President’s Corner

437 1 00227 S17 I3526 Jack Goras

April 2024:

Harm Reduction & Its Role in Public Health

The mission of public health is centered around health equity by preventing disease and injury, promoting safe and healthy living, and protecting the environment for all in one’s community.

Two of those pillars of public health are evident in harm reduction strategies–preventing disease and injury and promoting safe and healthy living. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), harm reduction is an “evidence-based approach that is critical to engaging with people who use drugs (PWUD) and equipping them with life-saving tools and information to create positive change in their lives and potentially save their lives.” Harm reduction is very much a “meet people where they are” approach and can serve as a pathway to additional prevention, treatment, and recovery services.

At Linn County Public Health, we have been focusing on leveraging harm reduction strategies within our community. One of the notable accomplishments in our agency is hiring our first Harm Reduction Coordinator. In this role, our staff member is focused on implementing harm reduction strategies, educating the community on substance misuse, and providing access to safe drug use supplies. This staff member is a good resource for our entire agency, as it enables us to have a strong understanding of the substance use disorders that are present within our community, as well as identifying strategies that can have a positive impact on those with substance use disorders within our community.

Another example of a harm reduction strategy at work is through our Lock Box Program– a community-wide partnership that provides a locked box with safe and clean drug use supplies, such as syringes, wound care kits, alcohol wipes, etc. This program has been well received and used throughout our community. One of the advantages of implementing this type of program into our community is to cut down on some of the diseases we see in those who do not safely inject drugs, such as Hepatitis A or the Human Immunodeficiency Virus (HIV). While safe and clean drug use supplies does not prevent all diseases, it does ensure that the supplies are circulating throughout our community.

In addition to providing supplies, Linn County Public Health also has a robust Harm Reduction Toolkit that is available on This toolkit is meant to be a valuable resource to those who have substance use disorders by providing information that pertains to safety, naloxone, HIV, hepatitis, mental health, addiction treatment programs, and healthcare referrals. This toolkit enables individuals to receive educational information about help that is available within their community.

Last, but certainly not least, Linn County Public Health is working with several community organizations to implement a Naloxone Vending Machine Program within Linn County. This program is in the early stages and is still being finalized, but we do know that seven vending machines with naloxone, wound care kits, hygiene kits, alcohol swabs, tampons, condoms, and other supplies will be available in Linn County soon. These supplies are free to all and provides easy access to naloxone, which can save a life for someone who is experiencing an opioid overdose.

Overall, these are just a few of the ways Linn County Public Health is implementing harm reduction strategies within our local community. I challenge our fellow local health department officials to consider how harm reduction strategies may benefit their communities; these actions could save lives.

Recapping My Time in Washington, DC

During the week of February 26, I had the privilege of traveling to Washington, D.C. for Leadership Week, notably attending the National Association of County and City Health Officials, also known as NACCHO’s, Board of Directors meeting and our annual Local Public Health on the Hill Day on February 28.

Throughout my time in Washington, D.C., I was fortunate to connect with national leadership organizations and elected officials to discuss the issues facing local public health departments. This was important work, as the voices of local public health departments should be heard, because we are at the center of any public health emergency. In addition to national leadership organizations, I also spoke with Iowa’s federal elected officials which included Senator Joni Ernst and staff members from the offices of Senator Chuck Grassley and Representative Ashley Hinson. In total, NACCHO colleagues and public health leaders had over 100 interactions with elected officials.

Another federal lawmaker I had the chance to engage with was Representative Jason Crow (CO-6) and for a rather exciting reason. I presented Representative Crow with the inaugural National Champion of Local Governmental Public Health Award. This award recognizes outstanding, significant, and innovative activities and accomplishments by an individual, agency, or organization that has consistently or, in an extraordinary way, promoted the visibility, importance, and recognition of local governmental health departments or NACCHO on a national basis. Representative Crow was recognized with this award for introducing and advocating for the bipartisan Public Health Workforce Loan Repayment Act in the U.S. House of Representatives in 2021 to help health departments recruit and retain exceptional staff with the skills to tackle emerging and ongoing challenges. This act became law in December 2022 as part of the Consolidated Appropriations Act, 2023.

