria and One Health activities. Most recently (2015), he provided consultation for the Ebola outbreak in West Africa for the World Health Organization (WHO) as a member of the Global Outbreak Alert Response Network (GOARN).

Khan received his medical degree from Downstate Medical Center in Brooklyn, NY, and completed a joint residency in internal medicine and pediatrics at the University of Michigan, Ann Arbor. He has a master’s of public health from Emory University’s Rollins School of Public Health. He is a fellow of the American Academy of Pediatrics and the American College of Physicians. He has authored numerous papers and publications and consulted extensively for multiple U.S. organizations, ministries of health, and the World Health Organization. Dean Khan’s vision is for the College to play an integral role in making Nebraska the healthiest state in the Union.

Public Health Law Webinar Series Completed - Available on NALBOH WebsiteNALBOH would like to thank the Robert Wood Johnson Foundation’s Public Health Law Research program and The Network for Public Health Law for their partnership in presenting a four-part webinar series that took an in-depth look at the role of law in local board of health practice. These sessions were well attended by boards of health from around the US. These sessions offered attendees a number of best practices and lessons learned to take back to their boards. Recordings of these sessions are available on the NALBOH website as a resource for members. Please let the NALBOH office know if you have a topic for future NALBOH webinars.

Public Health Law 101: Understanding the Role of Law in Practice: Presented by Jennifer Ibrahim, Public Health Law Research Network and Jill Krueger, The Network for Public Health Law. This webinar explored the use of law as a public health intervention, a tool to improve health and wellness, and will briefly review the importance of evaluation and understanding what’s working to improve health. At the conclusion of this session, attendees were better able to understand the role of law as a governance issue, namely what gives boards of health their power and defines their role in their communities.

Public Health Law and Governance: This session was presented by Scott Hays, Public Health Law Research Network and Andy Baker-White, The Network for Public Health Law. The session explored the role of law in managing risk, providing authority to boards of health and how that authority can impact a board’s ability to respond to issues. 

Public Health Law as a Health Intervention: Presented by Corey Davis, The Network for Public Health Law, Julia Dilley, Multnomah County Health Dept and Oregon Health Authority, Public Health Division, and Kim Weidenaar, The Network for Public Health Law. In this presentation presenters explored how law impacts behaviors and environments and can be used effectively as an intervention for public health. This webinar explored this idea through real-life cases and presented science-based evidence.  

Public Health Law and the Importance of Evaluation: In this session Jennifer Ibrahim, Public Health Law Research Network and Dawn Hunter, New Mexico Department of Health, discussed how and why a legal intervention has been effective and is essential in this resource-strapped environment. This webinar introduced key concepts of evaluation and drew from real-life examples.  In this last installment of our public health law webinar series with the RWJF Public Health Law Research program and the Network for Public Health Law. This webinar focused on strategies for evaluating laws and policies to better understand how and why our activities have impacted public health in our communities.

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President’s MessageMargaret A. Brink, MSPresident, National Association of Local Boards of Health

Greetings,

We have an important role as board of health members. Our public health community will be safer and healthier if we fulfill our responsibilities and obligations as involved partners and exercise our leadership. One of our board functions is to build and strengthen community partnerships.

Public Health professionals working in the system are aware of the importance of partnering with the right stakeholders. We as board of health members also acknowledge the importance of partnering and establishing relationships. If our board of health members represent a broad cross-section of the community, we bring added value to the health department we serve.

The challenge for us is to build and strengthen community partnerships that enhance the health of our communities. We do this through education. As leaders, we need to be fully participating in the conversations regarding public health issues. The public health professionals are the content experts, but the board of health member is the community voice and ear. We serve as a strong link between the public health agency, the community and other stakeholder organizations. When we share our interests, skills and knowledge the board of health benefits.

As a community leader, an elected official, a community advocate, the board of health member brings the ability to engage others in the community to ensure the collaboration of all relevant stakeholders in promoting and protecting the community’s health. All of us could share the examples of how we work together in our communities and how we are sharing the energies to make our communities (districts/regions) healthier places to live and work. We are among the partners and stakeholders.

From the Newsbrief article, Nebraska-An Epicenter of Ebola Monitoring and Care, ”Established relationships and partnerships played a critical role in our response…..Things went smoothly because these people had trained and exercised together as part of preparedness planning and responded together to real-world events…..” See page 4 for article.

