Hidden Heroes: The Vital Role of County Officials in 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 players, 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 that benefits generations to come. As part of a growing partnership between the de Beaumont Foundation and the National Association of Counties (NACo), we aim to ensure that county officials are equipped to make decisions that lead to healthier, more resilient communities. 

Public Health Infrastructure at the Local Level 

Among the 2,800 local health departments nationwide, 70% are county-based and 61% serve rural areas. These departments often face the dual challenge of meeting health care demands while also addressing public health priorities such as prevention, emergency preparedness, substance use, and more. 

The COVID-19 crisis presented an opportunity for county officials to be more involved in public health priorities beyond emergencies. To foster stronger collaboration, public health professionals need to help county leaders shift their focus upstream to address social determinants of health — to change the community conditions that make people sick — rather than the social needs that result from those conditions.

Policy: The Prescription for Social Determinants  

It is vital to distinguish between public health and health care, recognizing that health care usually takes place at the individual level while policy is the best tool for more upstream change. County officials have long fought to secure resources to address individual-level social needs, but through our partnership, we encourage them to view policies as a way to address the social determinants of health at the county level. Policies affect long-term health outcomes, and through enforcement they change practices, rather than simply treating the symptoms and effects of those issues. 

At the NACo Annual Conference in July, de Beaumont CEO Brian C. Castrucci, DrPH, presented to NACo’s Healthy Counties Committee, a group of commissioners and county administrators tasked with rethinking local approaches to health. He shared three key points with the audience: 

• County officials have a greater impact on people’s health than health care providers. 
• Lower health care costs do not necessarily mean people are healthier; it means they cost less to the system. 
• Good community health indicators do not mean everyone shares in health equally. 

These points speak to the importance of addressing the root causes of poor health rather than merely managing their effects. For instance, reducing health care costs may lower the price of treating asthma, but it doesn’t 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. 

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. 

• Foster Relationships: Some commissioners sit on their local health boards. If you work for a local health department, determine if there is already an existing relationship. Do you know the commissioners who serve your jurisdiction and their priorities? Do they already have an interest in public health priorities? Cultivating a relationship through regular check-ins or briefings creates open lines of communication, ensuring an avenue for commissioners and health departments to share their priorities. 
• Find a Common Language: 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. 
• Promote Partnerships: External stakeholders and community partners are vital to the success of many public health initiatives. County officials should be aware of existing partnerships between health departments and the community to bolster those relationships and avoid duplicative efforts. 
• Bridge the Gap: It took many public health professionals years to fully grasp how interconnected public health is. Public health leaders 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’s 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.