While engaging with governmental and organizational leaders was valuable, I also found it to be insightful to hear from different experts about key issues that are impacting all of our communities. One of those priorities rose to the top – climate change.

Sonia Angell, MD, MPH, FACP is a Bloomberg Distinguished Professor of the Practice at Johns Hopkins Bloomberg School of Public Health and briefed us on the impact climate change can have on the public’s health, proving to us all that we should be concerned with our current state of climate change. Some of the highlights from her presentation included data about how our climate has shifted and different types of pollution we are exposed to. The biggest takeaway from Sonia’s in-depth presentation is that climate change impacts health directly and indirectly and is strongly mediated by environmental, social, and public health determinants.

Keeping with the theme of the environment, I also had a special guest join our NACCHO colleagues in Washington, D.C. Maya J. van Rossum represented Green Amendments for the Generations, an organization in which she founded. She spoke to our leadership team to bring awareness to this valuable organization in helping us fight environmental challenges across the nation and the world. The mission of Green Amendments for the Generations is to “ensure every person and community across the United States is able to experience the health, quality of life, education, joy and economic prosperity provided by a clean, safe, and healthy environment; to end environmental racism; and to help ensure that nature itself is able to thrive, by constitutionally empowering all people to secure and enforce their inalienable human right to pure water, clean air, a stable climate, healthy ecosystems and environments.” This presentation and conversation was insightful to me, as it reaffirmed that local public health departments are not alone when facing environmental challenges. We have terrific organizations, such as Green Amendments for the Generations, walking alongside us in this journey.

These are just a few highlights from the stimulating events and discussions that unfolded during NACCHO’s Leadership Week and annual Local Public Health on the Hill Day in February. I extend my gratitude to all frontline public health colleagues whose tireless efforts underscore the importance of our work on a national stage. Without their dedication, our cause would lack the momentum needed to effect meaningful change. I also extend my heartfelt gratitude to my NACCHO colleagues for their exceptional organization and coordination, which contributed to the success of the week's events.

Public Health Data and Why it Matters

In public health, data drives decisions and is a powerful tool in understanding the needs and health status of our communities. By using data, local health departments make informed decisions that assist communities in their quest of preventing disease and injury, promoting safe and healthy living, and protecting the environment.

At Linn County Public Health in Cedar Rapids, Iowa, we are equipped with a robust assessment and health promotion program that provides health data and compiles reports, making it easier for us to comprehend the overall public health picture for our community. Our programs conduct research and collect data, both primary and secondary, to identify health issues worthy of public health interventions. Our data helps us to underscore health inequities and discuss different health topics, such as the state of health in our community or something more specific, like disease outbreaks and vaccination rates. Additionally, our program may assist with data requests, internally and externally. This is an important part of the work, as it allows us to share data with key stakeholders who may help us in our public health efforts.

Now, for the real question...why is public health data important and what purpose does it serve?

Data is vital for public health professionals. Most of our work is rooted in science and data.

One instance where data has been helpful is understanding health disparities. By using data, we can gain a better understanding of how someone’s background may have an influence on their health. Some of the specific ways data can help us be informed about health disparities include:

  • Highlighting inequalities in health outcomes among different demographics
  • Assisting in identifying and tackling social determinants of health
  • Aiding in the advancement of strategies to reduce health inequities
  • Driving interventions and initiatives in high-risk areas or populations

Aside from health disparities, data continues to be beneficial for public health professionals in numerous other ways, too. Some of those include:

  • Providing the evidence needed to support public health programs
  • Informing health education materials and campaigns
  • Helping to inform the public during public health emergencies and providing guidance on public health measures
  • Helping governments and organizations distribute resources appropriately based on identified health priorities
  • Identifying health issues and disease outbreaks
  • Providing the prevalence and distribution of diseases
  • Supporting and informing the implementation of effective prevention measures
  • Allowing the public to make informed decisions
  • Enabling the evaluation of the effectiveness of public health information

Thanks to all of you for telling your public health stories through data. Your work does not go unnoticed and makes a significant contribution to the public health field.

