Reflections on the Healthiest Cities and Counties Challenge during COVID-19: Conversations with 10 Counties

The Healthiest Cities and Counties Challenge (HCCC or the Challenge) is a partnership between the Aetna Foundation, the National Association of Counties, the American Public Health Association and Healthy Places by Design. In July 2020, the Challenge – a two-year, $2 million initiative – launched by welcoming 10 city and 10 county teams that are working across sectors to advance health equity and reduce disparities in chronic disease. The Challenge provides each community with flexible funds to implement their projects as well as intense technical assistance, monthly one-on-one coaching and access to a robust Peer Learning Network. NACo spoke with each of the 10 county teams in April 2021. The following provide highlights from those conversations which have been edited for brevity.

	Cambria County, Pa. As part of the Healthiest Cities and Counties Challenge, the 1889 Foundation and its partners are working towards improving care coordination and empowering Cambria County residents to lower the risk for chronic disease through a collaborative food security coalition. NACo spoke with project team members Rick Wilk, Susan Mann, Leanna Bird and Jeannine McMillan about their experience in the Healthiest Cities and Counties Challenge and how the COVID-19 pandemic has impacted the implementation of their work. The Healthiest Cities and Counties Challenge traditionally focuses on food access and health access. How has the COVID-19 pandemic impacted your county’s Challenge project and top public health challenges and opportunities? A top challenge for the Cambria County community is a high transient population and having the necessary resources to meet the influx of individuals with multiple health and human service needs. As part of this additional population, a current challenge during the COVID-19 pandemic has been an equitable vaccine distribution, which is especially important work because we lack a county health department and city-county public health infrastructure in the area. The 1889 Jefferson Center for Population Health (CPH) has provided a learning module that can be used to start conversations around vaccination. CPH is providing the infrastructure that would normally be operated by a county or city health department. We convened a large group of stakeholders through weekly calls with vaccine providers, the housing authority and county EMS/emergency services. In bringing these stakeholders together, we were able to discuss issues of equity and coordinate how to address barriers that prevent people from getting vaccinated. We have also seen improvements with our transient population through the work of a new committed leadership at the housing authority. A challenge with our largest public school district moving forward is that many students cannot be located, and it is difficult to get them supplies. One opportunity is collaboration. For the last two years we have been able to restructure our Vision Together initiative to keep a collaborative group moving forward, and health and wellness is identified as a key priority goal for the community. Through our HUB approach of coordination, training and collaboration, we have been able to identify a wide range of resources in our community. HUBs across the country have been able to maintain their community health workers during COVID-19, and in Cambria County we have been able to sustain our public health workforce for needed contact tracing and vaccine education.  In a particularly challenging year for public health, what has your county learned in the hopes of better responding to future public health emergencies? As a rural community, we were isolated from the COVID-19 pandemic at first, but we were eventually hit very hard. Having a collaborative approach to public health issues will help us be better prepared in the future. We have made progress improving our intergovernmental coordination and have seen more collaboration than ever before, which will serve us well moving forward. Since we do not have a county health department, this is an opportunity for us to take a lead in encouraging collaboration by scheduling meetings, bringing partners together and facilitating productive public health conversations. A focus area is implementing population health strategies and working on upstream initiatives that help those most at risk. How can organizations such as non-profits and academic institutions work together with county officials to meet the needs of your community?  It is crucial to engage across sectors and be mindful that organizations and government work better together and not in isolation. Collaboration is necessary to make significant change. We look at this from a holistic approach and recognize that you need medical providers to work with county departments. We have seen a more unified voice in certain categories such as health or workforce and have been able to communicate this one voice to whomever we are talking to, whether they are a federal, state or local officials. What do you think you and your county have gained the most from being part of the Healthiest Cities and Counties Challenge?  The Challenge pushed us to monitor our progress and measure our goals. This grant has various partners that are always available to answer questions and help hold us accountable. The individual coaching sessions help us talk through project activities and plans to sustain our program in the future. Having the opportunity to hear from others is very valuable, and the peer-learning network has been a great tool to share best practices and learn from other communities and projects.  For more information on Cambria County’s efforts, visit the Healthiest Cities and Counties Challenge website.
