Hurricane Harvey: In the Eye of the Storm

By Big Cities Health Coalition Staff

It’s been one year since Hurricane Harvey hit Houston and the surrounding area with record-breaking rain and devastating floods which inflicted injuries, infectious diseases, chemical exposures and mental trauma on residents. Public health officials from the Houston Health Department, a member of the Big Cities Health Coalition, were on the front lines in the lead up to the hurricane and its aftermath. Today, many are reflecting on the events of those four historic days in August 2017 and what lessons were learned, and can still be learned, from the disaster.

Global Health Now, a project of the Johns Hopkins University Bloomberg School of Public Health, is hosting a live event in Houston, “Hurricane Harvey: In the Eye of the Storm” on September 27, 2018. This event will feature a conversation with Dr. David Persse, Public Health Authority for the City of Houston and Dr. Joshua Sharfstein, the Vice Dean of the Johns Hopkins Bloomberg School of Public Health and Big Cities Health Coalition alumna, on the leadership lessons learned from the storm and its aftermath.

Dr. Persse played an integral role in Houston’s preparations for the storm, as well as the city’s response to the hurricane, flooding and aftermath. He will discuss how--together with local health workers on the ground--he coordinated the local and federal responses and continued to lead within a diminished local structure. He will also talk about many of the unique public health challenges posed by natural disasters, such as working with local medical personnel who are themselves personally impacted or displaced by a storm. Another topic will be how cities can leverage less conventional partners such as medical and nursing schools, pharmacies, and dialysis providers. 

Dr. Sharfstein oversees the Office of Public Health Practice and Training and is director of the Bloomberg American Health Initiative. He will address how the Houston Health Department learned from previous emergencies to implement an effective response to Hurricane Harvey, and discuss with Dr. Persse how his leadership and management style has evolved with experience. Dr. Sharfstein will also explore Dr. Persse’s experiences in the context of some of the topics covered in his new book, The Public Health Crisis Survival Guide: Leadership and Management in Trying Times.

If you’re in Houston on Thursday, September 27, please join this important discussion. You will find more information and an RSVP link here.  

Let schools be places for learning—not “JUULing”

By Brian A. King, PhD, MPH, Deputy Director for Research Translation, Office on Smoking and Health, Centers for Disease Control and Prevention

Remember your high school bathroom? If it was anything like mine, the bathroom was a fairly foul-smelling place that you wanted to leave as quickly as possible.

But things are changing. Kids are flocking to school bathrooms across the country faster than the cafeteria on pizza day. School bathrooms have become places where students gather to socialize and use e-cigarettes—in particular, e-cigarettes shaped like USB flash drives that deliver a high level of nicotine.


Using e-cigarettes in bathrooms is so common, in fact, that students are calling school bathrooms “the JUUL room” after JUUL, the top selling brand of e-cigarette in the U.S. Owing to the popularity of JUUL, other e-cigarette manufacturers are making look-alike products such as PHIX, SMOK, myBlu, and MarkTen Elite.

But regardless of the product, or what you call it, it’s an e-cigarette. In 2017, 2.1 million U.S. middle and high school students reported current use of e-cigarettes. This is a public health concern because the use of any tobacco product—whether smoked, smokeless, or electronic —among young people is unsafe. Most of these products contain nicotine, which is highly addictive. The U.S. Surgeon General has concluded that nicotine exposure during adolescence can also harm the developing adolescent brain. Specifically, nicotine exposure during adolescence—which continues until about age 25—impacts learning, memory, and attention and primes the brain for addiction. In addition to nicotine, the aerosol that users inhale and then exhale into the environment can expose both themselves and bystanders to other harmful substances, including heavy metals, volatile organic compounds, and ultrafine particles that can be inhaled deep into the lungs.

Many students say their e-cigarettes do not contain nicotine, but sales data cast doubt on youths’ self-reported understanding of what’s in these products. A CDC study of retail scanner data found that 99% of all e-cigarettes sold in U.S. convenience stores, supermarkets, and other similar outlets contain nicotine. Many of these products also come in kid-friendly flavors. In addition to making e-cigarettes more appealing to young people, some of the chemicals used to make certain flavorings may also have health risks. For example, although some of these flavorings may be safe to eat, we don’t know the long term health risks of inhaling them deep into the lungs. The gut can handle a lot more than the lungs, and the gut also has a clear exit strategy.

