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Impact Briefs
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The Impact Brief is the official newsletter for the National Association of Chronic Disease Directors. It is distributed monthly to approximately 4,800 NACDD members, partners, and stakeholders. You can view NACDD's Impact Brief archive here:


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Top tags: Arthritis  capacity building  CNMI  CVH  Diabetes  Health Promotion  Healthy aging  heart disease  Louisiana  Medicaid  STAR  StEM  stroke  Walk with Ease 

NACDD continues work to advance arthritis public health approaches

Posted By Heather Murphy, Thursday, May 28, 2020

May is National Arthritis Awareness Month. Arthritis affects about 1 in 4 adults in the United States, or more than 54 million people. Arthritis is common among people with multiple chronic conditions. For example, among people with heart disease, diabetes, and obesity, the prevalence of arthritis was 49%, 47%, and 31%, respectively. Arthritis makes it more challenging to manage other conditions since people with arthritis are less likely to be physically active, and physical activity is an important management technique for chronic conditions.


“Arthritis,” which can also be framed as “musculoskeletal conditions,” is a top driver of employer medical costs. By implementing low cost, evidence-based, self-management programs like Walk With Ease, people with arthritis and other chronic conditions will experience increased balance and strength, reduced pain, and improved overall health. Leveraging Partnerships to Develop a Sustainable Approach to Increasing Adoption of Arthritis Appropriate, Evidence-Based Interventions with Employers is a “living” document that provides a step-by-step approach to engage employers as payers of Walk With Ease.


NACDD works with State Health Departments, national and regional partners, and community-based partners to continue working to advance arthritis public health approaches. Several success stories were recently added to the NACDD What’s Working in Chronic Disease Prevention and Control database that features the work of NACDD arthritis grantees. In addition, the NACDD General Member Webinar for March 2020 featured speakers from CDC, the Osteoarthritis Action Alliance, and Oregon Health Authority speaking on Chronic Pain, Arthritis, and the Opioid Crisis: A Public Health Perspective.


The National Public Health Agenda for Osteoarthritis: 2020 Update was recently released by CDC, the Osteoarthritis Action Alliance and the Arthritis Foundation. This 2020 Update provides an outline of strategies to address osteoarthritis and a blueprint for action. It encourages the involvement of a variety of stakeholders including healthcare providers, decision-makers, marketing specialists, insurers, researchers, and more.


And finally, the Arthritis Foundation's Live Yes! campaign features an online community, an INSIGHTS campaign that collects self-reported data, a virtual connect group, and more.


For more information on the efforts of the NACDD arthritis program, contact Heather Murphy at

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US Hispanics and COVID-19: Spanish-Language Outreach & Crisis Communications

Posted By Administration, Thursday, May 28, 2020

NACDD’s partner, Hispanic Communications Network (HCN) has created a white paper outlining the unique and unmet challenges Hispanic communities face amidst the COVID-19 outbreak and resulting economic upheaval.


With over 40 years of experience, HCN is the leading full-service, social change marketing agency delivering culturally driven – not translations driven – multimedia strategies to promote health equity and improve quality of life. Their content is produced by Latinos, for Latinos. As the largest U.S. producer and syndicator of Spanish-language public interest and educational content for traditional and digital media, organizations rely on HCN to positively impact issues that disproportionately affect Hispanics. Through its La Red Hispana multimedia networks, HCN currently reaches a measured audience of 8 million in urban, mid-sized and rural Hispanic markets weekly.


On page 7 of the white paper, you will find HCN’s recommendations for culturally appropriate communications solutions to address the scarcity of credible Spanish-language information and resources available to the public—especially for consumers who do not normally visit government portals. These recommendations are designed to enhance the ability of government agencies and nonprofits to fulfill their mission by connecting Spanish-speaking consumers and Hispanic stakeholders to their agency resources, initiatives, and programs.


You can access the white paper here:
US Hispanics and COVID-19: Spanish-Language Outreach & Crisis Communications


For more information, please contact: Alison Rodden, CEO at

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COVID-19 predictive model estimates hospital bed and ICU utilization over time

Posted By Bo Nemelka, Leavitt Partners, Tuesday, April 28, 2020

Leavitt Partners has developed a COVID-19 burden model to estimate hospital bed and ICU utilization over time due to COVID-19. This model has informed our thinking as we’ve engaged with other health care stakeholders and state governments to develop a color-coded guidance framework for businesses and the general public to observe during the spread of COVID-19. Our work in this space is ongoing, and we have been retained by stakeholders ranging from Governors to other national entities (providers, payers, and foundations) to provide this perspective. View the COVID-19 predictive model. 