	Collier County, Fla. As part of the Healthiest Cities and Counties Challenge, the Southwest Florida Regional Planning Council and its partners are working across sectors to improve public health and prevent chronic disease using a food policy council approach. NACo spoke with project leads, Asmaa Odeh and Megan Greer, about their experience in the Healthiest Cities and Counties Challenge and how the COVID-19 pandemic has impacted the implementation of their work. The Healthiest Cities and Counties Challenge traditionally focuses on food access and health access. How has the COVID-19 pandemic impacted your county’s Challenge project and top public health challenges and opportunities? Collier County’s efforts and priorities have been grounded in establishing the Food Policy Council (FPC), which has become a public health opportunity for our county to address food insecurity. During the COVID-19 pandemic, we’ve received questions around accessing healthy food and have made connections with local food banks. There’s also the challenge of ensuring the school district has access to fresh food for students. We have yet to see the economic impact of COVID-19, and it might take a while to understand how this past year has affected vulnerable populations.  In a particularly challenging year for public health, what has your county learned in the hopes of better responding to future public health emergencies? Because we are in a tropical climate here in South Florida, we have had to implement contingency plans before with the Regional Planning Council. We also have a regional crisis management response as we have had many hurricanes that call for emergency action plans that go in effect immediately. With the Challenge, we are thinking about the fragility and resiliency of our local food system and how it has been impacted by COVID-19. Our vision is to create a response plan that is food-focused, because we have seen that a food crisis requires preparation. We need to work to ensure people know where the nearest distribution site is located to go to if they need food. It is also important to have these resources translated so that everyone has access.  How can organizations such as non-profits and academic institutions work together with county officials to meet the needs of your community?   Members of the Food Policy Council have expressed interest in collaborating more with county leaders, and we encourage everyone to join and get a seat at the table. The FPC will be a place to highlight projects and initiatives and where stakeholders can come together to discuss the issues that need to be addressed in the county around food access. These partnerships are about figuring out how to stop duplicating efforts and truly coordinating across sectors. What do you think you and your county have gained the most from being part of the Healthiest Cities and Counties Challenge?  The Challenge is about bringing community partners together, identifying the most significant needs and establishing the groundwork for a movement to make meaningful change. This grant gives the community a voice in a way that has started to gain momentum to make a real impact. The exciting part of the Challenge is that you are not sure what’s going to happen. The work keeps us motivated.  The peer-learning network has also been helpful in connecting us with some of the cities and counties that are interested in developing food policy councils.  For more information on Collier County’s efforts, visit the Healthiest Cities and Counties Challenge website.
	Cumberland County, N.C.  As part of the Healthiest Cities and Counties Challenge, the Cumberland County Department of Public Health and its partners are improving food accessibility by working with local residents to develop a food policy council and use community data to understand the needs of their community. NACo spoke with project lead Martina Sconiers-Talbert about the department’s experience in the Healthiest Cities and Counties Challenge and how the COVID-19 pandemic has impacted the implementation of its work. The Healthiest Cities and Counties Challenge traditionally focuses on food access and health access. How has the COVID-19 pandemic impacted your county’s Challenge project and top public health challenges and opportunities? COVID-19 has opened up many opportunities for collaboration within our community. We are on the WIDU radio three times a week and we have done many events, town halls and programs. This has allowed us to build strong relationships with organizations that we believe will impact our events and programs well into the future and post-pandemic. Our main challenge in Cumberland County right now is the COVID-19 response, as we are focused on scheduling and administering as many vaccinations as possible. We are trying to manage our other programs within our department, including the tobacco initiatives and parenting programs, while also meeting the demands of COVID-19 response efforts. As we begin reopening, programs like the Food Policy Council and Food Assessment through the Healthiest Cities and Counties grant are imperative as we rebuild and get back out into our community.  In a particularly challenging year for public health, what has your county learned in the hopes of better responding to future public health emergencies? We have had the chance to meet and work with different departments, programs and sites, which has allowed our staff to develop a further understanding of the importance of teamwork and supporting one another during a crisis. We are also realizing how crucial it is to stay up to date on trainings and have tried different ways to reach the community, especially right now for those who are vaccine hesitant. Partnerships are key to effectively responding to public health emergencies, and we are trying to build new partnerships in the community. Technology was something we had to consider as everything went virtual. That was a big shift, not only as an agency but community wide. Services needed to look and feel differently. Fundamentally, we really felt the impact of the lack of public health funding. Being understaffed impacted our ability to respond as quickly as we wanted. We had an all-hands-on deck approach to this response. The state provided great manpower resources and our community came out to volunteer in different capacities.  How can organizations such as non-profits and academic institutions work together with county officials to meet the needs of your community?   