Empowering County Officials to Champion Public Health

The COVID-19 pandemic underscored many lessons, but one stands out clearly: public health is an interconnected ecosystem. It requires community members, stakeholders, and decision makers working together to address critical health challenges. Among these actors, county officials have emerged as key leaders in the effort to safeguard public health. Whether elected or appointed, they often balance state and local priorities, playing a central role in strengthening local public health systems. County officials are committed to improving the well-being of their communities, often by serving on local health boards. They make decisions every day that directly affect public health agencies and the lives of millions of county residents across the United States. With the right knowledge, tools, resources, and support, these influential policymakers can create lasting change in their communities that benefits generations to come. Building the Bridge to Collaboration As was the case with the pandemic, many community leaders’ first deep interaction with their local health department is often during a crisis. Leaders in public health and in local government joined forces to protect their communities from COVID-19, navigating an unprecedented challenge together. Now that this connection has been established, county officials have an opportunity to address everyday public health priorities more intentionally and without the stress of an emergency. To foster stronger collaboration, public health professionals can help county leaders shift their focus upstream to address social determinants of health—to change the systems and infrastructure that impact community health—rather than the social needs that result from those conditions. For an effective partnership, public health professionals and county leaders should take the time to understand each other’s priorities. These concepts can serve as a starting point for county leaders to understand their role in advancing public health: Public health is distinct from health care. The field of public health is broad and often conflated with health care. Charged with improving the health of populations, public health can and should be implemented in all city functions, from transportation to education. Health care takes place at the individual level, typically once a person is already sick or injured. Public health serves not only patients in medical settings but the overall community. In fact, county officials can have a greater influence on people’s health and well-being than health care providers by improving the conditions to increase safety and reduce illness. Policy is the prescription for long-term community health. County officials have long fought to secure resources to address individual-level social needs, but they may not view policy as a way to shape health outcomes at the county level. When these officials enact policy, they address the root causes of health disparities instead of their symptoms. Explaining how policy affects the long-term health of communities helps to illustrate a commissioner’s influence. For instance, reducing health care costs may lower the price of treating asthma, but it does not solve the issue of mold-infested housing that causes asthma in the first place. County officials, who control budgets, zoning laws, and emergency response, have the power to address these determinants through informed policies. Good community health indicators do not mean everyone shares in health equally. Public health leaders know that the hallmarks of a thriving community, such as low levels of disease, access to green space, and safe housing, are only enjoyed by some community members. Even if a community looks good on paper, it is critical to recognize who is missing from the narrative. Public health addresses longstanding inequities resulting from systemic forms of injustice. Before local government officials can celebrate positive community health indicators, they need to first consider whose voices are missing. Practical Actions for Public Health Leaders Public health leaders can support county officials in advancing health solutions further upstream. The following suggestions provide a starting point for developing these efforts. Meet county leaders where they are. Too often, county commissioners and public health agency leaders work in siloes addressing community health needs. One entry point to bring these groups together is the local health board. Some commissioners sit on their local health boards, making these governing bodies well-suited to foster partnerships. Check if your health department has an existing relationship with the local health board. If so, do you know the commissioners who serve your jurisdiction and their priorities? Has the commissioner demonstrated an interest in public health priorities? Cultivating a relationship through regular check-ins or briefings creates open lines of communication for commissioners and health departments to exchange insights. Find a common language: Officials in local government and public health are both pursuing better health outcomes for their communities, but they may use different language in their efforts. For example, “social determinants of health” can be rephrased as “influences on health” without losing the meaning of the concept. Further, it is important to understand that county officials juggle many priorities across expertise areas. By ensuring that information provided to commissioners is brief and effective, uses minimal public health jargon, and is readily accessible, you can help improve the uptake of knowledge from health departments to commissioners. Tap into existing collaborations. External stake-holders and community partners are vital to the success of many public health initiatives. Public health leaders can help make county officials aware of existing partnerships between health departments and the community to bolster those relationships and avoid duplicative efforts. Ensure public health is at the table. Public health leaders need a presence in local decision-making efforts, especially those that have not historically incorporated a public health lens. County officials also need to champion health in all policies to ensure the best outcomes for their constituents. Public health officials can serve as conduits, helping county officials understand how transportation decisions, zoning laws, and budget allocations can directly influence community health—long before disease or emergencies arise. It is time to broaden the scope of public health decision making and empower county officials to make upstream changes that will improve health outcomes for future generations. By providing county officials with the tools and knowledge to address social determinants of health, we can build healthier, more equitable communities for all. A version of this column was adapted from the blog post, Hidden Heroes: The Vital Role of County Officials in Public Health, first published on the de Beaumont Foundation website.1