Using public health data allows us to identify trends and patterns, inform decisions, and make a difference in public health. Simply put, the use of data can have a positive influence in achieving better health outcomes in our communities and beyond.

Advancing Health Equity, Behavioral Health & Global Health: A New Year's Resolution

As we welcome 2024, I have been reflecting on the importance of advancing health equity and social justice for all our hometowns across America. As part of that, this month, I highlight the innovative work of Meharry Medical College, the oldest historically black medical college in the South. For nearly 150 years, Meharry Medical College has been at the forefront of training African American physicians and dentists. In addition to its longstanding commitment to health equity, Meharry recently made a significant stride by announcing the creation of the first “School of Global Health” in the U.S. This new school is a testament to Meharry's commitment to advancing health equity and its dedication to training future health leaders devoted to advancing diversity.

As we ring in the new year, I have also been struck by an initiative led by Meharry Medical College, entitled Dry January USA. It encourages individuals to abstain from alcohol for the first month of the year. This initiative promotes behavioral health and fosters a culture of sobriety and wellness. It is a testament to the power of collective action in promoting health and wellness. The Director of the National Institute on Alcohol Abuse and Alcoholism (NIAA) provides timely advice in his recent monthly column about Dry January USA. You can view the column at As we embark on this new year, I encourage every local health department to consider participating in Dry January USA. It is a gentle and non-judgmental nudge to remind people about the benefits of being alcohol-free. You can learn more about Dry January USA at; and you can share the free app with your community.

As the President of NACCHO, I am committed to promoting health equity, social justice, and behavioral health. I am excited about the opportunities that lie ahead, and I am confident that together, we can make significant strides in improving the health of our communities. NACCHO has developed tools, inclusive of trainings, guides, videos, and recommended readings, for you to share with your staff with the goal of advancing the capacity of local health departments’ ability to confront the root causes of inequities in the distribution of disease and illness through public health practice and organizational structures. You can view the resources at

Here's to a healthier 2024!

Gun Violence Is An Epidemic; It’s Time To Treat It Like One

As of December 11, 2023, more than 40,000 people were killed in gun violence in the United States, there has been over 22,500 deaths by gun suicide so far this year, there has been 635 mass shootings, there has been 39 mass murders, and more than 5,900 children and teenagers have been killed or injured by gun violence in the U.S. since mid-December, according to the Gun Violence Archive.

U.S. public health leaders and professionals work tirelessly to stop COVID-19 and other diseases. What about the gun violence that is besetting America? Gun violence is also a disease, and it is a preventable epidemic.

Tragically, we know this isn’t just a problem in large states or big cities; it’s a problem everywhere. It happens in U.S. neighborhoods, towns, small and medium-sized localities, and rural communities.

It’s time to act and enact laws to save lives from gun violence. Our communities have had enough with the thoughts and prayers; we need action. This time let’s all work together.

We are living in a culture of desensitization. We are becoming numb, seeing, reading and hearing about the data associated with this issue, but here are some statistics to consider from the Pew Research Center:
– Four in ten U.S. adults say they live in a household with a gun, including 32% who say they personally own one.
– Six in ten Americans increasingly say that gun violence is a major problem, up nine percentage points from spring 2022.
– Looking ahead, 62% of Americans say they expect the level of gun violence to increase over the next five years.
– A majority of Americans (61%) say it is too easy to legally obtain a gun in the United States.
– About a third (32%) of parents with K-12 students say they are very or extremely worried about a shooting ever happening at their children’s school.

Firearm shootings in our country are ubiquitous: in homes, in schools, in places of worship, in workplaces, at shopping malls, at clubs, on the streets, and at events. When these shootings happen, they shake us up. Then, a while later, we go on “business as usual.”

As public health practitioners, we rely on data and evidence. Our work uses certain frameworks to prevent/control a disease or health event. An outbreak or epidemic exists when there are more cases of a particular disease than expected in a given area, or among a specific group of people, over a particular period of time. By most of these measures, this is where we find ourselves when it comes to gun violence.