We work with our partners to identify the common needs of the community. For example, we have partnered with local food banks in the area as they were very interested in being involved with the Food Policy Council to combat food insecurity. We also try to find commonalities among those who we are trying to reach and recognize there needs to be special attention to address food insecurity in children. We work closely with our partners by serving various coalitions across sectors and stakeholders to bring more agencies around the table.  One way we try to build partnerships and engage the community is through a community health needs assessment that we do every three years, and we are currently completing one this year. This is a community wide effort to bring the data together and identify community strengths and assets as well as needs. We conduct surveys of community members to learn about the issues people are facing, which helped us identify food insecurity as a problem. Fort Bragg Public Health just completed theirs with 3,500 responses. We will be cross sharing data to get a better picture of the community.  What do you think you and your county have gained the most from being part of the Healthiest Cities and Counties Challenge?  The peer-learning network has been helpful to learn about the projects being done in other communities to support food security, especially those using a food policy council approach and have accomplished food systems change. We were given the opportunity with these funds to hire a resident leader. This has made our work easier and has assisted in the gathering of these community partners. Last month, the board of county commissioners officially approved the joint military-county food policy council as a board under their purview and we are excited to start filling seats and getting this council off the ground and informed by our food assessment.   For more information on Cumberland County’s efforts, visit the Healthiest Cities and Counties Challenge website.
	Dougherty County, Ga. As part of the Healthiest Cities and Counties Challenge, Dougherty County, with Flint River Fresh, Inc. and University of Georgia Cooperative Extension, works with the community to distribute food more equitably and educate residents through the Dougherty Fresh initiative. NACo spoke with project leads, Scott Addison, James Morgan, Fernando Jackson and Kerrie Davis, about their experience in the Healthiest Cities and Counties Challenge and how the COVID-19 pandemic has impacted the implementation of their work.   The Healthiest Cities and Counties Challenge traditionally focuses on food access and health access. How has the COVID-19 pandemic impacted your county’s Challenge project and top public health challenges and opportunities? In Dougherty County, our top challenge and focus has been on the COVID-19 response and vaccine efforts, especially for our local health departments. Dougherty County has an older, unhealthy population, and we are trying to ensure everyone is vaccinated, particularly those at higher risk of contracting COVID-19 or having adverse outcomes. Our county officials have been instrumental in bringing resources to the county, and we are now running mass vaccination sites and providing vaccine education. COVID-19 has also highlighted a fundamental problem in our community, which is that many people do not have access to fresh fruits and vegetables. The pandemic has exacerbated the fact that we have food deserts in our community. COVID-19 exposed our food access needs and spurred momentum in trying to fill the gaps in food access through food boxes and donations. With the resources that have become available through this project, we have the opportunity to reach areas of the community that are in the most need. In a particularly challenging year for public health, what has your county learned in the hopes of better responding to future public health emergencies? As a county, we’ve experienced and responded to a number of natural disasters over the past several years, and our county leaders have made efforts to build partnerships throughout the community and state to strengthen our response efforts. We’ve established strong relationships with local legislators, state officials and other stakeholders that make us well-positioned to handle major public health events. We are continuously striving to get people in the community involved, whether that is with voting, COVID-19 vaccinations or this Challenge, because we know that participation from everyone is required to make a meaningful impact.  How can organizations such as non-profits and academic institutions work together with county officials to meet the needs of your community? The Challenge is an example of collaboration in real time. Our project team consists of academic partners, grassroot/non-profit groups and county-level departments that are coming together to improve food access in our community. Some of us have worked together or at least known each other for years, and we’ve been able to build a team that is supportive of each other's strengths and assets. We couldn’t accomplish this work without the cross-sector nature of this group.  What do you think you and your county have gained the most from being part of the Healthiest Cities and Counties Challenge?  This project has been really helpful in advancing our grassroots efforts and has allowed us to build relationships across multiple stakeholder groups throughout the county. The Challenge has grounded our vision by improving our ability to work together and in collaboration with other partners. Through this iterative process, we’ve discovered how to support each other in the varied ways that we work together. The team and the peer-learning network have strengthened our understanding of our own internal operations and of the implementation of our community-based workshops and presentations to the Board of Commissioners.   We want to ensure that everyone contributes to the conversation and has a voice. Each member of the cohort brings a different perspective to this work and within their respective roles, we are learning from them. The peer-learning network is more powerful when we are grouped together with similar projects and are able to give and receive feedback as well as share challenges. For more information on Dougherty County’s efforts, visit the Healthiest Cities and Counties Challenge website.
