1. Yox, Emily MPH

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The COVID-19 pandemic has provided the United States with an unprecedented opportunity to understand the important lessons that global health can teach us. As public health organizations in the United States strive to address this and other challenges, looking beyond our country's borders for creative and scalable solutions may provide more effective approaches, especially in the areas of mental health and substance use disorder (SUD). Yet, it is not only within the context of a worldwide pandemic that global health can be a powerful resource for US local health departments (LHDs). Successful health initiatives know no boundaries, and approaches adapted from other countries can provide a wealth of knowledge and inspiration for LHDs working to address challenges in their own communities.


In 2009, the Consortium of Universities of Global Health's Executive Board published an article in The Lancet, offering a definition of global health:


Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual level clinical care.1(p1995)


Koplan and colleagues1 also made a key distinction between global health and its predecessor-international health-in their definition, clarifying that global health should not be a unidirectional endeavor like international health but rather bidirectional, with "a mutuality of real partnership, a pooling of real experience and knowledge, and a two-way flow between developed and developing countries."1 This bidirectional definition is crucial as we start to think about what US LHDs can learn from global health, especially as we consider the lasting impact of COVID-19.


The global learning around COVID-19 is just beginning. Hindsight will provide us with the opportunity to see which national strategies around response, testing, contact tracing, mitigation, and risk communication were most effective at minimizing the spread of the virus. In addition, the predicted impact of COVID-19 on mental health and SUD is becoming an area of focus.2 Robustly supporting mental health and combating substance use problems are challenges that many countries face already, and social isolation, increased financial strain, stigma, and anxiety from growing uncertainty may translate into unstable mental health or unsafe behaviors, including increased substance use during and post-COVID-19 pandemic.3 Evidence from previous mental health studies postdisaster also indicates that these challenges are ubiquitous in already vulnerable populations and are greatly exacerbated by disasters.3 The aftermath of COVID-19 is expected to be no different, highlighting the need for prevention and preparedness for the likely increase in these challenges. LHDs have been, and will be, a key frontline resource in providing continued support to communities.


NACCHO's Role in Global-Local Health

The connection between global health and the National Association of County and City Health Officials (NACCHO) may not be readily apparent. What role does global health play in a US national association focused on local counties and cities?


NACCHO believes that all health is global health. The health and well-being of all people are intrinsically linked, and LHDs can learn from successful approaches, models, and solutions that have been developed and successfully executed in other countries. The global camaraderie brought about by the entire world grappling with COVID-19, and the critical need to work together, has reinforced this approach and is very much in line with NACCHO's existing plan to increase the exchange of information among US LHDs and local health organizations in other countries.


Prior to the outbreak of COVID-19, NACCHO saw the opportunity to learn from other countries about how to address mental health and SUD challenges on the local level. With support from the Robert Wood Johnson Foundation (RWJF), NACCHO initially sought to determine the openness and willingness of LHDs to learn from global health and to identify some of the challenges that LHDs face, for which they believe other counties may be able to provide new approaches and solutions.4 The findings from this initial research indicated that both mental health and SUD are top challenges for LHD leaders, and they believe that other countries have valuable insight and innovative approaches that would be beneficial to implement in the United States.4


Many also saw the availability of data and proven history of success as benefits of adopting and adapting global practices that have already been implemented in other countries.4 As a result, NACCHO is looking to provide LHDs with the opportunity to learn from successful global mental health and SUD initiatives so that they can better address these areas in their own communities. These resources will be particularly salient in the post-COVID-19 future.


Armed with the information gleaned from our previous research, RWJF supported NACCHO again to propel the idea of global-local health further and to plan how to support LHDs to integrate global best practices into their work. As we thought about where LHDs currently are in their approach to global health solutions, the analogy of a swimming pool came to mind. There are some LHDs that have been involved in the global-local space for some time and regularly scan the globe for solutions to challenges requiring a new approach. We think of those people as swimming laps in the pool; they are potentially in need of a coach to improve but, overall, happily swimming along. Then there are those who are dipping their toes in the pool, perhaps staying near the shallow end. They may have heard or thought about using global health for inspiration but need a guide to confidently jump in the water. Finally, there are those who have no idea the pool even exists. These folks have not considered global health as a resource at all and need guidance in becoming aware of the possibilities.


NACCHO is now engaged in work to assist and educate LHDs, regardless of where they are (or are not) in the pool. Our first objective is to learn from US early adopters who have cultivated a mental health or SUD program within their own communities originally developed from a global health approach. NACCHO has substantial experience in providing technical assistance and mentorship opportunities for LHDs to learn from each other, and this new project leans on that experience. These LHDs will be given the opportunity to share their experiences and adaptation process with those who are ready and interested in engaging in the global-local realm but do not necessarily know where to begin.


The second objective is to identify and share other global approaches that have potential for adaptation in the United States through partnerships with apolitical and other organizations that share the mission of connecting global and local health. This will help guide LHDs with no experience in global solutions and provide a broader platform and wider audience for these innovative, successful, and oftentimes cost-effective approaches to mental health and SUD.


Social isolation, increased substance use, and other mental health challenges are expected to follow the COVID-19 pandemic.2 As the world begins to address the myriad effects of this pandemic, global health collaboration provides an unparalleled opportunity for shared learning. The world has come together to address the immediate needs of COVID-19, but we can continue to come together to address the expected long-term challenges that are anticipated as well. Global health at its core is grounded in bidirectional sharing of information and expertise, and NACCHO wants to tap into the unique resources that a global-local perspective can provide, ensuring that the mental health and SUD needs of people across all local communities are met.




1. Koplan JP, Bond TC, Merson MH, et al Toward a common definition of global health. Lancet. 2009;373(9679):1993-1995. [Context Link]


2. Galea S, Merchant RM, Lurie N. The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention. JAMA Intern Med. 2020. doi:10.1001/jamainternmed.2020.1562. [Context Link]


3. Pfefferbaum B, North CS. Mental health and the COVID-19 pandemic. N Engl J Med. 2020. doi:10.1056/NEJMp2008017. [Context Link]


4. Yox E. From Global to Local: Bringing International Lessons to U.S. Local Public Health Practice. Washington, DC: National Association of County and City Health Officials; 2019. Accessed May 7, 2020. [Context Link]