Anya welcomes Dr. Pramod Dwivedi , director of Linn County (Iowa) Public Health and president-elect of the National Association of County Health Officials (NACCHO). They talk about how public health works at the local level and how it dovetails with big picture work at the national level.

Anya Morozov:

Hello everyone, and welcome back to From the Front Row. Public health work can happen in every sector, but one of the staples of the public health system in the United States is the work that goes on in county and city health departments. Today, we have a special guest at the College of Public Health to talk about his work in this space. Dr. Pramod Dwivedi. Pramod currently serves as the health director of Linn County Public Health, a full-service health department serving approximately 230,000 people in Eastern Iowa. A native of India, Pramod has held numerous leadership positions in both local and state public health agencies in the United States. One of his substantive works has been building epidemiologic capacity at local and state health agencies. In his nearly 30 years of public health practice, Pramod his championed and advanced health equity and social drivers of health as a means to improve overall population health.

In addition to serving on local and state level boards, he is the president-elect of the National Association of County and City Health Officials or NACCHO’s board of Directors, and he serves on the advisory board for Iowa State Hygienic Lab. I’m Anya Morozov, and if it’s your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and outside the field of public health. Welcome to the show, Pramod.

Pramod Dwivedi:

Thank you very much, Anya.

Anya Morozov:

Yeah. You’re currently the director of Linn County Public Health, and you have been for a decade now. I’ve spoken to a few health department directors. I know it’s not an easy role. What drew you to the role in the first place?

Pramod Dwivedi:

Anya, as you know that my public health career started right here on the campuses of the University of Iowa. I got my first taste of local public health practice during my internship at Johnson County Public Health here in Iowa City. Since then, I have followed no other profession, but public health all my life. This was when I was working at Johnson County Public Health. It was very stimulating, and as a governmental public health practitioner, I feel very satisfied, I would say, and happy about my work because it’s really improving public’s health, our neighbors’ health in our community. It’s really, really important work. As a public servant, I am very proud of this.

Anya Morozov:

I do think a lot of people in public health that I talk to, it’s a very mission driven field, which I really appreciate as well. Especially after the height of the COVID-19 pandemic, I know it took a toll on a lot of public health directors. There’s been a lot of director turnover. What has kept you in the role, even through the pandemic?

Pramod Dwivedi:

As you said, mission driven. Right? If you have a mission, you don’t want to leave your mission until the mission is accomplished. Right? That’s exactly what we have been doing. As you know, that in recent years, public health has been politicized as well. It has created a lot of turmoil on public health professionals. According to a recent survey, there have been about 50% of workforce, public health, local and state have left or retired. Even with that turmoil, I feel very strongly that the mission that we have as a governmental public health agency, we must fulfill that and continue to do our job. Even though there are turmoils, there are challenges, there are issues, but we are here to improve the health of our neighbors, and that’s exactly what we have been doing.

Anya Morozov:

That makes a lot of sense. Let’s move on to talk about Linn County Public Health. It became the first accredited health department in Iowa in 2015 and was named the Health Department of the Year by NACCHO in 2018. What do you think contributed to that title? Or in other words, what are some of the initiatives that you’re proud of at the health department?

Pramod Dwivedi:

Thank you for asking that question, because we feel proud of the fact that we are an innovative local public health agency. We established or launched different projects in Linn County Public Health, and one of those was we received a grant from the Centers for Medicare and Medicaid, which allowed us to look at or address social determinants or social drivers, I would like to call social drivers of health. We created this program by which people can be connected to different services. Let’s say for example, if somebody comes to our clinic, based on that person’s needs, we can connect that person to social services, to medical services, to transportation, or to housing, to education, all kinds of needs that person might have. NACCHO like this a lot. They really recognized us as a public health, a medium population category public health department of the year.

Then, with regard to our accreditation, we feel very strongly that you need to be abreast with things that are happening in public health practice. In that spirit, we also applied for our accreditation, and we received that first in Iowa, as you mentioned, and one of the 55 in the nation when we received that recognition. We are very proud and happy. But, all of these things cannot happen without your workforce, your colleagues. It’s a team sport. Public health practice is indeed a team sport, and getting everybody together to really look at our goal is important. What I’m trying to say is that if you have a competent group of team members, you can accomplish your goals, and that’s exactly what we’ve done throughout the years I’ve been here.

Anya Morozov:

Yeah, I agree with the fact that public health really is a team sport. I see it in a lot of group projects here at the college, but the issues that you’re trying to address through public health are things like social drivers of health, and they’re big issues that are multi-level. Advocacy is not a single person effort. You need to have a group of people to come together to be able to make change. I just want to make sure that the listeners have some background about what public health accreditation is.

Pramod Dwivedi:

It’s a really national public health accreditation where you have certain standards that you need to meet. Let’s say that one health department in Linn County have the same standard another department in another county has. Our services are standardized based on the model, the framework that Public Health Accreditation Board has developed. The accreditation allows us to meet those standards and provide our services or deliver our services based on those standards. Any department in the country, which is accredit, you can expect the same kind of services with same standard or same quality. That make sense?

Anya Morozov:

Yeah, yeah. It’s very important. They talk about how, if you’ve seen one health department, you’ve seen one health department. I think that can still be true even when you have those standards in place. Those are guidelines and then you adapt them to your community. Having at least a baseline set of guidelines, I think can be very helpful.

Pramod Dwivedi:

Yeah.

Anya Morozov:

Moving on from the health department to your national level work, let’s talk a little bit about NACCHO or the National Association of County and City Health Officials. Can you give a little bit of background as to what NACCHO is and what NACCHO does?

