The following is a transcript of an episode of From the Front Row: Student Voices in Public Health, the University of Iowa College of Public Health’s student podcast. This episode features and interview with Dr. Nalo Johnson, director of the Division of Health Promotion and Chronic Disease Prevention at the Iowa Department of Public Health. This episode was published on July 23, 2020.

Ian Buchta:
Welcome back to From the Front Row, brought to you by the University of Iowa, College of Public Health. My name is Ian Buchta and I’ll be your host today. If this is your first time with us, welcome. We’re a student run podcast, that talks about major issues in the field of public health and how they are relevant to anyone, both in and out of well, the field of public health.

Ian Buchta:
On the docket for today, we have an interview that I’ve been really wanting to release for a while, but of course, with COVID-19, our release schedule got shifted. This episode is about how local public health agencies help people in normal times.

Ian Buchta:
My guest is my former boss and mentor Dr. Nalo Johnson, who at the time was the community health manager at Johnson County Public Health, but now is with the Iowa Department of Public Health as the division director of the Division of Health Promotion and Chronic Disease Prevention.

Ian Buchta:
Dr. Johnson shared some insights about her time in local public health, how to connect with communities in public health and why that is so important. Finally, she even turned the interview around on me and asked me some questions about the project that we had worked on together.

Ian Buchta:
I will make one caveat before we shift over to that interview. This was recorded before the pandemic. We aren’t going to be touching on COVID-19. Obviously, because we hadn’t really heard of COVID-19 yet, since this was recorded in November.

Ian Buchta:
All right, here is my conversation with Dr. Nalo Johnson. The first question that I asked her was what does a day in the life of a community health manager look like in local Public Health?

Dr. Nalo Johnson:
Crazy and varied. I think it’d be easiest to start out and just talk about all of the different programs that we have in community health. We have what I refer to as our communicable disease programming. We have two disease prevention specialists who are responsible for following up on all reportable diseases as identified by the state. It’s a list of about 50 different diseases outside of STDs and STIs.

Dr. Nalo Johnson:
Then they’re also responsible for things like school immunization audits and looking at compliance around that and investigating things like animal bites and whatnot.

Dr. Nalo Johnson:
We have our health promotion programs. That includes things like our HIV and hepatitis C testing and outreach. We have a tobacco prevention and cessation health educator. We also have some smaller contracted employee programs. Like a certified application counselor, assist with people looking for health insurance through the marketplace. As well as an empowerment coordinator and a community health worker. Those are programs related to specific populations around chronic disease and health promotion efforts.

Dr. Nalo Johnson:
Then we have our planning and assessment team and that includes emergency preparedness planner dealing our public health emergency preparedness response. We have a full time epidemiologists, systems analyst to focus on performance management, quality improvement, public health accreditation. As well as a health planner who’s thinking about our interventions as we identify different community needs.

Dr. Nalo Johnson:
The planning assessment team work with me on one of our larger projects, which is our community health needs assessment and health improvement planning project.

Dr. Nalo Johnson:
In terms of what a day in the life of the community health manager, it’s responding to any of those kind of immediate needs that develop in those programs. It’s overseeing any kind of budget or grant focused needs. So communicating with our different funding streams, largely the state. We have passed through funds through the state as well for some of our programs, but also it’s the component from the community standpoint of being able to work with the college of public health, be able to work with our community based organizations and be in conversation about what they’re seeing in their different fields, sectors, or populations that they serve. That we need to be aware of as a health department and may have some ability to assist.

Ian Buchta:
That sounds like there’s quite a lot going on. I know you already began to talk about this, but what projects have you overseen at Johnson County Public Health?

Dr. Nalo Johnson:
I’d have to say the largest project that we’ve undertaken in my time here has been our community health needs assessment and health improvement planning process, which we have branded Healthy JOCO in which you’ve been a major part of, so thank you.

Dr. Nalo Johnson:
Through Iowa state code, every health departments required to conduct a needs assessment at least every five years and Johnson County is on the five year cycle. As a part of that, we look at both quantitative and qualitative data to have an understanding of what community health needs are. Then subsequently develop a prioritization process and a plan to address those needs over this five year period.