Read Leavitt Partner’s recent white paper referencing state-by-state estimates on using the predictive model to flatten the curve of the pandemic.


For more information, including to set up a conversation with Leavitt Partners on how to use this model at the state level and in conversations with policymakers, please contact Alan Hanson.

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May is Lupus Awareness Month in the United States

Posted By Leslie Best, Tuesday, April 28, 2020

Lupus is a chronic autoimmune disease that can damage any part of the body. With autoimmune diseases, the body’s immune system cannot tell the difference between viruses, bacteria, and other germs and the body’s healthy cells, tissues, or organs. Because of this, the immune system attacks and destroys these healthy cells, tissues, or organs.[i]


Lupus is most common in women between the ages of 18-45, but it also can affect men. It is difficult to know how many people in the United States have lupus, because the symptoms are different for every person. It is estimated that 1.5 million Americans have lupus.[ii]  Other estimates range from 161,000 to 322,000 Americans with systemic lupus erythematosus (SLE).[iii]


Systemic lupus erythematosus (SLE), is the most common type of lupus. SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. There is no cure for lupus, but medical interventions and lifestyle changes can help to control it. The causes of SLE are unknown, but are believed to be linked to environmental, genetic, and hormonal factors.

Recent studies indicate that lupus incidence rates are almost three times higher in black women than white women and affect one in every 537 young African American women. Minority women tend to develop lupus at a younger age, experience more serious complications, and have higher mortality rates—up to three times the mortality rate of white women. [iv]


In 2015, NACDD led a cooperative effort with the CDC, the Lupus Foundation of American and other stakeholders that included public health professionals, lupus experts, clinicians and individuals living with the disease to develop the first-ever National Public Health Agenda for Lupus to help prioritize public health efforts to improve the care and quality of life for people living with lupus. The Agenda outlines a broad public health approach to lupus diagnosis, disease management, treatment, and research.


Since then, NACDD has collaborated with the American College of Rheumatology (ACR), the Lupus Foundation of America/Georgia Chapter, the Big Bend Rural Health Network, and the University of Alabama to implement a Lupus School Nurse Training and Education Program. A workgroup was formed (including the ACR, NACDD, pediatric rheumatology fellows and rheumatology fellowship program directors, a certified registered nurse practitioner, and representatives from LFA/GA and BBRHN) to develop the training format, to be accompanied by a Lupus Care Plan and the ACR’s Child to Adult Lupus Transition Plan. This year, the project is on track to reach more than 100 school nurses. 


For more information about lupus, please visit our Lupus Program page. Or visit our partners' pages, the American College of Rheumatology/The Lupus Initiative, the Centers for Disease Control and Prevention's information on lupus, and the Lupus Foundation of America.


[i] Centers for Disease Control and Prevention accessed March 18, 2020.

[ii]Lawrence, R.C., Felson, D.T., Helmick, C.G., Arnold, L.M., Choi, H., Deyo, R.A., et al, for the National Arthritis Data Workgroup. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis Rheum; 58(1):26–35.

[iii]Helmick, C.G., Felson, D.T., Lawrence, R.C., Gabriel, S., Hirsch, R., Kwoh, C.K., et al, for the National Arthritis Data Workgroup. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part IArthritis Rheum; 58(1):15–25.

[iv] Lim, S.S. et al, The Incidence and Prevalence of Systemic Lupus Erythematosus.  Arthritis & Rheumatology 2014,66:369

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An Improvement Science Application to Organizational Development in State Health Department Chronic Disease Units

Posted By Jeanne Alongi, MPH DrPH, Tuesday, April 28, 2020

Public health agencies at all levels have struggled to identify the optimum structure to support administrative and programmatic efficiencies that will maximize public health impact with the available resources.


In order to support state-level chronic disease prevention and health promotion practice, a national public sector public health practice organization developed an evidence and improvement science-based approach to organizational capacity building and improved effectiveness.