	Forsyth County, Ga. As part of the Healthiest Cities and Counties Challenge, Forsyth County and its partners are forming a robust collaborative approach to close gaps for people with mental illness and/or substance use disorders who are involved in the criminal justice system through data-driven decisions. NACo spoke with project lead Brandon Kenney about the team’s experience in the Healthiest Cities and Counties Challenge and how the COVID-19 pandemic has impacted the implementation of their work. The Healthiest Cities and Counties Challenge traditionally focuses on food access and health access. How has the COVID-19 pandemic impacted your county’s Challenge project and top public health challenges and opportunities? Vaccinations are our top priority right now in Forsyth County. We have an opportunity to figure out how to get everyone vaccinated and how to do this in an equitable way so that we are serving as many people as possible. Another main challenge is dealing with the spike in mental health issues as a result of COVID-19 and how we are going to address that. In a particularly challenging year for public health, what has your county learned in the hopes of better responding to future public health emergencies? We have seen that public-private partnerships work well as it relates to vaccine distribution. Our public health system was overwhelmed and required mobilizing other community partners such as private hospitals, the fire department, sheriff's office, community volunteers, information technology experts, emergency management workers, churches and others. We all came together to work on improving our public health response capabilities. The scale of COVID-19 has taught us best practices in emergency response and that planning for the future will require thoughtful collaboration among a diverse set of stakeholders. We have had the chance to interact with citizens in a much different way that has had real value. Moving forward, we have a better understanding of the role of public health, and we want our work to impact people’s lives for the better.  What do you think you and your county have gained the most from being part of the Healthiest Cities and Counties Challenge?  Even though we aren’t working on food access, like many other communities in this cohort, we are trying to build better access to behavioral and mental health services in our county, which aligns with the spirit of this grant. This opportunity has created connections for us that have been invaluable and through the individual technical assistance calls we have gained an understanding that there are more networks out there that are involved in similar work. There is value in thinking about how the other communities in the cohort are talking about the social determinants of health around food access, because we can apply that learning to what we are trying to do around increasing access to mental health services. We want to find what is driving rising levels of mental health concerns in our community and what we need to be thinking about more to address it. We are excited to start collecting this data and understanding the direct and indirect correlations to the social determinants of health. We can then work with decision makers to put policies in place that could have a positive impact on people, programs and systems.  For more information on Forsyth County’s efforts, visit the Healthiest Cities and Counties Challenge website.