Dr. Nalo Johnson:
Over the last year we began our next needs assessment data collection effort and we really had a large goal around the concept of broad community engagement. Particularly as we have this focus on health equity and the social determinants of health, we wanted to ensure that we were able to engage a broad spectrum of community members to really two fold. To not only understand how people are articulating their community health needs or what they view as the needs of the community, but also to build relationships so that they have a different understanding in ways in which they’re engaging with the health department.

Dr. Nalo Johnson:
This summer, we, along with that goal around broad community engagement, we also wanted to bring a more robust data collection strategy. What we have created and what we call our Healthy JOCO methodology is really bridging those two goals. Of bringing these evidence-based robust data collection methods with this focus on broad community engagement and had a large undertaking this summer.

Ian Buchta:
With broad engagement and robust data collection, are those the targets that focus a lot of your programs? How do you decide which projects and initiatives you’re going to implement in order to serve your community?

Dr. Nalo Johnson:
Yeah, I think we also most recently updated our strategic plan and we actually aligned it on a five year cycle so it’ll align with our needs assessment process as well. Our five strategic priority areas are very specific to what we have supported through our Healthy JOCO efforts.

Dr. Nalo Johnson:
One strategic priority areas specific to health equity. As a part of that, we’re also a strategic priority area around authentic community engagement. As well as this idea of how do we support our professional development so our staff can utilize the most effective and efficient tools and methodologies in order to do their work?

Dr. Nalo Johnson:
I think what I saw reflected in what we determined for our strategic plan was really these concepts that grew through Healthy JOCO and the efforts that we had there. One example in developing our Healthy JOCO method, we sought to use a student team.

Dr. Nalo Johnson:
We worked with 12 undergraduate and one MPH student, yours truly, who helped us go out in the field and do data collection. We trained students on community based participatory research methods. We trained students on the CASPER methodology, which is a CDC rapid needs assessment tool. We had students in the field doing intercept surveys throughout the county, as well as deploying the CASPER survey in this randomized selection of households for data collection. Using tablets and ArcGIS in survey one, two, three so in a very sustainable way for data collection.

Dr. Nalo Johnson:
Subsequently, we’ve had our tobacco program recently deploy an effort in relation to the county prohibition around e-cigarettes that was adopted earlier this summer. Thus, they’re choosing to use the same type of methods that we crafted this summer and how they’re not only providing education around the e-cigarette prohibition, but also collecting information from an educational perspective on what businesses know about e-cigarette use and vaping as well.

Dr. Nalo Johnson:
To me, we have helped support kind of the proof of concept of how this method of thinking about broad community engagement and robust research methods really allows the health department to do their work in a more meaningful way.

Ian Buchta:
I’m going to pull something out of your answer, but first I want to just throw in a shameless plug. With the work that Johnson County has been doing with e-cigarettes, if you have not had a chance to listen to our interview with Susan Villeta, go back a little bit. If you’re interested in Johnson County’s work with e-cigarettes.

Ian Buchta:
I want to pull out a thread. You started to talk about health equity a little bit. Why is health equity so important at the local level and how do you foster a culture in the local health department to promote equity in all policies?

Dr. Nalo Johnson:
Yeah, I think that as you’ve seen nationally over the last five to 10 years, the conversation around health equity has become really prominent. I think it makes sense that that’s trickled down to the state and the local levels as well.

Dr. Nalo Johnson:
I think we also see that not only within our funding streams, but just this broader conversation around, we can’t have one size fits all methodologies for our communities and expect to see the same outcomes. That from a public health perspective, if we’re not attuning to our health disparate or disproportionately impacted populations, then we won’t see further gains in positive health outcomes for our community members writ large.

Dr. Nalo Johnson:
It’s just that broader conversation and I think from the academic side, the research behind that as well, has just been helpful to say, “We need to think differently what health equity means and how we’re doing our work,” and have honest conversations about how best to go about achieving those goals.

Dr. Nalo Johnson:
For us at Johnson County, we created our own language around health equity because I think that’s part from a capacity building standpoint. People may have this kind of ephemeral idea of what health equity is, but when it comes down to what does it mean in their work? Those are conversations that you have to have as a team and talk about concretely.