Further complicating the issue for parents and educators is that e-cigarettes can also be used to deliver marijuana and other drugs. USB flash drive-shaped devices such as the Pax Era closely resemble JUUL, but deliver marijuana without the characteristic smell of marijuana smoke.

Ecigarettes images.png

According to results from a survey conducted in April 2018 by the Truth Initiative, nearly one-fifth of middle and high school students have seen JUUL used in school. And although sales of e-cigarettes to minors are prohibited by federal law, 3 out of 4 kids who had used JUUL said they obtained the device from a physical retail location.

Furthermore, students may have low awareness of the addictive potential of these products: 63% of JUUL users ages 15-24 did not know that the product always contains nicotine. JUUL not only always contains nicotine, it always contains a lot of nicotine—according to the manufacturer, each liquid refill “pod” contains as much nicotine as an entire pack of regular cigarettes. Each pod can deliver about 200 puffs for the user, or even more depending on how hard the user inhales. These products also use nicotine salts, rather than the freebase nicotine used in most other e-cigarettes and tobacco products. These nicotine salts allow particularly high levels of nicotine to be inhaled more easily and with less irritation than free base nicotine. This is of particular concern for people who have never used nicotine before, such as youth, because it could make it easier for them to initiate the use of nicotine through these products.

However, stronger and more efficient delivery of nicotine in e-cigarettes may also increase the products’ acceptability as a complete substitute for cigarettes among adult smokers. This could be positive for these individuals given that e-cigarettes have the potential to benefit adult smokers who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco products. But the science on the effectiveness of e-cigarettes for cessation is still uncertain, and we still have more to learn about their long-term health risks.


Regardless of any potential benefit that e-cigarettes may have among adult smokers using them to successfully quit, unless we take aggressive steps to protect kids, these highly potent products also risk exposing a new generation of teens to nicotine. Media reports document that educators and parents across the country are struggling to deal with teen e-cigarette use and nicotine exposure. Out of 53 suspensions last year at Northgate High School in Walnut Creek, California, 40 were for e-cigarette devices. And a high school administrator in Jamestown, North Dakota suffered from symptoms of nicotine poisoning after confiscating an e-cigarette from a student.  

This emerging public health issue represents an important opportunity for city and county health officials to partner with counterparts in education and to help parents, educators, health care providers, and other youth influencers protect our nation’s kids from this completely preventable health risk. Health departments across the country are forging new partnerships in creative ways. For example:

To help facilitate this type of dialogue and inform key partners, CDC offers easy to understand, visually appealing resources that explain what these products are, highlight their risks for young people, and provide action steps to protect kids. Here are some simple steps you can take today to get informed and spread the word:

In summary, as city and county health officials, you can play a critical role to help parents and educators recognize e-cigarette products, know their risks, and to take action to protect our nation’s kids from this preventable health risk. Schools are for learning, and school bathrooms aren’t for JUULing. Every student deserves to learn in a healthy and safe environment.

Minneapolis Health Department Supports a Young Food Entrepreneur

By Dan Huff, Director of Environmental Health, and Gretchen Musicant, Commissioner of Health, Minneapolis Health Department

This blog originally appeared here on The National Association of County & City Health Officials (NACCHO) Essential Elements Blog.


Jaequan Faulkner, 13, started selling hot dogs in front of his Minneapolis home in 2016, calling his establishment “Mr. Faulkner’s Old Fashioned Hot Dogs.” His food stand came back this summer bigger and better than before, and it grew popular with customers in the neighborhood.

Recently, his business came to the attention of local officials when someone complained that he did not have official permits.

To make sure people are safe from food-borne illnesses, all events that serve food to the public in Minneapolis must be permitted, and violators are subject to an immediate shutdown.

Instead of making Jaequan close shop, the Minneapolis Health Department worked with him to get his food stand officially permitted as an event food stand. The health department provided food safety training, handwashing equipment, a thermometer, and chemical test strips so Jaequan could operate legally and safely. Health officials advised him on which foods could safely be kept at the correct temperature during his hours of operation. The staff even chipped in to help pay for Jaequan’s initial permit so that he could operate for 10 days in front of his home per Minneapolis policy.

Health department staff also put him in touch with the North Side Economic Opportunity Center (NEON), a local non-profit that helps startup businesses.

Jaequan was nervous about his initial encounters with the health inspectors, and he thought the city might not be supportive of his efforts. However, shortly after he began talking with the health department staff, he realized they were there to help him serve food safely and be successful while doing so. This changed his perception of the city.