	Greenbrier County, W.Va. As part of the Healthiest Cities and Counties Challenge, the Greenbrier County Health Alliance and its partners are distributing mini-grants to support community members in developing resident-led actions that address access to food and health services. NACo talked with project leads, Julian Levine and Sally Hurst, about their experience in the Healthiest Cities and Counties Challenge and how the COVID-19 pandemic has impacted the implementation of their work. The Healthiest Cities and Counties Challenge traditionally focuses on food access and health access. How has the COVID-19 pandemic impacted your county’s Challenge project and top public health challenges and opportunities? Some of the biggest challenges we face in Greenbrier County are access to healthy foods and health services. As our communities are trying to build their way out of economies based in extraction industries, they’re prioritizing infrastructure such as broadband access and diversification of the economy. These will be critical factors for building healthier communities over the next 20 years. With all of this in mind, it is not just about eating more fruits and vegetables; it is also about stimulating the local food economy in the region. We can create access to healthier food options by collaborating with local growers and kitchens. Another challenge is developing a focus on health equity in rural communities. While the communities in rural Appalachia are not always culturally seen as marginalized areas, rural Appalachian communities experience serious challenges around health inequities, poverty and cultural marginalization. In a particularly challenging year for public health, what has your county learned in the hopes of better responding to future public health emergencies? The biggest takeaway from this public health emergency is that communication, collaboration and coordination are vital. In our county there is a cultural norm around collaboration rather than competition. We’ve had a local COVID-19 Task Force meeting at least once a week for a year. This conversation that first started about COVID-19 became a conversation around broadband access. The Task Force has pulled together the assets that exist in the county - individuals, community members, organizations and leaders - in order to have a more responsive network to solve public health issues. This task force is the ultimate cross-sector team and we’ve learned that the more connected and well-integrated a community network is, the more opportunities for improving health. Also, we’ve learned that developing data management capacity and scale are crucial to addressing the community’s needs; that being said, we have to build trust throughout the community as the first step. Public health does not work without trust. How can organizations such as non-profits and academic institutions work together with county officials to meet the needs of your community? The “task force” model seems to be powerful by getting stakeholders in the same virtual room to discuss community challenges. This model is replicable and has created a kind of decentralized “incident command” structure for the whole county. It’s also important to foster collaborations and linkages between non-profits, academic institutions and public health agencies. Due to the pandemic, we’ve started to work in tandem with our county public health department to support health equity work and it’s been a fruitful partnership.  Additionally, we know that we are a small community, so there is perhaps a lot more cross pollination because of the scale we operate within our county. All in all, to meet the needs of the community it really is about conversation and how to share, listen and learn together.  What do you think you and your county have gained the most from being part of the Healthiest Cities and Counties Challenge?  In rural communities, organizations tend to work in isolation and are at risk of getting tunnel vision about what they are doing, so being a part of the Challenge has helped us take the blinders off in a much bigger way and allowed us to learn from our peers in the network. For example, we are now incorporating health equity training in our community ambassador project. We weren’t doing that before, and it feels more meaningful for being able to integrate community projects. We are also supporting capacity building of local leaders as they share what they learn with their partners at the grassroots level. This project has a lot of potential for promoting health equity county-wide and can help define health equity in a rural community. There are many nuances related to learning about who is marginalized in a community such as culture, discrimination and disparities. The Challenge has sparked conversations about how history has shaped social conditions and how to own it in a responsible way.  For more information on Greenbrier County’s efforts, visit the Healthiest Cities and Counties Challenge website.
	Orange County, N.Y. As part of the Healthiest Cities and Counties Challenge, Orange County Department of Health’s Community Health Outreach Division and its partners strive to reduce chronic disease and support partnerships that strengthen the county’s ability to identify and actively refer food insecure residents to food programs. NACo talked with project lead, Meg Oakes about the department’s experience in the Healthiest Cities and Counties Challenge and how the COVID-19 pandemic has impacted the implementation of its work. The Healthiest Cities and Counties Challenge traditionally focuses on food access and health access. How has the COVID-19 pandemic impacted your county’s Challenge project and top public health challenges and opportunities? The top public health opportunity and challenge we face in Orange County is COVID-19 response efforts, which have been a priority for both the hospitals and health department. Everyone in health care is focused on setting up vaccination and testing sites and coordinating all the logistics that go along with vaccine roll-out. There are several other public health issues and campaigns that we work on, including tobacco reduction, sexually transmitted infections, worksite wellness, maternal health and lead programs.  In a particularly challenging year for public health, what has your county learned in the hopes of better responding to future public health emergencies?   We have learned to prioritize equity to ensure that people have access to vaccination and testing. We have put a lot of effort into considering harder-to-reach populations like seniors that cannot navigate online tools. To better respond to future public health emergencies, reach underserved areas and connect those in need to services, we need to collaborate with multiple partners and agencies. How can organizations such as non-profits and academic institutions work together with county officials to meet the needs of your community? Working collaboratively across sectors or through coalitions is an effective way to meet the needs of the community. It is also important to have diverse representation from all groups and to include schools, nonprofits, churches and various government departments in the coalition.  What do you think you and your county have gained the most from being part of the Healthiest Cities and Counties Challenge?  The frequency of the one-on-ones and the peer-learning network sessions helps us structure the pace of this initiative and keeps us on track. There is an open feedback loop as well that keeps us thinking about our program activities from a different perspective. The informal and smaller sessions provide a way to have deeper discussions and develop closer connections with the other grantees, particularly because there is a diverse range of projects and communities in this cohort. This allows us to learn about important work that is being done in other areas like mental health and food security. For more information on Orange County’s efforts, visit the Healthiest Cities and Counties Challenge website.