Dr. Nalo Johnson:
I know from my perspective personally, when I think of health equity, I’m thinking about where do these health disparities exist and being very data driven and understanding how we can see where health disparities exist. Then allowing us to then pivot and move towards thinking about interventions that make sense specific to those health disparate populations.

Dr. Nalo Johnson:
That ties in that idea of community engagement as well because if you don’t have the insight of the experiences of the communities in which you’re trying to serve, then you’re not going to be able to develop interventions that make sense and have an impact.

Dr. Nalo Johnson:
Not only from my personal perspective, do I think having that data driven focus around understanding a disease conviction or a behavior within the population is essential, but the second component of being able to be in conversation with members of that community is also clearly essential to any kind of health equity effort.

Ian Buchta:
Yeah, and when you say having the conversation with the community that you’re working with, I mean, we are seeing all around the country that public health is struggling with our messaging. Whether it’s starting to lose battles like vaccination and even fluoridation is starting to come up as a hot topic. These are battles that we won 50 years ago.

Ian Buchta:
Can you talk about the way that you use messaging to promote the community health needs assessment at Johnson County and to work with our community here?

Dr. Nalo Johnson:
Absolutely. A big part of what we started out with was this idea of needing to engage community members in a meaningful way. We rebranded what was the community health needs assessment and health improvement plan or the CHNA HIP, or some folks refer to it as a [CHA CHIP 00:13:13], as Healthy JOCO precisely for that reason because we can’t go out in the community and try and get people excited about giving us their opinions about what their personal health needs are when they don’t know what it means to do a CHNA HIP.

Dr. Nalo Johnson:
That was precisely our thinking around our communication strategy. We also use the tagline of live, work, learn and play, which is aligning with county health rankings definition of what is health that’s found in the places where you live, work, learn, and play. We just felt we created the ways in which we were talking about what the health department was doing around assessment and planning in a way that people could really find accessible and engage in.

Dr. Nalo Johnson:
We created a logo, we created a website. So as we’re going out and doing these surveys, we’re able to provide people with information to say, “Hey, check out our website. We’re going to have data and information. We put national, state and local articles and statistics up on the website for people to be able to kind of do their own legwork to build a relationship with Healthy JOCO and subsequently the health department. We also will be able to use that as a communication tool where we can share out on our needs assessment findings.

Dr. Nalo Johnson:
As we go through the prioritization process, be able to bring people in who may want to work on some interventions that we’re developing or working with our community partners to develop.

Dr. Nalo Johnson:
I’m glad you asked that question because part of messaging is not knowing what’s going to resonate with people, but also taking the time to build relationships. I can’t underscore that enough through this effort.

Dr. Nalo Johnson:
I had all of my community health staff out in the field. We also had others throughout the department, across our divisions participate as well. Either the Healthy JOCO chats, which were intercept surveys or in the field doing the door to door survey for CASPER and our rural incorporated survey as well.

Dr. Nalo Johnson:
To me, those moments were critical because it means something for our health educator or a public health nurse to be on somebody’s doorstep and communicating with them about their community health needs. In the same respect, it means something from the community member perspective to be able to know that their health department is willing to show up on their doorstep to have a conversation with them as well.

Ian Buchta:
Yeah. I think that’s a really interesting point that you make. I think that from my experience in this project, it’s so easy when you’re in the office to be reductionist. To think that the world is just so much smaller than it really is. To even think our county is so much smaller and more alike than it really is. I found it was so interesting to be able to go and knock on doors and really see people where they are and keep people in their own context. I’ve just learned a ton from the community that way.

Dr. Nalo Johnson:
Let me ask you a question then Ian.

Ian Buchta:
Sure.

Dr. Nalo Johnson:
What is one of the most memorable or surprising interactions that you had while you were out in the field?

Ian Buchta:
I think everything surprised me [crosstalk 00:16:31]. I was shocked by how friendly people were. We didn’t really run into that many people who were just like, “Yeah, what you’re doing is not valuable.” People might’ve said, “Oh, we don’t have enough time for you,” which is a different conversation.

Ian Buchta:
I think some of the things that interested me was some of the conversations that I had with… I didn’t realize how many mobile home communities we had here in Johnson County. I certainly came into those with a presupposition. When I was there, I realized that people are people and people are proud of where they live. They’re proud of their homes and they’re proud of their communities. I thought that that was really interesting to me.