The case to prevent gun violence in our communities is complicated because there are a number of components, including mental health issues and scarcity of research to identify precise risk and protective factors and preventive measures. However, something must be done in light of the staggering tolls associated with firearm deaths, disability, and economic costs.

As president of the National Association of County and City Health Officials (NACCHO), the organization and its local health department members and partners recognize firearm-related injury and death as a preventable public health crisis.

Per NACCHO’s “Prevention of Firearm-Related Injury and Death Policy Statement,” “NACCHO supports a comprehensive public health approach to promoting safe communities and preventing firearm misuse, injury, and death, while acknowledging an individual’s right to own and use firearms for legal purposes.”

“NACCHO also recognizes the disparate impact of firearm-related injury and death on vulnerable communities. Structural racism, social marginalization, and economic inequalities can increase one’s risk of perpetuating or experiencing firearm violence. As such, NACCHO recommends that local health departments consider addressing the root causes of these inequities by crafting policies that address the systematic and structural causes of firearm-related injury and death.”

“Local health departments play an important role in preventing intentional and unintentional firearm-related injury and death. In coordination and collaboration with other local, state, and national efforts, local health departments should engage in primary prevention strategies, while addressing the intersection of related public health issues such as suicide, substance misuse and addiction, community violence, and domestic violence.”

To read the entire NACCHO policy statement and associated recommendations, click here.

Respiratory Illness Season: How Local Health Departments Can Make a Difference

It’s hard to believe it’s already late fall; the leaves have changed, and the temperatures are beginning to drop here in Cedar Rapids, Iowa. With the change of the seasons, comes the opportune time for local health departments to promote COVID-19 and influenza vaccines, as well as many of our routine respiratory illness precautions. These measures include the 3 C’s that we share with our communities: cover your coughs and sneezes, clean your hands, and contain your germs by staying home when sick.

At Linn County Public Health, we were excited to get some doses of the 2023–2024 formulation of the COVID-19 vaccine. With this vaccine being recommended for all individuals aged 6 months and older, it’s a welcomed opportunity to prevent severe illness and hospitalization in people of nearly all ages. The added bonus of the updated COVID-19 vaccine is that it is a better match at targeting the variants currently circulating in our communities.

To further expand our opportunity for protection during respiratory illness season, it’s a great idea to also get an annual flu shot. Those who want to receive the updated COVID-19 and influenza vaccines, can get both during the same appointment; it’s a win-win!

When it comes to gearing up for respiratory illness season, local health departments have a unique role to play. First and foremost, local health departments should strive to deliver trusted messages to residents through a variety of platforms. At Linn County Public Health, we’ve used media releases, social media, interviews, and graphics to spread the word about vaccines for respiratory illness season. It is paramount that local health departments reinforce recommendations from regulatory entities, such as the Centers for Disease Control and Prevention (CDC) and/or state health departments. Additionally, Linn County Public Health developed a respiratory illness webpage to convey key messaging about COVID-19, influenza, and RSV to our local residents.

Another opportunity for local health departments to shine during respiratory illness season is by striving to vaccinate residents, whether for COVID-19, influenza, or both. We have a dedicated team of professionals in our clinic that have administered countless COVID-19 and influenza vaccines to our Linn County residents. This is a vital component to keeping residents safe and healthy during respiratory illness season, while also getting individuals to engage with their local health departments.

Last, but not least, local health officials are encouraged to seek out opportunities to stand apart from other organizations in our communities. While keeping a community healthy is certainly a team sport, there are numerous ways local health departments can offer unique services or programs. Linn County Public Health is one of two Bridge Access Providers in Linn County. This program enables our clinic to offer the updated COVID-19 vaccine at no cost to individuals who are uninsured or underinsured. This helps to eliminate barriers for individuals getting vaccinated against COVID-19 and protecting themselves from severe illness and hospitalization this winter.

Local health departments and their residents can ultimately work together to ensure a healthy and safe respiratory illness season. Even though vaccines and the COVID-19 pandemic can be a polarizing issue to discuss, it’s important to have proactive and empathetic conversations with local residents.