	Perry County, Ky. As part of the Healthiest Cities and Counties Challenge, the University of Louisville School of Nursing is teaming up with local university partners, community-based organizations and county departments to improve health outcomes by identifying and addressing the root causes of food insecurity through the Food & Faith Coalition. NACo spoke with project leads, Frances Hardin-Fanning and Jennifer Weeber, about their experience in the Healthiest Cities and Counties Challenge and how the COVID-19 pandemic has impacted the implementation of their work. The Healthiest Cities and Counties Challenge traditionally focuses on food access and health access. How has the COVID-19 pandemic impacted your county’s Challenge project and top public health challenges and opportunities? COVID-19 response efforts are the biggest public health challenge in Perry County – and now, vaccinations are taking precedence. A priority for the School of Nursing has been volunteering and supporting vaccination sites. The pandemic shifted our time, focus and resources. Over the last several months, there have been efforts to re-vitalize some of our other public health work, particularly around diabetes. Diabetes is a huge issue in our community, which requires targeted prevention and management efforts. Our Challenge project also aims to increase access to healthy, local foods as a strategy for improving diabetes management. In a particularly challenging year for public health, what has your county learned in the hopes of better responding to future public health emergencies? Over the past year we have deepened our community partnerships and relationships with multiple stakeholders. These stronger and established networks have the potential to better prepare us for future public health emergencies. We have been focused on getting through this public health emergency though primary and secondary prevention efforts. We are responding to vaccine hesitancy issues. We have also established standard operating procedures in nursing and continuously try to improve health care coordination for our patients and community. Our community has also recently experienced severe flooding. We have learned to be more efficient, flexible, collaborative and aggressive in our response efforts, especially when it comes to overcoming structural barriers. How can organizations such as non-profits and academic institutions work together with county officials to meet the needs of your community? The partnership between the Food and Faith Coalition and the University of Louisville has been an essential connection. For the Challenge, we are working with academic institutions, non-profits and nurses. It is crucial to create a bridge to connect this work at the local level. There are significant differences between the needs of people in rural and urban areas, so it is important to understand the value of listening to people in the community. We approach our work by conducting a root cause analysis by establishing trust with people that allows them to open up to us. Another necessity is having county elected officials that are open to this work and creating partnerships.  What do you think you and your county have gained the most from being part of the Healthiest Cities and Counties Challenge?  The most beneficial part of the Challenge is having peer connections to learn about programs in other communities and to share what we are doing. This exchange helps us see a different perspective. This initiative has energized our existing partnerships and has captured the interest of other potential partners. With the infusion of extra resources, we have been able to strengthen our local workforce and bring on people from the community. The addition of these fresh eyes and new ideas has sparked the advancement of our work. It is exciting to see commitment from people who live in the county and want to make a difference.  For more information on Perry County’s efforts, visit the Healthiest Cities and Counties Challenge website.