Ian Buchta:
I also did not realize the demographic makeup. I didn’t realize that I was going to be using a lot of my Spanish as I was in the different mobile home communities. I didn’t realize that was the demographic makeup of Johnson County and so that was eyeopening to see the community looked very different than I thought. I’ve lived here a couple of years now and yet I’d totally missed that.

Dr. Nalo Johnson:
Yeah. I think we were fortunate to be able to be teamed up a lot, when we were out in the field. One of the things that was really striking to me and as we’re going through analysis now of all the data. We’re talking about our findings. Nothing in terms of here’s the definitive, here’s the picture of health for the county, but more where are areas of curiosity? Where are we seeing something interesting in the data collection that we feel like we need to dive deeper into?

Dr. Nalo Johnson:
I guess anecdotally for me, what I found really interesting is based upon our findings from the CASPER, which was the door to door survey that we did this summer in Coralville, Iowa City and North Liberty are most three populous or highly populated communities in the County. Being in a very high income neighborhood doing surveys one evening.

Dr. Nalo Johnson:
Then the following evening being in a mobile home community and finding that pretty much all of the respondents in both of those communities, our question was, are you employed? If so, how many jobs do you have? Do you have health insurance through your primary job? Yes or no. Do you feel that your basic needs are met through your employment?

Dr. Nalo Johnson:
That in both of these communities, the high income and the mobile home community where we saw a distinct difference in income levels yet almost to a T, everyone said, “Yes, my basic needs are met through my employment.”

Dr. Nalo Johnson:
Cognitively for me, I have found that as an area of curiosity because we know that there are folks who aren’t necessarily covered by health insurance. We know that there’s a distinct difference and what you’re able to obtain based upon your level of income. Yet in both these communities people felt that their basic needs are met.

Dr. Nalo Johnson:
I’m interested in what that means and how do we as a health department then say, “Okay, we didn’t in our question, define what basic needs were. We left that up to the respondent to determine. If we have a more strict definition around basic needs, will people still have the same response or will they have a different response if we say, “Well, we don’t just mean that you have a roof over your head. When we’re talking about basic needs, we may want to discuss whether or not you have health insurance or whether or not your income covers your ability to pay for childcare,” and so on and so forth.

Dr. Nalo Johnson:
Those areas of curiosity is where we’re at now in trying to think about what kind of conversations we need to have further to better eliminate what’s occurring in community health.

Ian Buchta:
Yeah. I think that question of basic needs I feel like it strikes the heart of the American identity. In a way it’s asking, can you provide for yourself? I don’t think that or at least that’s kind of the way that it seemed like people were starting to take that question. I think that wasn’t how we first, or how we [crosstalk 00:21:14]. Yeah.

Dr. Nalo Johnson:
Conceived the present, yeah.

Ian Buchta:
Yet, that kind of psyche gets into the question because no one wants to say, “Yeah, no, I can’t provide for myself.”

Dr. Nalo Johnson:
No, that’s a good point. You’re absolutely correct. We didn’t perceive that question to factor in the idea of pride, or success or anything like that. Yeah, again, given the vast range because we were intentional about ensuring, even though this was a random selection of households, ensuring that we were in all types of communities across the county so that we would have that broad representation of community members.

Dr. Nalo Johnson:
We know there’s a difference between a high income household and a low income household and what they’re able to just have expendable income for. Yeah. It begs the question around are there further conversations that we can have to better understand what kind of needs people may be experiencing?

Ian Buchta:
Yeah. Yeah, absolutely. I think my last reflection before we kind of switch over is just the other thing I learned from this project is in my classes, when I sit in front of a data set of a million observations, that’s actually a million people. Every one of those data points has a face, has a name, has a story.

Ian Buchta:
When I was able to get out and collect primary data, I realized in my head, when I can think about when I’m thinking about the project, I can see a bunch of faces. When I was doing the data entry for parts of the Healthy JOCO project, I was entering data, I was analyzing the data and I also could remember the faces and people who were part of that data set. I think that that’s something that will absolutely follow me throughout my career. To remember that it’s so easy to be detached, but it’s so important not to be.