It’s OK to ask questions about the COVID-19 vaccine and respiratory illness season. A priority of the National Association of County and City Health Officials and local health departments is to provide evidence-based information about vaccine safety. As local health departments, it’s our duty and honor to be a resource to our communities, be at the front line of combating illnesses, and be a major contributor to optimal health for all.

Racism and Its Impact on Health

In the realm of public health, it is well-established that institutional racism has dire consequences for the health and well-being of people of color. According to the Centers for Disease Control and Prevention (CDC), racial and ethnically minoritized communities in the United States experience higher rates of illness and death from heart disease, hypertension, diabetes, and other health issues compared to their White counterparts.

My own research underscores these health disparities. The COVID-19 pandemic has had a disproportionate impact on racial and ethnic minority populations, which is another stark example of these enduring health disparities. Black, Latinx, and American Indian persons have been hospitalized and have died at a higher rate than White persons consistently from the start of the pandemic. Moreover, the economic repercussions of the pandemic disproportionately affect minority communities – worsening the gaps in wealth, employment, housing, and access to health care: the social determinants of health that caused the disparities in the first place.

Every day, we witness numerous instances of discrimination, persecution, and tragically, racist violence against racial and ethnic groups in the United States — which extend deep into the history of our country. In Linn County, we have used data to highlight the disparities that impact our own residents. For reference, 7.1% of Linn County’s population is Black, according to the United States Census Bureau. Some of the data points that highlight how racism and health disparities influence health outcomes include:

  • Infant mortality in Linn County is three times higher for Black mothers, as compared to White mothers, per Iowa Department of Health & Human Services’ Vital Statistics Report.
  • Black males have a significantly higher mortality rate from lung cancer with 126.4 deaths per 100,000 population, as compared to 70 deaths per 100,000 population for White males, per the Surveillance, Epidemiology, and End Results (SEER) Program.
  • From 2018-2020, 24% of the Black population identified as having asthma, which can be compared to 9.4% of the White population, per the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System.
  • Black males have a higher mortality rate due to heart disease (222.8 deaths per 100,000 population), compared to White males with 199.2 deaths per 100,000 population, per CDC Wonder.
  • Being African-American is a risk factor for colorectal cancer, and the incidence and mortality among Linn County Black males is higher than White males, per the CDC and the SEER Program.

Aside from these evident health disparities among our Black community, we must note another feat this population and other racial and ethnic minority populations must overcome – racism.

Racism remains an urgent public health crisis, and the National Association of County and City Health Officials (NACCHO) is unwavering in its commitment to confront racism as a public health concern. Please see NACCHO’s policy statement on Health Equity and Social Justice. Addressing this crisis is not only a moral imperative, but a fundamental necessity for the well-being of society. NACCHO stands resolute in its efforts to combat racism's detrimental effects on public health.

To address these deep-seated issues, it is imperative that we intentionally educate ourselves about diverse experiences to change our behavior as health officials and take concrete actions to change policies and practices that perpetuate health disparities in communities of color. This transformation must happen in a genuine, bidirectional partnership with the communities affected.

NACCHO Board of Directors’ President, Pramōd Dwivedī, DrPH

On July 1, 2023, I assumed the role of President of the National Association of County and City Health Officials (NACCHO), representing more than 3,000 local health departments across the United States. It is an immense honor and privilege. In addition to this role, I am also honored to serve as the Health Director at Linn County Public Health in Cedar Rapids, Iowa, serving nearly 230,000 neighbors.

My name is Pramōd Dwivedī, which has roots in Sanskrit. Pramōd means the one who is blissful and is among the 1,000 names of Hindu god Vishnu. I received this name from my dear mother and father – both in the heavens now.

And Dwivedī, my last name, belongs to an illustrated lineage of Vedic Scholars from ancient India, with its origins estimated to date back nearly 5,000 years ago.