	Tompkins County, N.Y. As part of the Healthiest Cities and Counties Challenge, The Childhood Nutrition Collaborative, a project of the Cornell Cooperative Extension of Tompkins County and its partners, is a community initiative that ensures equitable food access. NACo spoke with project leads Lara Parilla, Grace Parker Zielinski and Chris Kai-Jones about their experience in the Healthiest Cities and Counties Challenge and how the COVID-19 pandemic has impacted the implementation of their work. The Healthiest Cities and Counties Challenge traditionally focuses on food access and health access. How has the COVID-19 pandemic impacted your county’s Challenge project and top public health challenges and opportunities? A main challenge in Tompkins County is getting people vaccinated against COVID-19. This work involves reducing vaccine hesitancy, improving access and removing structural barriers to vaccine uptake and ongoing preventive care. Health is a reflection of the values of a society and how we move forward. COVID-19 has created a challenge and opportunity to start a conversation both explicitly and implicitly around what we mean by health, wellness and well-being. The Challenge captures this energy and moves the discourse in a positive direction. In a particularly challenging year for public health, what has your county learned in the hopes of better responding to future public health emergencies?   Cornell Cooperative Extension brings research to action and knowledge to practice in pursuit of economic vitality, ecological sustainability and social well-being. We are reflecting on how to meet future crises in society. Our collaborative involves many stakeholders talking through these issues, and we’ve discussed the role of the extension in public health. We can redefine what public health means and how we can help communities by framing it more broadly through considerations of the social determinants of health. This can make communities and public health organizations more capable and prepared for emergencies and promote long-term sustainability. We have had to innovate due to necessity. Our infrastructure for delivery networks has improved and will hopefully be transformed for future public health crises. In terms of service delivery, COVID-19 has pushed us to meet people where they are at and to innovate how we connect to those in need. Our emergency food response network has strengthened its ability to recognize who is involved and can be responsive to emerging needs. The silver linings of COVID-19 from a county perspective are that it has shown how certain gatherings are more successful when they are remote and that a virtual setting can give people the freedom to participate in activities they may not otherwise. Cornell’s Master of Public Health program is working with many community partners to rethink how COVID-19 has changed our instruction, particularly how we may need to reduce the number of partners we work with. We want to provide higher quality services and deeper relationships rather than overpromise and underdeliver to large numbers of partners. Most of our community partners are heavily involved in public health and with the pandemic response as their top priority, we felt we could not ask them to continue working with us.  We have also seen changes in statewide funding and attention to frontline public health work that help our county deal with adverse events. New York State decided to launch a Public Health Corps that funds positions for public health workers across the state. Cornell’s Master’s of Public Health program is developing the training curriculum for this program.  How can organizations such as non-profits and academic institutions work together with county officials to meet the needs of your community? We have representation from the county health department and the communications director for the county on our Steering Committee. Our collaborative also has support from a member of the New York State Assembly and County Youth Services. We are also closely connected with county elected officials through the Food Policy Council’s work, which is funded by the county and is held accountable by the county legislature. We are creating a food system dashboard to better understand all the factors that influence a family’s ability to provide healthy food for their children. Many people are interested in food systems data, so we can continue to involve new partners to add more information. This is an opportunity to provide education and awareness to elected officials and to offer best practices. We can offer a compelling proposal to the legislature by telling them what we have learned from our community and the solutions that they believe will work for them. We are working with the county planning department to assess the qualitative data we are collecting as well as the federal and state data we compile related to food security, poverty and demographics. This information will be included in our dashboard. The intention is that our collaborative work with county departments will help raise the level of interest among elected officials. What do you think you and your county have gained the most from being part of the Healthiest Cities and Counties Challenge?  The Challenge brings together diverse groups involved in similar work to be a part of this cohort, which is extremely valuable in getting to know different communities and identifying opportunities for learning and collaboration. This grant is different than others because it allows us the freedom to move in varied directions that are focused on outcomes. We have ideas for building resident leadership and about bringing money into communities, so they can design and implement their own projects from within. The wraparound support from the Challenge is something we can translate and develop into our projects. The peer-learning network keeps us connected to other grantees and promotes the sharing of best practices, including tools and resources. This level of support and technical assistance is helpful and having the opportunity to receive feedback on the Challenge Plan and Evaluation Plan was a unique part of this grant. Having the recognition of being a part of this national award also elevates our program in our community. For more information on Tompkins County’s efforts, visit the Healthiest Cities and Counties Challenge website.