Dr. Nalo Johnson:
Yeah. That’s a beautiful point and thank you for sharing that. Again, I think that underscores why from my professional standpoint, why I believe it’s so important that we have our workforce in the field. So that people remember why we’re doing the work that we do and that we are serving others, that’s public health, we serve.

Ian Buchta:
Yeah, absolutely. It kind of in the same way, what’s this idea of community based participatory research and why is it so important especially at the local level?

Dr. Nalo Johnson:
Yeah. It’s really interesting. I guess, to share a little bit about me. My PhD’s in American studies. I have spent my career predominantly in public health or community health efforts, but I had no formal training in public health.

Dr. Nalo Johnson:
As I’ve worked more and more with students and academics within the field of public health and learning kind of their key methodologies, I have subsequently learned that my training in American studies is essentially a base for public health. One of those things is community based participatory research, which is this concept around working with community members to be a part of the process and understanding of phenomena within a community or within a population.

Dr. Nalo Johnson:
To be a part of developing what kind of interventions, whether that’s from a program or a policy standpoint. As well as being a part of that implementation of those interventions. Also, being able to be accountable to community members as your following up on impact and outcomes and anything that’s created from a research or I guess a public health practitioner perspective. That we’re sharing that with community members so that they themselves can use those tools or use that information however best they see fit as well.

Dr. Nalo Johnson:
It really goes to this concept of co-creation and we may have as public health professionals a certain expertise, or access or resource, but that we can’t be creating these ideas in isolation without having the experience, the insight, the expertise of the community members themselves participating with us.

Ian Buchta:
Yeah, I think part of public health that I learned is just the humility to understand that you are on the outside of the community. The more that you can tap into, as you were saying tap into that community knowledge. I think that the more that we do that, the better we are at reading our data and the better we are at collecting that data as well. I think you make a good point there.

Ian Buchta:
If you don’t mind me shifting a little bit, what are the skills that you need in order to be a manager in the world of public health?

Dr. Nalo Johnson:
Well, I think some of those managerial skills I think just writ large, regardless of what field you’re in. The kind of people management portion you’re going to have those day to day duties. Understanding people’s needs, understanding accountability, understanding process, as you’re dealing with things like evaluations, or pay scales and kind of performance improvement, that kind of thing.

Dr. Nalo Johnson:
I also think having somewhat of a fiscal background because you’re responsible for budgets and being able to multitask. For at the local level, we have funding coming from not only our county dollars, but also from the state and federal pass-through funds.

Dr. Nalo Johnson:
We also have the potential to have private funding if we apply for philanthropic grants as well. So that’s a multitude of different budgets, grant years, fundings years, along with your funding stream that you are accountable for.

Dr. Nalo Johnson:
Then also the compliance around all of those funding streams from an audit perspective. I think in particular for public health and particularly thinking about any of the community based or community health focused positions. Being able to have that relationship and people skillset is important because you are responsible to multiple audiences. So internally to your organization and your staff and your leadership, but also externally to all of your community partners.

Dr. Nalo Johnson:
I think that for me personally, what I have found very useful in my career now is particularly moving to my new role in state level director position. The fact that I have had multiple experiences in the field has really added value to my broader understanding of public health.

Dr. Nalo Johnson:
So to be a little more specific instead of abstract. I started off doing needs assessment within a hospital system and grant writing within a hospital system. I then moved to an evaluation role for a state health department and was responsible for evaluation across their chronic disease programming. Moved to a management position in their communicable disease division. So was familiar with the world of communicable disease from that standpoint.

Dr. Nalo Johnson:
That served me well coming here in community health because they have both the health promotion, and chronic disease prevention and communicable disease under community health. Now in my new role at the state, will be responsible for health promotion and chronic disease prevention activities.

Dr. Nalo Johnson:
I share all that to say, I think the fact that I have not been trained specifically to think about public health through one lens because I’ve only been in one field or one division has served me well in seeing the intersections between a multitude of public health efforts. If you’re interested in a manager or above role, I think that’s useful in growing your skillset.

Ian Buchta:
I like the way that you say you have that very broad approach to public health. I think that’s really interesting. Yeah, and helpful at least for my career and hopefully to some of your careers out there listeners.

