A new cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the National Association of County and City Health Officials (NACCHO) has been launched to increase the capacity of local health departments to obtain and use health related data.  Asked why the project, entitled “Partnerships for Epidemiology and Surveillance” was undertaken at this time, NACCHO’s Paul Etkind, Senior Director of Infectious Diseases and Project Lead, told the Epidemiology Monitor that it became evident after the 2009 H1N1 pandemic that data collection, surveillance, and epidemiology capacities at the local health level are not well understood.

Unknown Capacity

He added, “We do not really know what we can expect from epidemiologists and other public health professionals working there, particularly in light of new information collection technologies now available.” He contrasted this with the detailed knowledge we have about epidemiologists at the state level because of very comprehensive capacity  surveys conducted periodically by the Conference of State and Territorial Epidemiologists. Such surveys to measure and characterize local level epidemiology capacity have not been conducted. “We hope that the work we are undertaking will lead to a parallel understanding of the  local capacity that will be valuable to NACCHO, ASTHO, CSTE the CDC and to public health in general,” said Etkind. Summarizing the situation in a nutshell, he added “Epidemiology at the local level is, to some extent, a ‘black box’”.

Epi Roster

One of the key enabling elements of the new project will be to compile a roster of epidemiologists with formal training in epidemiology working at the local level and of other professionals whose primary training may be in sanitation, nursing, or other disciplines. These professionals do not think of themselves as epidemiologists but they are doing epidemiologic work, particularly during outbreaks or emergency situations. Future initiatives and capacity surveys will depend heavily on being able to identify epidemiology practitioners in the local health departments.

First Objective

The NACCHO project has been funded for one year and will be renewable on an annual basis. It has four principal objectives, the first of which is obtain a situation assessment of epidemiology and surveillance needs and priorities at the local health department level. The project expects to produce a report for NACCHO, CDC, and public health partner organizations based on the outcomes of two meetings held with persons working locally on epidemiology and surveillance issues, as well as other survey work that may be developed.

The second objective is to enhance the policy contributions of an Epidemiology and Surveillance Workgroup convened by NACCHO. The Workgroup, representative of different size health departments from various geographic areas and including different subject matter experts, is charged to produce policy statements and provide a local health perspective input into national policy conversations. These activities will help give voice to local health departments and to NACCHO to advocate for issues in their communities or advance local health department positions during national level policy forums.

Community Health Needs

For example, the new Affordable Care Act mandates that hospitals take the lead in conducting community-level health needs assessments in their areas every three years. The legislation does not specifically mention local health departments as participants, or indicate that local health departments need to participate in this process.   Many hospitals are not conducting the needs assessments, however, the relationships between community hospitals and local public health departments have not often been ones of close collaboration, according to Etkind.  A policy statement specifically calling for inclusion of local health departments would help give voice to NACCHO at the national  level and to local health departments at their level to advocate for health department involvement.

This in turn could help to ensure broader community participation and more of a population focus for these assessments.

Resources

The third objective of the project is to identify and distribute strategies, tools, and the other resources epidemiologists can use at the local level. The Epidemiology Work Group coordinates with Informatics Work Group at NACCHO to help identify innovations in health IT to support the work of epidemiologists.  NACCHO expects to devote a portion of its website to epidemiology, carry news about the profession, list partner organizations epidemiologists can link to, have a tool box where epidemiologists can look for tools and strategies that might be applicable to challenges in their own jurisdictions, and perhaps publish an electronic newsletter that could also feature brief opinion pieces or peer-to-peer questions and answers. The overall goal is to improve the practice of epidemiology at the local level.

The fourth objective of the project is to solicit from members  at least one new model in the area of local health department epidemiology and surveillance practice. This would be part of NACCHO’s annual Model Practice initiative

Getting Involved

Readers who currently are engaged in epidemiology work at the local health department level are encouraged to contact Paul Etkind at NACCHO (petkind@naccho.org) to add their names to the developing roster of epidemiology practitioners at the local health level.