Finally, our partner engagement function is an important encouragement for us as a board of health because we are building linkages between the public and partners that can mitigate negative impacts and emphasize positive impacts of current health trends. With the real-world events happening in our neighborhoods, districts, regions, states and our country, we have an important role as a board of health member. Communities will be safer and healthier if we respond to our involvement and obligations as responsible partners and leaders.

Together we are leading the race of governance by engaging new partners or establishing new public health relationships. We have an important role as board of health members.

See you in August at the Annual Conference,Margaret

Boards of Health to Be Recognized for AccreditationRegister for the NALBOH Conference to be recognized for your Health Department’s work in becoming a leader in Board of Health Governance through Accreditation. Health Departments that have received PHAB Awarded Accreditations in 2014-2015 will be congratulated at the Annual Conference.

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Nebraska – An Epicenter of Ebola Monitoring and CareBy Leah Bucco-White, Nebraska Department of Health and Human Services

Nebraska has been recognized as a national leader in preparedness since the early 2000s when the state initiated its smallpox vaccination efforts, created pandemic flu response plans and opened the Biocontainment Patient Care Unit. The unit was officially unveiled March 7, 2005 in Omaha, a partnership between the Nebraska Department of Health and Human Services, Nebraska Medicine and the University of Nebraska Medical Center. A news release from that day heralded it as “the first-of-its-kind in the nation.” The unit was built with the purpose of providing specialized care to people with potentially deadly and infectious diseases. Almost 10 years later, it would be this unit and a deadly disease called Ebola that would put Nebraska in the national and worldwide spotlight.

Last summer while the Ebola outbreak in West Africa was making headlines, the U.S. State Department visited the Biocontainment Unit. Federal officials were very impressed with the facility. That was Aug. 1. On Sept. 2, DHHS received a call from the State Department about an Ebola patient – a U.S. physician who contracted the virus while working in West Africa. The State Department wanted to bring him to Nebraska. Decision time. Ebola itself was not new to us but having Ebola patients on U.S. and Nebraska soil was. This was about more than treating a patient. This decision impacted everyone in the state. We had the facility. We had the expertise. And we had a person who needed our help.

“This is what the unit was built for, what people had trained for. We believed the staff at Nebraska Medicine could safely treat the patient while protecting the public and that the risk to Omaha and greater Nebraska was minimal,” said Dr. Joseph Acierno, Director of Public Health and Chief Medical Officer for DHHS at the time. DHHS and Nebraska Medicine have been partners in preparedness for more than 10 years. Building the unit was a joint effort and so was the decision to open it. It was a decision that required careful consideration on both sides because one of us couldn’t move forward without the other. Dr. Rick Sacra arrived at the Biocontainment Unit on Sept. 5 and all eyes were on Nebraska. Nebraska Medicine’s team successfully treated Dr. Sacra and he was released almost three weeks later on Sept. 25 with a standing ovation, smiles and tears. And there would be more patients to come. One would be treated and released and another who arrived gravely ill would die. Nebraska had now become a national epicenter for Ebola care and treatment and with that came more responsibility.

Health care professionals with a possible high-risk Ebola exposure were now being transported to Nebraska to be near the Biocontainment Unit if care was needed. They were either monitored inside the unit or housed close to the unit in a controlled and safe environment during their 21-day incubation/monitoring period. Monitoring was a joint effort between the Douglas County Health Department and Nebraska Medicine with support from DHHS. At the same time, other local health departments across the state were monitoring more people who recently returned from West Africa. These travelers were in a lower risk category and didn’t need to be placed near the unit. A total of 23 travelers were monitored statewide since late October.

Established relationships and partnerships played a critical role in our response. There were many more key players including the Centers for Disease Control and Prevention, State Patrol, local law enforcement, fire and EMS. Things went smoothly because these people had trained and exercised together as part of preparedness planning and responded together to real-world events like flooding, tornadoes and H1N1 influenza. “Beyond its role in opening the Biocontainment Unit and monitoring people with potential Ebola exposure, public health was able to quarterback coordination between federal, state and local partners as well as Nebraska Medicine and help make sure other important parties who may not be directly participating were in the loop,” said Jenifer Roberts-Johnson, Deputy Director of Public Health for DHHS.