When a police officer approached him, he was again on guard until he heard that the police department wanted to sponsor his food stand at the nearby precinct for several days. Again, his perception of the city’s role expanded.


Jaequan has now been invited to multiple civic events to be a food vendor, and he plans to take his food stand on the road to serve customers all over Minneapolis. Stops include the Minneapolis Police and Fire Departments, the Urban League, and Sanctuary Covenant Church. As for the profits, Jaequan hopes to make enough this year to buy school clothes and a food cart for the summer of 2019.

The story of Jaequan’s hot dog stand and the role that the Minneapolis Health Department played in helping him sell food safely has been picked up by local, national and international print, radio, television and social media. For Jaequan, this has been an exciting opportunity to tell a positive story about his community.

This is also the story of true public servants looking out for the common good, assuring that food is prepared and served safely, that a business can thrive, and that the youth in this community are supported. The approach the Minneapolis Health Department took is possible because the department infuses the values of equity, leadership, community investment, and harm prevention into all its work.

Our Top Takeaways from NACCHO Annual 2018

By Big Cities Health Coalition Staff

We just returned to D.C. from the NACCHO Annual Conference, a summer pilgrimage for public health enthusiasts, which took place this year in New Orleans. The theme of this year’s conference was Unleashing the Power of Public Health. Our time in The Big Easy was especially frenetic this year, with lots and lots of sessions that we found fascinating. Below is a collection of our top takeaways from some of the most engaging sessions we participated in. Tell us which moments you thought were most important in the comment box below, or on Twitter at @BigCitiesHealth.

Public Health and Medical Community Pledge to Decrease Gun Violence

By Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County

This blog originally appeared here in the Public Health - Seattle & King County blog Public Health Insider

Firearm-related injury and death, from suicide to accidental injury and homicide – is a major public health problem and a leading cause of premature death in King County and nationally. In 2016, 663 adults and 20 children died from a firearm injury in Washington state, including 144 adults and 7 children from King County.

Firearm-related injuries have very high personal and financial costs to individuals, families and society – and that’s why prevention is essential.  In 2015, the cost of firearm fatalities alone (not counting non-fatal injuries) in King County was almost $200 million from medical costs and lost productivity, and nationally the cost is in the hundreds of billions of dollars each year.

LGBTQ Pride and Public Health

By Ginger Lee, MPH, Bureau Manager, Collective Impact & Operations,
Long Beach Department of Health and Human Services

June is LGBTQ Pride month.  Pride is a time when lesbian, gay, bisexual, transgender, queer and questioning people join together to further strengthen community by celebrating joyously, with parades and other events.  Pride is also a time when the LGBTQ community remembers its history. And for public health professionals, Pride is a time to reflect on what we can do to address social conditions that negatively affect the health of LGBT people, and to strengthen conditions that support health within our LGBTQ communities.

Hepatitis Awareness Month 2018: Addressing Hepatitis A

By Meghan McGinty, PhD, MPH, MBA, Deputy Director of the Big Cities Health Coalition, and Michelle Cantu, MPH, Director of Infectious Diseases and Immunization, NACCHO

This blog originally appeared here on The National Association of County & City Health Officials (NACCHO) Essential Elements Blog.

The month of May is designated as Hepatitis Awareness Month in the United States and May 19th is Hepatitis Testing Day. During this month, NACCHO will highlight the role of local health departments (LHDs) in responding to this silent epidemic and work to bring increased attention to viral hepatitis. Through a series of three blog posts, NACCHO will focus on the most common types of viral hepatitis, which are hepatitis A, hepatitis B, and hepatitis C. This series seeks to raise awareness of the importance of vaccination for hepatitis A and B, testing for hepatitis B and C, and the availability of effective care and treatments that, in the case of hepatitis C, result in a cure for most people. Additionally, the series will highlight current events related to viral hepatitis – such as outbreaks of hepatitis A in jurisdictions across the country and soaring rates of hepatitis B and C associated with increased injection drug use that is being fueled by the opioid epidemic – and how LHDs are on the frontlines of responding to these worrying trends.

Chicago health commissioner: Big Tobacco is targeting our youth and we must stop them

By Dr. Julie Morita, Commissioner, Chicago Department of Public Health

The U.S. Food and Drug Administration recently announced a crackdown on e-cigarette sales to minors, but before then, the city of Chicago had already taken matters into its own hands. The City Council passed an ordinance to require tobacco dealers to post warning signs at their doors about the health risks of e-cigarettes and other tobacco products. These signs, once designed and distributed, will also contain quit-line numbers to help our residents beat a nicotine addiction. 

