1. Context, change, and a longer view Robert M. Pestronk Executive Director National Association of County and City Health Officials rpestronk@naccho.org 2014 North Carolina State Health Director’s Conference January 23, 2014

3. Once…

4. Then…

5. Forces for Convergence Jackson Pollack, “Convergence”, 1952

6. Perspective is important

7. Local health department directors and departments

8. Personal experience FiveNavigating relationships

9. Striking a balance the three challenges underlying local health department practice…

10. The first challenge New Yorker magazine, 2012

11. The second challenge… AssessmentPolicy developmentAssurance

12. The third challenge… Relationships (constituency and politics) Science and/or

13. The national context: state health departments Accessed 1/19/14, http://www.50states.com/us.htm#.UtwYd2co6P8

14. North Carolina within the national context Accessed 1/19/14, http://geology.com/county-map/north-carolina.shtml

15. Percentage of LHDs that are Part of a Health and Human Services Agency for all LHDs and North Carolina, by Size of Population Served, and Type of Governance All LHDsNorth Carolina LHDs LHD is part of HHSA 20%12% Size of Population Served <25,00015%9% 25,000—49,99919%13% 50,000—99,99925%5% 100,000—499,99925%11% 500,000+26%100% Type of Governance State42%-- Local12% Shared30%-- n=1,966n=78 Source: 2013 National Profile of Local Health Departments

16. Percentage of LHDs where the Organizational Structure Changed within the Past Two Years for All LHDs and North Carolina, by Size of Population Served and Type of Governance All LHDsNorth Carolina LHDs LHD Changed Structure 11%12% Size of Population Served <25,0007%9% 25,000—49,99912%13% 50,000—99,99911%9% 100,000—499,99916%15% 500,000+20%0% Type of Governance State9%-- Local10%12% Shared19%-- n=1,967n=78 Source: 2013 National Profile of Local Health Departments

17. Percentage of LHDs with a Local Board of Health for All LHDs and North Carolina, 2010 and 2013 All LHDsNorth Carolina LHDs 2010201320102013 LHDs has LBOH 75%70%100%87% Size of Population Served <25,00076%69%100% 25,000—49,99984%78%100%81% 50,000—99,99979%76%100%91% 100,000—499,99967%65%100%85% 500,000+54%50%100%50% Type of Governance State43%46%-- Local86%79%100%87% Shared54%52%-- n=2,099n=1,974n=79n=78 Source: 2010 and 2013 National Profile of Local Health Departments

18. Percentage of LHDs that are Local Governed with Select Local Board of Health Functions for ALL LHDs and North Carolina, 2010 and 2013* LBOH Function All LHDsNorth Carolina LHDs 2010201320102013 Advise LHD or elected officials on policies, programs, and budgets 87%86%94%97% Set policies, goals, and priorities that guide the LHD 81%79%95%99% Adopt public health regulations 79%76%97% Approve the LHD budget 74%75%77%82% Set and impose fees 73%71%77%82% Hire or fire agency head 65% 96% Request a public health levy 39%37%11%10% Impose taxes for public health 18%19%0%3% n=1,565n=1,371n=79n=67 *Among LHDs with a Local Board of Health Source: 2010 and 2013 National Profile of Local Health Department

19. Teutsch, IOM Roundtable on Population Health Improvement, 2013 Making use of what we know and water (climate, earth, air, water ) Preparedness

20. The panel: Gibbie Harris Director Buncombe County Health Department David Stanley Director Brunswick County Health Department Carolyn Moser Director Pender County Health Department