The Vedas are a collection of ancient scriptures that form the oldest and most authoritative texts in Hinduism. They are written in Sanskrit and are considered to be the divine experiences of the ancient sages. The Vedas proclaim the profound statement, "The whole planet is my family."

Personally, they have been a tremendous source of inspiration for me, strengthening my belief in the inherent goodness of humanity and the unity of all living beings.

Our mission at NACCHO is to promote and protect the health and well-being of communities throughout this beautiful nation of ours.

Taking on this significant national role as an immigrant and a person of color, and now an American with a family, fills me with both pride and humility.

I identify as a public health professional and scientist.

As I stood before the largest gathering in the history of the association’s annual meeting NACCHO360, in Denver, I felt it necessary to acknowledge the territories and ancestral homelands of the Cheyenne and Arapahoe nations on which we convened. The space was also vital to many other Native Nations, including the Lakota, Ute, Kiowa, Comanche, Apache, Shoshone, and others.

Recognizing the Indigenous peoples as the original custodians of the land, water, plants, and animals is crucial, as is acknowledging the painful history of genocide and forced removal of tribes from this territory.

I also felt it important to acknowledge the labor of enslaved Africans and their descendants who worked the stolen land for the colonists and who continue to disproportionately face economic oppression, racism, violence, and exploitation.

Today, health disparities and inequities have plagued our communities for too long, disproportionately affecting people of color, low-income individuals, and rural communities. To achieve health equity, we must address systemic racism, poverty, and discrimination — the root causes of these disparities.

Our nation faces unprecedented challenges, brought to the forefront by the COVID-19 pandemic, exposing vulnerabilities in our public health infrastructure. We must address decades of disinvestment that have crippled governmental public health systems. Local health departments are on the frontlines during public health emergencies, yet we often find ourselves at the back of the line when it comes to resources. This must change, and we, the public health community, must reclaim our rightful place in public discourse and strive for an equitable and inclusive system.

Through NACCHO advisory workgroups, our local health department members continuously develop and review policy statements that guide our work. I encourage you to explore these policy statements on the NACCHO website, particularly those related to health equity and social justice, environmental justice, mass incarceration, policing and racism, climate change, women’s health, and injury and violence prevention, including firearms.

In terms of advocacy, NACCHO made significant strides, including the inclusion of the public health student loan repayment program in the December 2022 omnibus, which is now law. This program aims to not only build a diverse workforce but also attract young professionals to public health by offering loan repayment in exchange for working in local or state health departments.

On public health workforce development, NACCHO will continue to garner resources through its advocacy. And, as President, I have asked each Board member to work toward this goal. The workforce is our biggest asset, our biggest infrastructure, and we must do everything to build a strong, equitable, fun-loving, and culturally-sensitive workforce and a public health system that can sustain it.

Let’s also make sure our workforce does not leave the public health field.

We want to continue to encourage new views toward direct funding to local health departments where and when it makes sense and to continue strengthening our communication linkages between the federal and local governments.

A few years ago, the CDC initiated the Ending the HIV Epidemic, which provided direct funding to local health departments that targeted communities with the highest prevalence of HIV spread and infections. At the time, this was a landmark change in targeted funding directly to local health departments based on data and outcomes. This year, NACCHO continued to work hard to push more money into the hands of our county and city health departments. As a result, the CDC directly funded 47 health departments with workforce dollars. We worked to ensure the introduction of language in notices of awards for states to allocate 40% of workforce dollars to all local health departments not directly funded. This is progress, and NACCHO will continue to advocate for local health departments to receive funding.

NACCHO remains committed to striving for local health departments across the nation to develop strong foundational capabilities before another public health emergency reaches our doorsteps.

And, programmatically, we continue to grow our work to provide resources, programs, reports, and technical assistance to local health departments across the country.

As an Iowan, I am humbled and honored to receive this grave responsibility. My commitment as NACCHO President is to work collaboratively with all stakeholders in government, academia, and the private sector to build a stronger, equitable, and sustainable public health infrastructure. Public health is a team sport, and together, we will leave no stone unturned in our pursuit of a healthier, more equitable, and joyous future for our communities in Iowa and the United States.

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