Give Women the Gift of Good Health

By Mysheika W. Roberts, MD, MPH, Health Commissioner, Columbus Public Health

As we celebrate all the women in our lives for Mother’s Day and National Women’s Health Month, we are reminded that despite the advances women have made in many areas, great disparities still exist when it comes to their health. 

Women make the majority of health care decisions for their families and are powerful partners by advocating and modeling healthy lifestyles and behaviors for their children, colleagues and friends. But when it comes to their own health, they are often left behind.

Supporting Older Adults in Houston: Ramps, Rails and Toilets

By Deborah A. Moore, Assistant Director, Human Services Division, Houston Health Department and Scott Packard, Chief Communications and Public Affairs Officer, Houston Health Department

When you think of Older Americans Month, toilets probably aren’t the first thing to come to mind. But at the Houston Health Department, commodes are a major component of one of the Harris County Area Agency on Aging’s most gratifying programs.

Allow me to take a step back to explain.

Multnomah County’s Community Powered Change

By Rachael Banks, Public Health Director, Multnomah County Health Department

After years of unacceptable disparities data, we knew we had to do something different.  In the summer of 2015, Multnomah County Health Department (MCHD), set out to create a community health improvement plan (CHIP) centered on things that are largely outside of the control of the individual. In response, MCHD released a request for proposals (RFP) for the coordination of a CHIP that was created in partnership with communities of color. Oregon Health Equity Alliance (OHEA) was selected as the contractor to lead the development and implementation process for the CHIP.

Throughout 2016 OHEA, with the support of MCHD’s Health Equity Initiative (HEI), intensive community engagement and outreach (forums and interviews) were conducted to gather input from a variety of communities including: African-American, Asian, Immigrant/Refugee, Latino, Native American, Pacific Islanders, and youth and elders of color. The outreach and engagement was followed by a tremendous amount of planning, analyzing and prioritizing areas over the next year. Through these engagement efforts, a framework was developed outlining 23 goals and over 150 strategies.

Sexually Transmitted Diseases (STDs) are Making a Comeback – Recognizing April as STD Awareness Month, We Highlight BCHC Activities to Address Vast Increases in (STDs)

By Chrissie Juliano, Director, Big Cities Health Coalition

STD Awareness Month is an opportunity to focus on raising awareness of a problem that affects millions of Americans every year. STDs in the United States are at record highs, despite years of dropping rates, with the latest CDC data showing chlamydia, gonorrhea, and syphilis infections rising to exceed 2 million reported cases nationwide.  The increases are dramatic - 4.7% for chlamydia, 17.6% for syphilis, and a whopping 18.5% for gonorrhea. In short, we’ve lost ground in this fight. Left undiagnosed or untreated, STDs can cause serious long-term problems. Importantly, they are largely preventable and treatable.

On Earth Day: Local efforts are making a difference on climate change

The world-wide scientific consensus is clear: climate change is real, it is being driven by human causes, and we must act now to avoid its worst effects. However, it also clear that leadership in the fight against climate change will not come from Washington, D.C. anytime soon. The EPA is being targeted for huge budget cuts, and the U.S. withdrew from the Paris Climate Accord. In a heartening trend, businesses, community organizations, non-profits, states, counties and cities are stepping up to fill this leadership vacuum. Within this growing coalition there is one player that is often overlooked: local Health Departments. We have a unique perspective and the community connections to play a significant role in helping our communities adapt to the effects of climate change while also fighting against its causes.

Making Public Health Visible

By Narintohn Luangrath, Special Assistant to the  Baltimore City Health Commissioner and
Dr. Leana S. Wen, MD, MSc, FAAEM, Baltimore City Health Commissioner

At a commencement ceremony several years ago, Dr. Linda Rae Murray, then-president of the American Public Health Association, recounted a famous saying: “When public health works, we’re invisible.” She followed that by urging the graduates to “refuse to be invisible, because […] we need to lend our strength and our science to broad social movements whose goal is to make things better.”

When public health is invisible, we only end up talking about it when things go wrong; people tend to think about public health agencies as entities that respond to infectious disease outbreaks or shut down a restaurant due to health code violations. We frequently think about health as healthcare, but what determines how long and how well we live is less about what happens in the doctor’s office and more about where we live, the air we breathe, and the availability of other resources in our communities. At the Baltimore City Health Department (BCHD), we believe that all issues – education, housing, employment, public safety, and beyond – can and should be tied back to health. We are committed to making the progress earned through public health visible, and to make the case for incorporating health-in-all policies across the City.

