Alonzo Plough has worked at the Robert Wood Johnson Foundation for nine years. In that role, he helps to select the winners of the foundation’s Culture Of Health Awards, which honors communities, including county health departments, where people and organizations are advancing health and equity.
Plough has served as director for several large county health departments that face challenges similar to those experienced by Allegheny County, including the Seattle and King County health department and the Boston Department of Public Health.
EHN: What types of expertise should be represented on a board of health?
Alonzo Plough: The majority of health challenges are rooted in social and environmental determinants of health. Things like clean air and water, access to healthy food and access to good medical care.
While it’s good to have someone with clinical expertise on the board, public health practice involves a lot of important context that’s generally beyond the scope of how most physicians are trained. Public health isn’t public medicine.
You want systems thinkers who understand the complex interactions of social, political and environmental determinants of health and inequality related to those challenges, and who will work to address them through systemic changes geared toward disease prevention.
EHN: The Allegheny County Health Department is responsible for dealing with a broad range of issues — everything from food safety and lead remediation to plumbing inspections, immunizations, the opioid crisis and regulating air pollution. Can you speak about how a well-rounded board of health works together to address wide-ranging issues like these?
Alonzo Plough: These issues may seem discrete, but they’re actually all related. You want systems thinkers who understand how these issues are interconnected.
You also want a board of health and a health department that knows how to communicate what it does and the interconnectedness of these issues. People may know that the health department conducts restaurant inspections, but they might not understand that this is one of several preventative approaches to managing food-borne disease.
You want collaborative knowledge building so communities understand what public health agencies are trying to do, and public health agencies understand barriers to equitable outcomes in health from the community’s perspective.
EHN: What kind of partnerships would you like to see between the board of health and outside organizations?
Alonzo Plough: It’s important that public health departments connect with local academic public health departments. A public health department needs to keep current and connected to evolving sciences that relate to public health practice. It’s often good to have a representative from academics working in public health on a board of health.
It’s also good to form partnerships with local health networks and medical practices, and with community health advocacy groups.
EHN: What types of representation should there be on advisory committees?
Alonzo Plough: If you’re going to have advisory committees, transparency is key. From a governance standpoint, it’s important that the director and the board of health have a strategy and a hypothesis about why they are developing advisory groups that answers the question, “what problem is this group trying to help us solve?”
For example, if you want an advisory group to address air quality, it has to have representatives from communities that are impacted by air pollution as well as individuals whose businesses might be part of the problem. An advisory group that doesn’t have both isn’t going to give you the information you need.
EHN: Are there any common pitfalls a board of health should avoid?
Alonzo Plough: The relationship between the board of health and director needs to be one of trust, candor and openness. The board should strategically guide where the department is going and help it align its resources to meet those goals and expectations, but not micromanage the day-to-day implementation of how that gets done.
At this stage of public health practice, the board of health, the director and the health department should be very deeply involved in extensive engagement with community partners.
There needs to be a primary focus on operationalizing health equity, which ultimately just means fairness. That’s really the operational responsibility of a county health department. And across the board, prioritizing transparency and building trust with the communities they serve is key.
