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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’s Inclusive Healthy Community National Pilot Project Nearing Its End

Posted By Administration, Monday, July 29, 2019

Almost four years ago, NACDD received funding from the CDC Disability and Health Branch to launch a national pilot project to make healthy choices the easy choices for people in areas where they live, learn, work, play, pray, and receive care – with a principle focus on disability inclusion. Through this Reaching People with Disabilities through Healthy Communities project, NACDD funded the five state Disability and Health Programs of Iowa, Montana, New York, Ohio, and Oregon and two communities from each of those states to receive training, technical assistance, and resources to achieve new policies, systems, or environments (PSE) that increase access and opportunity for healthy living behaviors, such as healthy eating, physical activity, tobacco prevention and reduction, and general accessibility and inclusion improvements.

State and community grantees were guided through a proven five-phased healthy community model by the NACDD Project Team to navigate the healthy community change process on the local level. Each community was paired with a State Expert Advisor, who provided state specific disability and health expertise to Community Coaches and coalitions throughout the entire project period. PSE strategies targeted the five community sectors of community-at-large (CAL), community institutions and organizations (CIO), schools, healthcare, and worksites.

With this year’s funding, the NACDD Project Team is focusing on broadly sharing the successes and lessons learned from this project in hopes to inspire other states and communities to integrate a focus on disability inclusion with their local and state healthy community efforts. To do this, NACDD and the state and community participants are implementing a number of communication and dissemination activities together, such as social media messaging, developing written testimonials, podcasts, recreating project webpages, presenting at conferences, submitting for publications, and developing new video success stories. 

NACDD is partnering with Rocket Camp to develop four new video success stories to showcase new project successes achieved within the last year. The four communities that were selected for the video success stories were Carroll County, Iowa, Sioux City, Iowa, Butte, Montana, and Helena, Montana. Below is a sneak peek at the soon-to-be-released video stories:

·      In Carroll County, Iowa, people with intellectual and developmental disabilities now have designated exercise time with certified personal trainers at a local fitness center, and construction of a new inclusive playground at Northeast Park is now underway.

·      In Sioux City, Iowa, Cone Park visitors now have winter and summer activity options with the creation of accessible sledding and ice rink in the winter, and an accessible splash pad in the summer.

·      In Butte, Montana, the new accessible pool and all-abilities playground is now open and serves as the main attraction at Stodden Park by park goers of all ages and abilities. The accessible pool is complete with zero entry options for wheelchair users, as well as features a lazy river, water slides, and a water park for kids of all ages. The all-abilities playground features multiple playgrounds for various ages of children and includes onsite exercise stations for adults. Another new Stodden Park feature includes recent updates to the park’s carousel, which now features new accessibility components so wheelchair users can participate in riding the carousel.

·      In Helena, Montana, a new inclusive employee workgroup was established at the Lewis and Clark Health Department, where local health department employees are now integrating new PSE changes that are inclusive to persons with disabilities who either work at, or are serviced by, the local health department.

The NACDD Project Team is currently reviewing all final PSE outcomes from the five states and 10 local communities, as well as reconstructing this project’s webpage on the NACDD website. Stay tuned for our release of the final project reports and the new project page!

For more information on how to integrate disability inclusion into your state or community efforts, please contact NACDD’s Project Lead Karma Harris at

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Wrapping Up Another Successful Walkability Action Institute Year

Posted By Administration, Monday, July 29, 2019

NACDD, with funding support from the CDC Division of Nutrition, Physical Activity, and Obesity (DNPAO), implemented the 5th Annual Action Institute to Increase Walking and Walkability in Decatur, Georgia on April 22 – 25, 2019. Referred to as the Walkability Action Institute (WAI), this multi-day course was implemented for 10 new, interdisciplinary teams who received expert faculty instruction from some of the nation’s most renowned leaders in public health, planning, advocacy, development, disability inclusion, and transportation and community design. The course included amazing keynote presentations, and experiential learning activities such as outdoor inclusive walk audits and scavenger hunts – all to assist attending teams with developing a Team Action Plan of their own respective walkability related strategies to pursue.