The resulting model is drawn from the current literature that includes aspects of organizational structure, function, and operations. Specifically, it examines the extent to which a State Health Department Chronic Disease Unit:

  • establishes strong working relationships with diverse partners;
  • is the unifying voice for the prevention and control of chronic disease;
  • employs a strategic and systematic approach to learning and professional development;
  • provides consistent administration and staff support necessary to maintain successful programs;  
  • provides a culture that supports life-long learning, balance, and a diverse workforce;
  • and promotes the use of evidence-based public health practice and decision-making.

Implementation of the model includes assessment of organizational capacity using measures of evidence-based attributes within the framework and provides a systematic approach to identify opportunities for increasing organizational capacity, facilitating development and implementation of a six-month plan for achieving improved organizational capacity, and supporting states during quality improvement cycle through peer learning opportunities and mentoring.


Seventeen states have applied the model in their chronic disease prevention practice units. Twelve-month follow-up evaluation results show organizational capacity improvement in conceptual model measures.

“In all my years of public health work, I have never been part of a process that has given my staff so much energy to continue to improve. STAR was a great return on investment for our team,” said Bruce Adkins, Director of the Office of Community Health Systems and Health Promotion at the West Virginia Bureau for Public Health.

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Impact Brief CEO Message: April

Posted By Administration, Tuesday, April 28, 2020

NACDD has never wavered in our commitment to the underserved, and now, more than ever, we are working hard to help state and territorial health prevent disproportionate morbidity and mortality from COVID-19 among communities of color.


Recently, in honor of National Minority Health Month, NACDD hosted a webinar featuring Dr. Renée Branch Canady, Chief Executive Officer (CEO) of the Michigan Public Health Institute, on improving the fundamental social, systemic, and economic structures to decrease barriers and improve supports that allow people to achieve their full health potential. [Watch the recording].


More resources related to underserved communities and the social determinants of health are listed on our page in observance of National Minority Health Month.


The Association has dedicated many years of work and activities to reducing health inequities and disparities through our Health Equity Council (including A Tool to Address Racial Equity for Public Health Practitioners) and through our work on the Reaching People with Disabilities in Healthy Communities national project.


Through our program work, we also support the state and territorial response to those health issues that are most prevalent among threatened populations: diabetes, cancer, and cardiovascular health.


Former NACDD Board President Gabriel Kaplan’s podcast series “Socially Determined: Moving Public Health to 3.0” shares practical examples of how Members can engage with a variety of non-traditional partners and industries to address the social factors influencing health disparities and communities’ chronic disease burden.


During these difficult times, we encourage you to remain steadfast in your active work supporting and partnering with those communities who have deserved greater consideration long before COVID-19. We have an important journey ahead. Let’s continue on the path to health and health equity together.

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March Impact Brief CEO Message

Posted By Administration, Friday, March 20, 2020
Connecting You to What's Important for COVID-19 and Chronic Disease Work

We appreciate and understand there may be a lot going on in your departments in these unprecedented times, and below, we have pulled together some resources we have created and some we have gathered to assist and inform your work.  
As a reminder, NACDD has a 30-year record of effective action to meet the needs of our Members in State and Territorial Health Departments as you work to reduce the burden of chronic diseases. And we stand ready to assist you as your work becomes more important than ever during this crisis that significantly threatens people with chronic diseases.
Please reach out to us if we can be of specific assistance to you and your teams.
Chronic disease and public health crises resources:
READ The Connector newsletter special edition on crises plans for management of populations with chronic diseases (2018)
Communicating to the public in crisis (2019):
PODCAST Whitney Hammond, Chronic Disease Director at the New Hampshire Department of Health and Human Services, discusses lessons learned in public relations while investigations continued into a cluster of pediatric cancer cases in her state. 
Supporting population health during crisis (2019):
PODCAST Dr. Jean O’Connor speaks with Dr. Judy Monroe, President and CEO of the CDC Foundation, on how the CDC Foundation focuses on emergency response, and supports population health during events such as the Zika outbreak. 
Lessons learned on multi-sector/collective impact approaches during crisis (2019):
PODCAST Dr. Jean O’Connor speaks with John Auerbach, President and CEO of Trust for America’s Health, on opioid use in the United States, and how it affects population health and public health. Auerbach also touches on topics such as importance of keeping people healthy and resilient, and how it has a positive effect on population health.

In Good Health and Good Hand Hygiene…


John W. Robitscher, MPH


National Association of Chronic Disease Directors

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Health Equity Council Webinar: Moving Upstream - What Does that Mean?