Wanted: Leaders for a TB-Free United States

By Joseph Iser, MD, DrPH, MSc, Chief Health Officer, Southern Nevada Health District

This blog originally appeared in County Line Magazine


Every year on March 24 the health care community commemorates World TB Day to bring attention to a preventable disease that still impacts many people in the United States and around the world. This year’s theme is “Wanted: Leaders for a TB-Free United States. We can make history. End TB.” It is a call for health care partners to work together on a local, national, and international scale to eliminate the disease.

Health care providers are instrumental in this process. For many patients, TB can present as a bad cold or respiratory infection that won’t go away. Physicians should always consider the possibility of TB when examining a patient with an ongoing respiratory infection, especially if it is accompanied by a persistent cough, night sweats, loss of appetite, and fatigue.

Seattle's Food Safety Rating System is One Year Old

In 2017, King County launched our new food safety rating system with the goal of making it the best rating system in the country. With a year under our belt, Public Health – Seattle & King County’s food safety team is proud to say that the new system has achieved measurable success.

  • Over 75 percent of all restaurants in King County now have easy to understand food safety rating signs in their front windows. This has greatly improved the ability for consumers to quickly assess the food safety practices at each restaurant.
  • Anecdotally, our food safety investigators report an increased interest from restaurant owners in improving their food safety practices, which means that the placards are motivating restaurants to do better. The number of perfect scores from all restaurants across King County increased 3 percent in 2017 from 52 percent to 55 percent.
  • The ratings provide a more complete picture of food safety than any other rating system across the country. Ratings reflect the trend of critical food safety practices over time in each restaurant and take inspector differences into account to make sure the playing field is level.

The 90 Days of the White House Opioid State of Emergency are up, and communities have little to show for it

By Chrissie Juliano, Director of The Big Cities Health Coalition

Today marks 90 days since the President declared the opioids crisis a public health emergency, and the White House announced last week that it would extend the declaration for another 90 days. To date, little has changed in the federal approach to the epidemic, and unfortunately, the emergency declaration has amounted to little more than administratively nibbling around the edges of a major national public health crisis.  Simply extending the emergency declaration does little to address the epidemic. What is needed is funding and leadership at the federal level.

Measles: An Ongoing Challenge to Prevent and Control Reintroduction Outbreaks

By authors including Jeffrey Gunzenhauser, MD, MPH, Interim Health Officer and Medical Director
and Franklin D. Pratt, MD, MPHTM, Immunization Program, Los Angeles County Department of Public Health

Since measles was eliminated from the United States in 2000, efforts to control reintroduction outbreaks have faced a variety of challenges. An outbreak in California was largely isolated to Los Angeles County and primarily affected a single social group in which anti-vaccination beliefs and behaviors prevailed. The outbreak resulted from a single individual who acquired infection from an unknown source, developed rash on Dec. 2, 2016, and subsequently exposed siblings and other contacts. This produced a clear chain of transmission. In total, 24 cases resulted from this outbreak, with 18 occurring in Los Angeles County and six occurring in nearby jurisdictions.

What a Long Strange Year 2017 has been in Public Health: Historic Storms, “Banned Words,” and Deep Funding Cuts – Just to List a Few

By Chrissie Juliano, Director of the Big Cities Health Coalition

In 2017, governmental public health shined in our country. In the face of historic natural disasters in Texas, Florida, Puerto Rico, and California, public health staff on the front lines dedicated to serving the American people – no matter what – did their work and delivered. Many stayed behind when others fled, or travelled from their safe, dry homes to help those in danger, save lives, or clean up.

Fighting Flu in Big Cities: Lots of Germs in that Big Petri Dish

By Chrissie Juliano, Director of the Big Cities Health Coalition

Fighting seasonal influenza (the flu) is serious business. It may sound rather pedestrian compared to headline-grabbing diseases like Ebola or Zika, but fighting flu, and other such “routine” outbreaks, is what local public health departments do every day to protect lives.

In a moderate to severe year, seasonal flu kills more Americans than car accidents. Over the past 30 years, it’s killed anywhere between 3,000 and 49,000 people in single a flu season. It also costs Americans $87 billion in direct costs and lost productivity. In short, there are many reasons to fight flu.