The 2019 cohort of teams includes the following locations, who competitively applied for and received travel stipends to attend this year’s course:

1)    Broward County, FL

2)    Clackamas County, OR

3)    Daytona, FL

 4)    Lane County, OR

5)    Larimer and Weld Counties, CO

6)    Marshall County, IN

7)    Maui, HI

8)    Montgomery County, PA

9)    Northwest VT

10) Spokane, WA

This year’s cohort of teams now marks 51 total teams who have participated across the five-year project period to make lasting PSE changes promoting improved environmental design, municipal policy structure, and systems improvements to improve active transportation. To date, an estimated 500 related changes have reached more than 20,000,000 people across the nation. 

For more information on NACDD’s WAI efforts, please visit NACDD’s WAI project page or contact NACDD’s Project Lead, Karma Harris, at

 PHOTO: WAI course faculty member Karin Korb leads participants through an outdoor walk audit activity in Decatur, GA.

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GEAR Groups Publish Accelerating Population Health

Posted By GEAR groups, Monday, July 29, 2019

NACDD is pleased to release Accelerating Population Health: Recommendations for Action, Resources, and Case Stories from the 2018 NACDD GEAR GroupsThis document is a compilation of resources shared through 2018 NACDD Generate, Educate, Activate, and Respond (GEAR) Groups, which focused on Accelerating Population Health.

GEAR Groups are NACDD’s professional development and leadership offering designed to provide peer-to-peer learning on various strategies that influence the health of populations. The 2018 GEAR Groups worked collectively across four domain areas and on the topic of health equity to draft these resources during their discussions over a six-month period. Additionally, the group developed a statement on population health that is provided along with recommendations for action, resources, and a series of case studies illustrating how State Health Departments are applying strategies to accelerate population health. Each case study highlights the actions, impact, challenges, successes, and includes contact information for the individuals implementing these promising population health practices. The document closes with a brief call to action and acknowledges the exceptional work of the 2018 GEAR Group members. State, Local, and Territorial Health Departments are encouraged to use this document as a guide for implementing promising or innovative population health strategies.  

 The 2018 NACDD GEAR Group focus on “Accelerating Population Health” was inspired by the CDC Preventing Chronic Disease article “Public Health 3.0: A Call to Action for Public Health to Meet the Challenges of the 21st Centuryand former NACDD Board President’s challenge to all Members to “Accelerate Population Health.” Improving population and public health outcomes require enhanced collaboration across public health, the healthcare delivery system, and the broader community.  

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NACDD Submits Comments on Lower Health Care Costs Act (S. 1895)

Posted By Administration, Monday, July 29, 2019

Chronic diseases account for 86% of health care costs in the United States. Investing in prevention methods will increase Americans’ quality of life, as well as decrease the trajectory of health care spending. The pressing issue of chronic disease and cost-effective preventive measures to avert such diseases should be part of any discussion about reducing health care costs.

On June 19, 2019, Senator Lamar Alexander (R-TN) and Senator Patty Murray (D-WA) introduced the Lower Health Care Costs Act (S. 1895), a bipartisan package of legislation intended to address factors driving health care costs. The legislation includes a provision on public health and chronic disease, specifically a section on evidence-based strategies for State Health Department obesity prevention programs.

NACDD submitted comments on the legislation, and as a result of NACDD’s comments, the Senate Health, Education, Labor & Pensions Committee changed the bill’s language to better reflect the work Chronic Disease Units are doing to prevent and reduce obesity. NACDD looks forward to continuing to work with members of Congress to address public health and health care policy issues.

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NACDD Supports Smoking Ban

Posted By Administration, Monday, July 29, 2019

Tobacco use is the single most preventable cause of death and disease in the United States. Smoking harms nearly every organ of the body, causing many diseases and affecting the health of smokers in general. The dangers of secondhand smoke from cigarettes and e-cigarettes are clear. Any level of exposure is dangerous and eliminating smoking in all indoor spaces is the only effective way to protect the public. E-cigarettes also release harmful chemicals into the air and may expose bystanders to unsafe elements including ultrafine particles, heavy metals, and volatile organic compounds.

