Volume 4: No. 3, July 2007
ROUNDTABLE ON COMMUNITY
The Role of Health Departments in Advancing a New Community Health and Wellness Agenda
Ellen Boyce, MPH, CHES, Joan Stine, MS, MHS, CHES, Ellen Jones, MS, CHES
Suggested citation for this article: Boyce E,
Stine J, Jones E. The role of health departments in advancing a new community health and wellness agenda. Prev Chronic Dis [serial online] 2007 Jul [date cited]. Available from:
The National Expert Panel on Community Health Promotion provided recommendations that are relevant not only to federal agencies
the Centers for Disease Control and Prevention (CDC) but also to state and local health agencies
(1). State and local health agencies have a strong foundation in convening nontraditional partners, coordinating public and private efforts, and serving as a model for accountability and stewardship. These skills can be used to
apply the principles outlined by the expert panel, including expanding surveillance systems to include social determinants of health and developing programs within the context of local culture and political processes.
Public health agencies must begin to develop surveillance measures of the socioecological determinants of health by seeking expertise in sociology, economics, and other sciences. With expanded surveillance measures, we
in public health can determine how social factors influence prevention and management of chronic diseases. We can develop methods to define, quantify, measure, and weigh these socioecological indicators and establish benchmarks for these determinants of health and disease. This information will be critical to the design of effective strategies that target the social precursors of disease and to the measurement of the impact of these strategies on both social and health variables. Some communities,
such as King County, Washington, have included social and health
indicators in tracking the well-being of residents and improvements in community health (2).
State and local health agencies also have a role in developing public health
programs in collaboration with community members and stakeholders and in coordinating these efforts to directly address community health concerns. As outlined in the expert panel report, true community engagement is needed
to sustain chronic disease prevention activities over time. This approach is also evident in the
tool Mobilizing for Action through Planning and Partnerships developed by
the National Association of County and City Health Officials in cooperation with the Public Health Practice Program Office, CDC (3). Evidence linking socioecological factors to health will help bring new partners and community participation to public
health when it becomes clear that our interests overlap. New surveillance tools will help us
recognize social and ecological problems, predict their public health impact, and plan for long-term public health solutions involving both the public and private sectors. The expected improvement in community health can contribute to higher education levels, improved productivity, and improved earning
As health departments balance their focus on immediate health concerns with long-term community health, they will need to build the skills of an interdisciplinary workforce to meet the public health challenges of the future. The Institute of Medicine’s report Who Will Keep the Public Healthy? promotes an ecological approach to addressing public health challenges in the 21st
century (4). It states that public health professionals must have a framework for action, an understanding of the forces that
and a model of health that emphasizes the linkages and relationships among multiple determinants affecting health. It goes on to recommend that public health agencies assess their workforce development needs, collaborate with schools of public
health, and assure that their leadership has experience in the ecological approach to public health.
The expert panel made a strong recommendation to the National Center for Chronic Disease Prevention
and Health Promotion to support training and capacity building to ensure that the
public health workforce has the knowledge, skills, and tools to implement community health promotion approaches. These capacities may include sustainability, program evaluation, and socioecological dimensions of health. The Directors of Health Promotion and
Education and the National Association of Chronic Disease Directors are devoting significant resources to assess training needs, provide relevant training opportunities, and expand the focus of community health training to address this recommendation.
Many public health agencies are taking advantage of new technologies to develop their existing workforce. Distance learning via satellite transmissions, webcasts, self-instruction using DVDs, and other new methods has provided access to quality continuing education even in rural areas. Public health agencies need to
ensure that application of the socioecological model is included in
determining the capacity of their workforce and that trainings are offered to build skills in using the model. Public health agencies must also disseminate best practices and lessons learned in applying these skills through traditional and nontraditional means as part of the larger framework of public health workforce development.
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This work was completed as a collaborative effort of three participants in the
National Expert Panel on Community Health Promotion and not affiliated with a single institution. Joan Stine is a voting member of the Association of State and Territorial Directors of Health Promotion and Public Health Education. Ellen Jones is an associate member of the Association of State and Territorial Directors of Health Promotion and Public Health Education and of the National Association of Chronic Disease Directors. None of the authors received financial support for work on this submission.
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Corresponding Author: Ellen Jones, MS, CHES, Program Consultant, National Association of Chronic Disease Directors, 115 Coventry Cove, Madison, MI 39110. Telephone: 601-540-6310. E-mail:
Author Affiliations: Ellen Boyce, Director, Office of Professional Practice, Region 1, South Carolina Department of Health and Environmental Control, Greenwood,
SC; Joan Stine, Director, Center for Health Promotion, Education, and Tobacco Use Prevention, Maryland Department of Health and Mental Hygiene, Baltimore, Md.
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- Navarro A, Voetsch K, Liburd L, Bezold C, Rhea M. Recommendations for
future efforts in community health promotion: report of the National Expert
Panel on Community Health Promotion. Atlanta (GA): Centers for Disease
Control and Prevention, National Center for Chronic Disease Prevention and
Health Promotion, Division of Adult and Community Health; 2006. Available
- Communities count: social and health indicators across King County. Seattle (WA): Public Health-Seattle & King County; 2005. Available
from: http://www.communitiescount.org/tableofcontents.htm *
- Mobilizing for Action through Planning and Partnerships (MAPP) model. Washington
(DC): National Association of County and City Health Officials; 2000. Available
- Gebbie K, Rosenstock L, Hernandez LM, eds. Who will keep the public healthy? Educating public health professionals for the 21st century. Washington
(DC): Institute of Medicine; 2003.
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