	Wilkes County, N.C. As part of the Healthiest Cities and Counties Challenge, the Health Foundation, Inc., Wilkes Health and Wilkes Community Partnership for Children form the Wilkes Healthy Action Team to address Wilkes County’s health and safety needs through cross-sector, community-informed work. NACo talked with project leads, Susan Cogdill, Sierra Watson, Jenn Wages and Heather Murphy, about their experience in the Healthiest Cities and Counties Challenge and how the COVID-19 pandemic has impacted the implementation of their work. The Healthiest Cities and Counties Challenge traditionally focuses on food access and health access. How has the COVID-19 pandemic impacted your county’s Challenge project and top public health challenges and opportunities? When we developed this grant, we did not expect to be dealing with a pandemic. In Wilkes County, vaccinations and addressing vaccine hesitancy have become a public health opportunity. We’re also thinking about the impact this past year has had on our school-age children and youth, particularly on their mental and behavioral health. We have seen a significant increase in behavioral health referrals in all areas. Additionally, school readiness is crucial to building a resilient community and education is one of the most important components of improving public health as it allows people the opportunity for upward mobility. We have a real opportunity to implement structural changes that improve the root causes of poor health in our community. Food insecurity and healthy living are more important now than ever. COVID-19 has caused an increase in the amount of people without access to healthy food not only because of the economic shutdown but because many people fear using public transportation or are afraid to go to the grocery store. In a particularly challenging year for public health, what has your county learned in the hopes of better responding to future public health emergencies? Our coalition believes that the only way to tackle complex problems, be they food insecurity or a pandemic, is by working together. When COVID-19 hit, one of the repercussions was an increased number of families experiencing food insecurity for the first time. Thankfully, the strength of our coalition provided resources that contributed to pandemic relief while also sticking to our core purpose of making sure that every child and adult knows where their next meal is coming from, and that it will be healthy. For example, last summer our local school system needed a two-week break from delivering meals to students so that staff could take vacations, participate in mandatory continuing education, and conduct routine maintenance on equipment. Our team stepped in and provided meals and volunteer power so that the meal program continued seamlessly.  During this past year, we have learned the importance of solving community issues with our own resources. As a nation, public health is underfunded, and it is not sustainable to be operating in crisis mode. We need to be able to build a stronger, more resilient and reliable public health workforce. Mobilizing under these circumstances in rural and underserved communities presents both a challenge and an opportunity.  This has been a bigger crisis than anyone imagined. Our health department has been providing daily testing services and vaccinations, which requires a lot of coordination. Managing the logistics of bringing this project to scale has improved our communication system and other essential infrastructure pieces. How can organizations such as non-profits and academic institutions work together with county officials to meet the needs of your community? Cross-sector collaboration is needed as we cannot solve complex problems alone. Stakeholders must be willing to try and figure out how to tackle the root causes of these problems and their solutions. Small, rural communities where everybody knows each other are well-positioned to work together and build on trust. In Wilkes County, we have a taskforce that has brought multiple stakeholder voices together to share resources and ideas. To make meaningful progress, we must be able to work together. This must involve people in the community from the bottom-up, including elected officials. Meeting people where they are will have a positive impact on everyone.   This challenge has supported our human-centered design process, which allows us to engage the community deeply and authentically in custom-based solutions to food insecurity. We have been able to reach historically marginalized community members, which proves that we are doing more than paying lip service to equity issues. Our work with a Hispanic church has led to several pilot projects on how to ensure access to culturally appropriate foods. The trust built through that process has enhanced efforts to better reach vulnerable populations for vaccination.  What do you think you and your county have gained the most from being part of the Healthiest Cities and Counties Challenge?  The past year has been a difficult time for our team. We are involved in response efforts that have changed the dynamics of everything we do. It has affected the resources of our health department, health care system and law enforcement and has stretched people to their limits, not only in their professional lives, but also personally. People are stressed and exhausted. The work is always the most important, and we receive a lot of support with this grant. The reporting and meetings have provided the structure that helps us keep moving forward. The external oversight helps bring people to the table and the networking connects us to other communities. There has also been transparency and flexibility around data collection and reporting, which has been very helpful to figure out where the communities needs are before creating budgets and plans. We believe that strong processes lead to strong programs and better outcomes. The Aetna Foundation and the Challenge technical assistance partners have invested in our processes (human-centered design), and we appreciate the support, because we feel it’s going to lead to change. Process-oriented work means leaning into the discomfort of mutual discovery and it requires the understanding that to engage the community, you cannot have a pre-determined outcome or all you have done is asked for a rubber stamp, and that is not genuine. We know that early childhood nutrition is fundamental to health, and we are pleased this project and process has allowed us to test programs that connect local farmers and their delicious produce with families for whom cost, and transportation issues are barriers to healthy eating.  For more information on Wilkes County’s efforts, visit the Healthiest Cities and Counties Challenge website.