On July 1, 2019, the Atlanta City Council voted to ban smoking and vaping in public places. While the State of Georgia has restricted smoking since passing the Smokefree Air Act of 2005, the new ban is stricter and closes loopholes in the 2005 law. Under the new ban, smoking is prohibited in restaurants, bars, places of employment, and other public places. The law includes e-cigarettes and their vapor in its definition of smoking and secondhand smoke. Notably, smoking inside Hartsfield-Jackson International Airport will be prohibited. The airport will convert smoking rooms in the terminals into other spaces and require those who want to smoke to exit the terminal.

NACDD submitted a letter of support for the proposed law. “Expanding smoke-free laws protects the public and prevents adverse health effects that can cause chronic disease,” said John Robitscher, CEO of the National Association of Chronic Disease Directors. “NACDD supports efforts by states and localities to limit the harmful effects of secondhand smoke.”

On July 10, 2019, Atlanta Mayor Keisha Lance Bottoms signed the legislation and the ban will go into effect starting January 2, 2020.

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NACDD’s ProVention Health Foundation Hosts a Thought Leader Roundtable on Oral Health and Chronic Disease in Older Adults

Posted By Barbara Park, Monday, June 24, 2019

In February, the ProVention Health Foundation (the Foundation established to support NACDD's work) convened a Thought Leader Roundtable on Oral Health and Chronic Disease in Older Adults. Invited participants included Chronic Disease Directors and Dental Directors from 13 states as well as a diverse group of national partners representing chronic disease, oral health, older adults, academia, and research.

Read the report from the roundtable, which summarizes the themes and recommendations that were identified related to addressing oral health and chronic disease in this growing population. Funding for this roundtable was provided by Glaxo Smith Kline.

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NACDD Receives Funding to Expand its Portfolio in Oral Health

Posted By Barbara Park, Monday, June 24, 2019

In 2018, NACDD was awarded funding under DP18-1811 “Partner Actions to Improve Oral Health Outcomes” by CDC’s Division of Oral Health to provide technical assistance to five states working on medical-dental integration projects focusing on diabetes prevention and control, hypertension awareness and early detection, and tobacco use prevention. NACDD will be responsible for developing success stories to document and promote the approaches these states take over the course of the 5-year project period in addition to providing opportunities for peer-to-peer learning and technical assistance. A brief synopsis of what the states will be doing is provided below:

  • The Colorado Department of Public Health and the Environment will implement a Diabetes, Cardiovascular Disease and Oral Health (DCVDOHI) model for medical and dental systems to sustain medical-dental integration interventions for patients with co-morbid conditions.

  • The Connecticut Department of Public Health will address diabetes and oral disease risk factors by integrating prediabetes and oral health screening, education, and bi-directional referrals into medical and dental systems in federally qualified health centers.
  • The North Dakota Department of Health will use evidence-based and supported strategies to address hypertension in dental office settings and encourage bi-directional referrals between dental and medical health professionals serving low income, rural, American Indian, and underserved populations in the state.
  • The South Carolina Department of Health and Environmental Control will collaborate with community leaders and partners to increase awareness and facilitate access to services for people with diabetes that have unmet oral health needs.
  • The Virginia Department of Health will develop a bi-directional referral system that encourages hypertension screening and counseling, including tobacco cessation counseling, by dental professionals, oral cavity examination by primary care physicians, and active referrals between the two healthcare providers in a safety net setting.

Learn more about NACDD's Oral Health work.

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STAR Teams Visit Louisiana and the Commonwealth of the Northern Mariana Islands

Posted By Jeanne Alongi, Monday, June 24, 2019
NACDD's STAR Program works with state and territorial chronic disease prevention and health promotion programs to build organizational capacity and practice effectiveness. This past month, NACDD subject matter experts in leadership shared information about the program and its unique approach at the National Network of Public Health Institutes Annual Conference in Washington, DC. Additionally, two STAR teams traveled to deliver workshops for Melissa Martin and her Chronic Disease Unit in the Louisiana Department of Health and Amber Mendiola and the Non-Communicable Disease Bureau in the Commonwealth of the Northern Mariana Island.