Local health departments engaged their local boards of health early on providing updates on Ebola before the first patients even landed in the U.S. The local boards of health supported their health departments and helped provide guidance and acquire additional resources like funding.

In 2005, Nebraska led the nation with its foresight to build the Biocontainment Unit.

In 2015, the unit is now a national asset in the fight against Ebola. Because of the dedication and diligence of the many people involved in our Ebola response, Nebraska has emerged as a national leader yet again.

State News from NALBOH Members

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Nebraska’s Pat Lopez Presented Public Health AwardPatricia Lopez was presented the Chancellor Robert D. Sparks, M.D., Award in Public Health and Preventive Medicine at the annual College of Public Health Awards Banquet.

Lopez is a site visitor for the Public Health Accreditation Board for local health departments in other states. She works with local health departments to assist them in preparing for national public health accreditation. For the past seven years, this project has taken Lopez to national meetings to work with peers in other states.

She was instrumental in the passage of LB692, the bill that created regional public health departments in Nebraska. Her work with the state legislature, community partners, primary care, education and others made it possible for so many to agree on the importance of establishing a state-wide local public health system with the funding from the Tobacco Settlement in 2001. Local public health districts now cover all 93 counties of the state to assure the public health of all Nebraskans.

Lopez played a major role in assisting the new health departments with examples of state and local laws, policies and procedures, human resource information and others. She volunteers as the director of the State Association of Local Boards of Health Section of the Public Health Association of Nebraska and provides education and assistance to board of health members.The Sparks award recognizes an individual who has shown outstanding innovation, excellence, collaboration and impact on health promotion, disease prevention and advancement of effective public health. Dr. Robert Sparks, a former chancellor of UNMC, established this award through the University of Nebraska Foundation.

Ali S. Khan, MD, MPH, Dean of UNMC’s College of Public Health, said, “Pat has been a tireless champion of public health for 30 years and she still continues.”

Brandon Grimm, Ph.D., director of public health practice and of health promotion, social & behavioral health, nominated Lopez for the award. It was the first time the award has gone to someone who works at the grass roots level, he said.“Without Pat, the public health infrastructure wouldn’t be where it is in the state. She was the one who brought all the partners together to determine how the tobacco settlement money can be put to the best use in Nebraska. She wants local public health departments to succeed and a lot of what she does is on a volunteer basis,” he said. 

Dr. Khan and Pat Lopez, recipient of the Chancellor Robert D. Sparks, M.D., Award in Public Health and Preventive Medicine.

Wisconsin Holds Board of Health Orientation Track at Annual ConferenceMaryCay Freiberg, City of West Allis, WI and Heidi Roekle, Adams County, Board of Health Members, along with many others, participated as well as moderated in the 2015 joint Wisconsin Public Health Association-Wisconsin Association of Local Health Departments and Boards Annual Conference Board of Health Track. Wisconsin had over 360 Board of Health members, public health professionals, partners, and others, attend the Annual Conference this past May, one of the largest WI conferences to date. The Board of Health track featured Karen McKeown, WI State Health Officer, Brittney Crock Bauerly, Attorney at The Network for Public Health Law, and Kate Konkle and Mary Bennett, County Health Rankings and Roadmaps staff to engage Board of Health Members to get active and move the needle forward on public health issues. County Health Rankings and Roadmaps will be a breakout presentation at the NALBOH Annual Conference that you will not want to miss! Freiberg has also been involved in the SALBOH Calls that take place the first Wednesday of each month. Pictured to the right are Freiberg, 2015-2016 Past President of WALHDAB, and Roekle, 2015-2016 President of WALHDAB.

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A Health Department’s Journey Into and Through AccreditationGary Edwards, MS, Executive Director, Salt Lake County Health Department

In December 2014, the Public Health Accreditation Board recognized the Salt Lake County Health Department (SLCoHD) as an accredited health department. That accomplishment is remarkable because just a few years earlier the SLCoHD leadership was opposed to national accreditation. In fact, the director wrote a letter to the editor of County News (Edwards, 2006) making a case against accreditation. What caused the mindset of the health department to go from being opposed to being accredited? What changed the opinion of the department’s director? How did health department leadership join many elected officials who have said (about topics other than accreditation); “I was against it before I supported it.” The simple answer is a Board of Health chairperson who wanted nothing less than the best for the residents of Salt Lake County; a chairperson who kept asking, “Is there anything in the accreditation requirements that won’t help the health department improve?” The acceptance of voluntary national public health accreditation among public health professionals is, in some ways, similar to the acceptance of the Patient Protection and Affordable Care Act by politicians and the public; there are those who are very much in support of the effort – even believing it does not go far enough – and there are those who are totally opposed to the effort, believing it has gone too far and should be scrapped. And, there are those who were initially opposed but, after taking the time to evaluate the measure, find there are components that make perfect sense.

