1. Hasbrouck, LaMar MD, MPH

Article Content

In communities across the United States, public health and health care systems are changing due to a number of forces. Health care reform spurs innovation in payment and service delivery. Economic instability leads to federal, state, and local budget cuts. Accreditation and community benefit requirements encourage collaborative assessment and improvement planning. The list goes on.


Despite facing these often challenging forces of change, local health departments (LHDs) are seizing emerging opportunities, exploring new partnerships, and continuing to minimize-and prevent-threats to the health and well-being of their communities. The National Association of County & City Health Officials (NACCHO) helps LHDs find their footing in this changing landscape. We strive to understand their needs and challenges, highlight innovation, disseminate evidence-based practices, provide training and continuing education, and advocate for policies that support health and equity.


Health Care Reform

In refining their role in the changing system, LHDs find themselves caught between 2 compelling needs. On the one hand, these agencies are often safety-net providers for essential clinical and preventive services. Until the health care system can meet the needs of all people in all communities, LHDs will need to fill these critical gaps. Doing so requires the development of efficient billing and reimbursement capacity and infrastructure.


On the other hand, to remain relevant and viable, agencies must promote their other strength as the community's chief health strategist.1 Specifically, health departments must position themselves as neutral conveners, cross-sectoral collaborators, and data-driven decision makers while reclaiming their historical role as catalysts for changing systemic inequities that lead to disparities in population health outcomes.2


NACCHO believes that health departments with a clear vision for their communities, a strong understanding of their value and role in the local health system, and the ability to communicate in a way that resonates with others are able to remain nimble leaders in face of change. Our public health transformation portfolio seeks to understand the forces driving change, identify the key decisions health departments need to make, pinpoint innovative ideas and promising practices, and spread information and resources to leaders across the nation.



As of November 2015, a total of 79 governmental public health departments across 28 states and the District of Columbia had achieved accreditation through the Public Health Accreditation Board (PHAB) since the program's launch in 2011. Achieving accreditation translates to higher-quality public health services for the nearly 121 million people that LHDs collectively serve. NACCHO has played an important role in helping LHDs prepare for accreditation, improve their performance, and build cultures of quality. As a founding member of the PHAB, NACCHO helps ensure that the PHAB program accurately reflects LHD needs and input while building LHD capacity to engage in accreditation preparation and other performance improvement work.


Quality Improvement

NACCHO provides training, technical assistance, tools, and resources to help LHDs successfully implement quality improvement programs. Such programs help LHDs provide public health services more efficiently and effectively and in ways that best protect and improve the public's health. Drawing upon an extensive membership of local health officials and professionals, NACCHO promotes best practices for quality improvement and facilitates peer connections and mentoring that enable health departments to become catalysts in their communities.



Regulatory and budget changes, most notably the Affordable Care Act, have significantly impacted the size, composition, and efficacy of the LHD workforce. According to NACCHO's 2015 Forces of Change survey, budget cuts, budget stagnation, and job losses remain notable challenges for LHDs. Given these financial challenges and the need for increased collaboration between public health and primary care, it is predictable that budget management and communication ranked highest among the professional skills LHD leaders view as important.


NACCHO is engaged in numerous initiatives to strengthen the local public health workforce at all levels. From training for new preparedness coordinators to managing a community of practice for new local health officials, NACCHO responds to the need for competency-based professional education. Partnering with the Centers for Disease Control and Prevention, NACCHO also offers both virtual and online training to help LHDs create a formal ethics infrastructure. The ethics training and additional educational offerings are housed on NACCHO University, NACCHO's learning management system. NACCHO also advises LHDs on creation and implementation of workforce development plans, staff development, and progress toward accreditation.


A New Era

Despite the demanding nature of change, LHDs are rising to the challenge. LHDs have increased their ability to accept third-party payments for clinical services, helping improve their bottom lines. They are forging partnerships with health care professionals to collectively define community benefit, creating new possibilities for their communities. They continue to adapt, making the most of new opportunities and coping with the difficulties, all while ensuring the conditions that promote health and equity, combat disease, and improve the quality and length of all lives. NACCHO remains their steadfast partner, helping chart a path into a new era of public health.




1. RESOLVE Public Health Leadership Forum. The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist. Washington, DC: RESOLVE; 2014. Accessed November 15, 2015. [Context Link]


2. Fairchild AL, Rosner D, Colgrove J, Bayer R, Fried LP. The EXODUS of public health: what history can tell us about the future. Am J Public Health. 2010;100(1):54-63. [Context Link]