Tags:  capacity building  CNMI  Louisiana  STAR 

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New Guide Provides a Roadmap for Operationalizing Medicaid Coverage

Posted By Kelly McCracken, Monday, June 24, 2019

New Guide Provides a Roadmap for Operationalizing Medicaid Coverage

NACDD and ChangeLab Solutions, in collaboration with CDC, has released Establishing and Operationalizing Medicaid Coverage of Diabetes Self-Management Education and Support: A Resource Guide for State Medicaid and Public Health Agencies. This guide walks readers through the steps required to make Medicaid coverage a reality for diabetes self-management education and support (DSMES). The guide examines strategies to support State Health Department and Medicaid agency staff in their efforts to increase coverage and utilization of DSMES services in their states. For states that now have Medicaid coverage of DSMES, this document offers additional information on increasing utilization of the DSMES benefit. It also provides stakeholders with information and resources to help promote the expansion of Medicaid coverage of DSMES services.

Specifically, the guide provides:

  • An overview of DSMES services
  • The landscape of Medicaid coverage for DSMES
  • Pathways to Medicaid coverage of DSMES
  • A summary of how to make the case for coverage and steps stakeholders can take to expand Medicaid coverage of DSMES
  • Suggestions about how to address the challenge of low utilization rates for DSMES

For more information, please contact Kelly McCracken or Trish Herrmann.

**Below are additional resources developed and supported by CDC to increase access to diabetes self-management education and support.**  

CDC’s Diabetes Self-Management Education and Support Toolkit

The purpose of this  toolkit is to increase use of DSMES services among people with diabetes and promote healthcare provider referrals. Expanded use of DSMES can help ensure that mpeople with diabetes receive the support they need. The toolkit provides resources and tools in one place to assist with the development, promotion, implementation, and sustainability of DSMES services.

Specifically, the toolkit is designed to:

  • Communicate the evidence supporting DSMES, including the clinical and economic benefits.
  • Clarify the process for establishing a DSMES service that meets minimum standards and is eligible for reimbursement.
  • Provide resources and tools to facilitate becoming a recognized or accredited DSMES provider.
  • Describe common barriers to DSMES use and referral, and provide tips for overcoming these barriers.

Diabetes Education: Policies to Help Patients

With support from the CDC, ChangeLab worked with the Temple University Policy Surveillance Program to develop an interactive website51 state fact sheets, and a national policy poster to analyze insurance coverage for Diabetes Self-Management Education/Training (DSME/T) and the DSME/T policy landscape. Get started here to check out these resources!


Tags:  Diabetes  Medicaid 

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From Our Experts: Cognitive Decline, Coronary Heart Disease and Stroke, and Caregiving: A Related Triad

Posted By Adeline Yerkes, Monday, June 24, 2019

Were you aware that one in nine adults aged 45 years and older report subjective cognitive decline? Or are you even aware of the term, "subjective cognitive decline"? Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss. It is a form of cognitive impairment, and one of the earliest noticeable symptoms of Alzheimer’s disease and related dementias.

Coronary heart disease (CHD) can lead to decreased cognitive function or SCD. One in five adults aged 45 years and older diagnosed with CHD, or a stroke, or both report SCD. Both SCD and coronary heart disease and stroke can impact effective chronic disease self-management and the successfulness of activities of daily living. This lessening ability to effectively self-manage conditions and daily living may lead to the need for a caregiver.

Almost one in four adults, mostly women, ages 45 to 64 years are caregivers. Caregivers are at increased risk for having multiple chronic diseases as they may neglect their own personal health needs while providing care to others. 
More than one third of caregivers report having two or more chronic diseases, and 14.4% reported having coronary heart disease or having had a stroke.

The National Association of Chronic Disease Directors and CDC's Alzheimer’s Disease and Healthy Aging Program are collaborating on the above issues to increase awareness and stimulate public health action by developing a series of five briefs. These briefs are based on the Behavioral Risk Factor Surveillance System (BRFSS) with data aggregated for years 2015-2017. The data are examined in two age groups (adults aged 45-64 years and aged 65 years and older) as well as by sex, race, Hispanic ethnicity, chronic disease status, and other demographic characteristics. The three briefs are formatted in the same style and address a number of common themes. Each brief ends with a public health call to action. To date, three briefs are published and reside on the Healthy Aging pages of NACDD’s and CDC’s websites: Subjective Cognitive Decline, Caregiving and Coronary Heart Disease and Stroke. Start implementing one or more of these calls to action in your community

Tags:  CVH  Healthy aging  heart disease  stroke 

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