With continued encouragement from this dedicated board chair, SLCoHD reviewed its position. The health department had already recently completed the National Public Health Performance Standards local and governance assessments that helped identify strengths and weaknesses. But even though that work had been done a year or two earlier, the department had not initiated (in fact, did not even have a plan to initiate) efforts to address the identified weaknesses. Could the accreditation process provide the encouragement a health department needs to address those areas of concern?

Two of SLCoHD’s weaknesses identified through the National Public Health Performance Standards assessment were in the areas of monitoring health status and mobilizing community partners to identify and solve health problems. There is not a health department official, at least one who would be employed for very long, who does not believe their health department should have a current assessment of their community’s health status. However, given the human resources necessary to complete a comprehensive assessment and the competing needs and priorities of daily public health work, this important effort often gets pushed aside.

Scott County’s Experience Addressing HIV OutbreakInALBOH Leader, Harley Robinson shares a bit about Scott County’s experience addressing their recent HIV outbreak: Indiana Governor approved the use of a syringe/needle exchange program in Scott County, which is not allowed in Indiana but was permitted on advice of the CDC. At the time of this article this is true only for Scott County. In March, Indiana Governor Mike Pence declared a public health emergency, and experts from the Center for Disease Control and Prevention and Indiana State Department of Health began working closely with local community members. Their goal is to coordinate a comprehensive approach to contain the epidemic through carefully collaborated medical care and social services. ISDH provided an complete outline of the Needle Exchange Law in Indiana and the Steps required by a jurisdiction to move ahead with a potential exchange program. This PH emergency necessitated collaboration from other counties to send workers to Scott County to help staffhl the One Stop Shop established by ISDH. Many volunteers assisted in the services provided at the One Stop Shop: HIV testing, HIV Care Coordination, mental health services, family and social services, immunizations and more. Some volunteers came from other health departments in surrounding counties just because they knew the Scott County people and wanted to help. Also, volunteers from across the state belonging to the Medical Reserve Core (MRC) came to assist. These volunteers were coordinated into work schedules by Holley Rose, environmental health specialist, from Ripley County, Indiana, Health Department. More information on the Scott County experience dealing with this outbreak have been featured in: TIME magazine ( June 15, 2015)CDC published (dated June 8) an article entitled: The Anatomy of an HIV Outbreak Response in a Rural Community.

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department official, at least one who would be employed for very long, who does not believe their health department should have a current assessment of their community’s health status. However, given the human resources necessary to complete a comprehensive assessment and the competing needs and priorities of daily public health work, this important effort often gets pushed aside. Instead of a comprehensive assessment, many health departments conduct program-specific “silo” assessments that provide some valuable information and give the health department some data to have a partial understanding of the community’s needs. But that approach neglects many important aspects of a comprehensive community health assessment that are necessary to truly focus public health efforts on the community’s priority areas.

That was the case in Salt Lake County. Without a current community health assessment and community health improvement plan, a health department cannot even apply for accreditation. So, yes, the accreditation process can provide encouragement to address identified weaknesses.

After completing a community health assessment and a community health improvement plan, a natural next step is the preparation of a strategic plan to keep the health department on course to address the issues identified in the community health improvement plan (along with other organizational and structural needs the health department may identify as essential to addressing the community’s needs). The strategic plan is also a prerequisite for accreditation.

In order for a community health assessment and community health improvement plan to be truly community-based, the health department must involve other community agencies and individuals. This coordination, while incredibly valuable to a comprehensive effort, can be challenging, frustrating, and time-consuming. But without it the effort is not complete. While this collaborative process is not a prerequisite for PHAB accreditation, it is required to fully meet the PHAB standard. After all, collaboration should be what public health is about, not just what public health does.