Posted By Administration, Friday, March 20, 2020
Updated: Thursday, March 19, 2020

April is National Minority Health Month. The month is recognized as an opportunity to increase discussion and take action to address the health disparities and inequities that continue to affect racial and ethnic minorities. Everyone in America should live in circumstances that allow them to live a healthy life, regardless of who they are, where they are from, or where they live. In honor of Minority Health Month, the NACDD Health Equity Council will host a webinar, ‘Moving Upstream - What Does that Mean?’ at 2 p.m. on Tuesday, April 14. The webinar will feature Dr. Renée Branch Canady, Chief Executive Officer (CEO) of the Michigan Public Health Institute, a nationally engaged Michigan-based, nonprofit, public health institute dedicated to advancing population health through public health innovation and collaboration.


Moving Upstream is a focus on improving the fundamental social, structural, and economic structures in order to decrease barriers and improve supports that allow people to achieve their full health potential. Many often have asked, "How can public health play a role in addressing upstream factors?" Dr. Canady has been recognized as a national thought leader in the areas of health inequities and disparities, cultural competence, and social justice. She has published and presented broadly on these topics, and her passion for this work is evident in her personal, academic, and professional life. Dr. Canady has been highly influential in broadening the discussion of health equity, health inequities, and social justice while serving on numerous national boards, review panels, and advisory groups. Dr. Canady has led numerous workshops and discussions about what it means to Move Upstream.


Join us on April 14 at For more information, email Robyn Taylor.

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Bending the Trend: Engaging Employers to Prevent Type 2 Diabetes

Posted By Administration, Thursday, March 19, 2020

NACDD’s Diabetes Technical Assistance and Support Team is partnering with Centers for Disease Control and Prevention to take a new approach to preventing type 2 diabetes. The Employer Learning Collaborative (ELC) was launched to assist select states in engaging large employers to cover the National Diabetes Prevention Program (National DPP) lifestyle change program for their employees. States were selected based on the interest and readiness of both the State Health Department and employers. The first cohort of six states is scheduled to end in June this year. In February, two new cohorts started up: one for six new states and another for five national partners. An additional cohort is being planned for 2021. The collaborative intends to:

  • Accelerate employer coverage of the National DPP lifestyle change program
  • Capture employer perspectives on the road to coverage
  • Develop a replicable model for employers to use while considering offering the program as a covered benefit
  • Provide technical assistance to states, national organizations, and employers

Sara Hanlon, NACDD’s lead of the ELC said, “The results of this program will include development of a clear and replicable model for employers to use as they decide if offering the National DPP as a covered benefit is a fit for their organization. In addition, we are building an Employer Network committed to cost-effective prevention of type 2 diabetes.” This project was made available and in collaboration with the Centers for Disease Control and Prevention. Watch for more details about this project in the next issue of The Connector newsletter. For more information, contact Sara Hanlon.

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House of Representatives Passes E-cigarette Legislation

Posted By Administration, Thursday, March 19, 2020


On Feb. 28, 2020, the U.S. House of Representatives passed the Protecting American Lungs and Reversing the Youth Tobacco Epidemic Act (H.R. 2339) by a vote of 213-195. Sponsored by Congressman Frank Pallone (D-NJ) who serves as the chairman of the House Energy and Commerce Committee, the bill prohibits all flavored tobacco products (including menthol). Additional provisions address non-face-to-face sales, limiting marketing and advertising, and providing additional resources to the Food and Drug Administration.


The passage of the legislation comes on the heels of a flurry of activity at the federal and state level to address the youth vaping epidemic that is driven by the availability of flavored products. In December 2019, President Trump signed a federal law banning the sale of tobacco products and e-cigarettes to anyone under 21. In addition, on January 2, 2020, the Trump Administration announced a partial ban on flavored e-cigarettes that excluded some e-cigarette products as well as menthol and tobacco flavored products.


Many state legislatures are also considering legislation to curb youth use of e-cigarettes. Several states have introduced their own state-level Tobacco 21 legislation that updates existing state laws and ensures that their state statutes will be consistent with the enforcement of the federal Tobacco 21 law. Some states are taking the opportunity to introduce or amend tobacco licensure and penalties for selling to underage individuals. Other state-level legislation includes banning all flavored e-cigarettes, providing additional education in school health programs about the dangers of e-cigarettes, including e-cigarettes in existing smoke-free laws, and taxing e-cigarette products.


To learn more about state legislation, check out NACDD’s State Legislative Tracker.

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