Ian Buchta:
What is one thing that you thought you knew, but later found out that you were wrong about?

Dr. Nalo Johnson:
I think from a professional standpoint, the idea that if you work hard and do your job well and get all the right checks that you’ll always win in the end.

Dr. Nalo Johnson:
I think as I’ve grown just matured as a human being, but also professionally within the workplace, it’s much more complex than that. As I think about the audience for this podcast, I guess that’s where I’m targeting this response to is just be mindful that yes, you need to work hard and do all the right things, but also recognize that there are other aspects that feed into your career and professional growth too.

Dr. Nalo Johnson:
To build those relationships. To make those attempts to bridge out of your safe space. I know for example, I love how you talk about you’re an epi, you love the data, but now you’ve recognized how there needs to be so much more of a human touch and human understanding to your data.

Dr. Nalo Johnson:
I’m particularly proud that you’ve learned that before you’re out in the field because that’s going to impact how you will be as a professional in whatever role or the multitude of roles that you’ll experience over your career. I think that that’s something that I didn’t realize earlier on. Is just knowing it’s more complex in trying to achieve your career goals.

Ian Buchta:
That’s a really deep answer. Yeah, I think that being able to see the more in it is something that I’m starting to see in my career as a professional and I look forward to hopefully finding out more about that.

Ian Buchta:
My last question for you today is, what is one thing that’s interested you outside of the world of public health or outside of the world of work?

Dr. Nalo Johnson:
I’ll have to say that I’m a workaholic. Pretty much my life revolves around thinking about public health 24/7. At this point in my life, especially because you’re catching me in a time of transition between position. So at this point in my life, I don’t have a lot of space to not be thinking about public health.

Dr. Nalo Johnson:
I guess this is still public health related, but it’s tangential. One of the things that’s top of mind particularly in Iowa, particularly this time of year is election. Just acknowledging that as public health experts, we have insight and expertise to help at all levels. Whether that’s local, whether that’s state, whether that’s federal level. To help people understand different concepts.

Dr. Nalo Johnson:
You mentioned before immunizations or fluoridation. There’s always the questions around federal public health prevention funding and that type of thing. Just remembering that we are trained in the field as experts and to be able to use our knowledge and expertise to help inform community members. To help inform our local state and federal leadership so that they can make well informed decisions about how bills should look. How money should be spent on different items.

Dr. Nalo Johnson:
They can’t do that in isolation without our expertise and support. I think that’s just something that I’m really cognizant of right now.

Ian Buchta:
Yeah and that’s got to be quite the balancing act. When you work in public service, you can’t be partisan. You can’t choose one side and yet, how do you ensure that you’re giving the correct advice without being partisan?

Dr. Nalo Johnson:
Absolutely. Again, that’s why I really focus on saying we are data driven. I’ll go back to your examples around immunizations and fluoridation. We have a long scientific history about why it’s important that these things exist in our communities.

Dr. Nalo Johnson:
If we can share that history and we can talk about the results of lives saved, disease avoided, health system savings that type of thing. Going back to your point around messaging. Message that in a way that’s accessible to people. It doesn’t mean that we should not be partisan about talking about community health. We’re here to support community health and it doesn’t matter what label you wear as long as you can share good education around these public health efforts. We just need to be good messengers in that way.

Ian Buchta:
Well, Nalo thank you for that answer and for coming on the podcast today. Are there any last thoughts that you have, anything that we haven’t covered?

Dr. Nalo Johnson:
Oh goodness. No. I think you’ve had great questions and I’ve really enjoyed working with you so it’s been a pleasure.

Ian Buchta:
Yeah. Well, thank you again. It’s been a pleasure on this end as well and best of luck in the new position.

Dr. Nalo Johnson:
Thank you. I appreciate it. I’m sure. I’ll see you again.

Steve Sonnier:
That was our episode this week with Dr. Nalo Johnson. This episode was hosted by Ian Buchta. This episode was edited and produced by Ian Buchta and Steve Sonnier:.

Steve Sonnier:
If you have any questions, please reach out to us at cph-gradambassador@uiowa.edu. If you enjoyed our podcast, please share it with your colleagues and give us a review on whatever your preferred podcasting platform is. Have a wonderful week and keep on keeping on.