So, can the accreditation process provide the encouragement a health department needs to address identified weaknesses? For the Salt Lake County Health Department, the answer was yes. Weaknesses identified in 2008 that they had not yet addressed in 2010 began getting attention in 2011 when the SLCoHD made the commitment to seek accreditation. The processes for the community health assessment and community health improvement plan were community processes. And as a result, those processes were better than they otherwise would have been.

Concerning the remaining PHAB domains: most health departments are already doing much of the work required, but probably are not keeping adequate documentation of their efforts. Therefore, gathering and preparing documentation for submission is a significant effort. This is another area where the process helps improve a health department. Not that the documents themselves make a better health department, but they help assure that all the things that demonstrate a department’s work and value – the efforts needed to provide quality services, promote the public’s health, work closely with the governing entity and elected officials, be prepared to respond to emergencies, and so on – are institutionalized and available. Having accurate and timely records at your fingertips helps a health department speak to these efforts more comfortably and more confidently.

In the end, every public health agency that goes through the process of identifying areas for improvement and following through to address identified weaknesses should be recognized for their efforts. Any health department that achieves national accreditation should be extremely proud of their accomplishments, but only if they can truly say they made improvements as a result of the process. At the end of the day, anyone considering accreditation has to ask themselves if the effort is worth the cost. What is the cost/benefit? Unlike many other accreditation processes, as a voluntary process national public health accreditation as it currently exists does not have funding or financial incentive to encourage participation. So, what is the cost and is it worth the result?

For the SLCoHD the human resource costs were significant. The process began in March 2011 when they initiated the community health assessment process, and it culminated in December 2014 with PHAB granting accreditation: three and one-half years of effort and thousands of staff hours devoted to the process. But because of the effort – driven by one Board chair’s commitment to excellence – the SLCoHD is a better organization; an organization that defines itself as a quality improvement organization, an organization more focused on the public health needs of its community, an organization more committed to being the best health department it can be while helping Salt Lake County become the healthiest county in the United States.

The process to accreditation is worth the effort, regardless of what motivates a health department to take the first step in what can be a very long but beneficial journey.

1Edwards, G. (2006, September 18). Letter to the Editor: Voluntary accreditation may not be best direction for public health departments. County News, p. 2.

2015 Annual Conference Snapshots

NALBOH’s MissionThe mission of NALBOH is to strengthen and improve public health governance.

Visit NALBOH online at:www.nalboh.org

The vision of NALBOH is boards of health that are:• Appointed as a result of a well-informed selection process.• Comprised of individuals who have demonstrated the knowledge, skills, and abilities to effectively represent and serve.• Well-connected to other stakeholders in public health and government.• Effectively and competently serving the public health needs of their community in accordance with the core functions and essential public health services.• Aware of NALBOH’s resources and actively engaged in its success.

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Advertise in the NALBOH Newsbrief

Contact the NALBOH office today to learn more.

920-560-5644NALBOH@badgerbay.co

2015 NALBOH Annual Business Meeting The NALBOH Annual Business Meeting will be held in conjunction with the 2015 NALBOH Annual Conference on Thursday, August 6th from 12:00-1:00 P.M. at the Brown Hotel in Louisville, KY. Lunch will be available. ALL MEMBERS of NALBOH are invited to attend.  This is an opportunity to hear more about what the organization is doing internally and externally.

Join us to:• Elect the 2016 NALBOH Board of Directors• Move forward with Bylaws Updates • Review 2015 NALBOH Successes• Discuss and approve 2015-2017 strategic plan

We look forward to your participation and feedback to take NALBOH to the next level!

Nominations – Become Involved!NALBOH is seeking to fill Board of Directors positions. The full Board meets twice a year in on-site, face-to face meetings- one being at the Annual Conference; it also meets monthly by conference call. 

The following positions are available:• President-Elect• Director at Large• State Affiliate Director-Southwest• State Affiliate Director-Southeast• State Affiliate Director-Northwest Please contact the NALBOH Office if you are interested! Elections will be held at the NALBOH Annual Meeting, August 6th from 12:00-1:00 p.m.

View NALBOH’s Public Health Law

Webinar Series

www.nalboh.org

Host your state meeting at the NALBOH Conference! We have reserved the 4:00-5:00 p.m. time slot on August 6th in the Conference schedule; don’t miss a chance to hold your meeting! Contact the NALBOH Office or Jamie Michael (jamie@badgerbay.co) for more information. There is limited space available!

ALL Members Invited!