Pramod Dwivedi:

Yes. As you said, it’s National Association of County and City Health Officials, which represents more than 3000 jurisdictions, health departments, in the country. It’s a resource for local health agencies to really do the meaningful work in their agencies. It could be workforce, could be CHA and CHIP you remember that Community Health Assessment and Community Health Improvement Plan. There is a model called Mobilizing for Action through Planning and Partnership. That’s really framework to do this CHA and CHIP work. There are other numerous resources that the local health agencies can benefit from. I have been serving on NACCHO board since 2014, and then in 2021 I was elected by my peers to become vice president, and now I’m on track to become president this year. From vice president, president elect, and then president, then after this I would become immediate past-president.

It provides me a forum or platform to uplift the local public health issues, local governmental, public health issues at national level. It’s also a very stimulating environment where I can really talk to whoever I want to. For example, recently I was in Washington D.C., I spoke to the CDC’s director there, White House folks, other people from HHS, Health and Human Services. In my position here, I can also influence some policy like funding, for example, for local health agencies to build our infrastructure, which is very important.

As you know that since 1988, the Institute of Medicines report, the Future of Public Health, we’ve been talking about building better infrastructure for both local and state health agencies. You remember that report specifically said that governmental public health agencies, or the system, was in disarray. Pandemic has proven that. Even after what, 30 years later, our infrastructure is not where we would like it to be to respond to any outbreaks, let alone pandemic. It’s a challenging enterprise right now. My effort would be with this forum to raise that issue and get some resources to build our infrastructure so that we are able to respond to any health event in a timely manner.

Anya Morozov:

Yeah. That is so important. For just anyone kind of working at a health department, why do you think it’s important to get involved in these national level organizations, even when you’re doing the work at the local level?

Pramod Dwivedi:

I think it’s important because as I said, local level, we are at the front of the line when it comes to pandemic response or any outbreak response or any health emergency, we are right there in the community addressing those issues. When it comes to resources, when it comes to infrastructure, when it comes to communication, we are at the back of the line mean. If CDC gives anything, money or any resource, it goes to the state and then it filters down to us. I think it would, I hope, improve our way of doing business so we are directly connected with our bosses at the national level.

Anya Morozov:

Yeah. You have this perspective at the local level that really needs to get onto the policy stage, but the organizations like NACCHO are kind of a platform for you to get your perspective in front of the people who disseminate resources and things.

Pramod Dwivedi:

Precisely. I keep saying that local health departments are very focused on regulatory stuff like your food safety, water safety, air quality, and they have been doing that for ages. Can we reimagine public health practice and local health agencies? Can we also have things like, as you guys know, upstream intervention? Can we also have some sort of innovation in our work? Regulatory work are certainly important, but then health education, health promotion, those kind of things should also be part of our curriculum or agenda, which in Iowa especially, we don’t see that in our local health agencies.

In Linn County, we have built that area. We have hired about 14 new staff. We have created new programming such as assessment, health promotion, we hired epidemiologist, we have also launched health equity program, we have communication program. We are doing things that could uplift public health or neighbor’s health in our community.

Anya Morozov:

Those things are so important. You’ve talked a lot about moving towards some upstream factors addressing social drivers of health, addressing health equity. If you could summarize your hopes for the future of city and county public health, what do you see as some major trends in the field today?

Pramod Dwivedi:

Well, I mean, for me, it would be an important thing to take care of everybody in our jurisdiction, every single neighbor, especially those who are on the margins of society. Right? Populations that are hidden that we don’t see. Could be immigrants, could be LGBTQ+ community, could be people of color. One important thing that we boldly did in 2020 was declaring racism a public health crisis. Our Board of Health did that. Based on that, we created this new Office of Health Equity and have hired a person to run that office. Our services should be spreading the message of kindness and love toward every single individual living in the county. Health equity remains the top priority. I would also like to raise this at national level as well through my NACCHO work.

Another area of excitement for me is really looking at global health, what we can learn from the outside world or what we can contribute to those folks so that that’s another area of interest. Climate change is another. It’s going to impact public health globally, and we are not immune to that. Those are some of the exciting things that I would be working through NACCHO and also locally too.

Anya Morozov:

Yeah, it’s so exciting that you bring up the global perspective as well, because we know that even though public health work is not siloed in the United States, the COVID-19 pandemic showed us that disease knows no natural boundaries.

Pramod Dwivedi:

Boundary. Yeah, exactly.

Anya Morozov:

Our public health systems shouldn’t either.

Pramod Dwivedi:

Yeah. Yeah. Yeah.

Anya Morozov:

Okay. Moving on to our last question. What was one thing you thought you knew but were later wrong about?

Pramod Dwivedi:

I’m still thinking on this question. I’ve been wrong about a lot of things. I would say I feel that inherently everybody is kind, all people are kind and caring, but sometimes when, in current political situation, when you see people behaving badly, you pause and you change your mind that maybe not. As a public servant, I have always felt that our mission has to continue, our work has to continue. During pandemic, there were stressors, which I had not thought about before. There were people who became very, like misinformation, disinformation, or calling you and being very abusive. I was wrong about that. I always thought that people are one people. What separates us is really our memories. Otherwise, we are all same people. The energy that works in you is same in me too. Just our memories have separated us. Sometimes, you are wrong about that too, to just assume that the entire humanity is that way.

Anya Morozov:

Or that they’re going to be on board with your initiatives or something.

Pramod Dwivedi:

Yeah.

Anya Morozov:

I think we learned from COVID that communication and buy-in into preventing a disease from spreading is not always as simple of a thing as we think it is.

Pramod Dwivedi:

Right, right. Yeah.

Anya Morozov:

Okay. Well, anything else to add before we wrap up?

Pramod Dwivedi:

Well, thank you very much indeed. I’m honored. Thank

Anya Morozov:

You. It’s been an honor to have you on the show and to have you at the college today, and I look forward to hearing your spotlight session later today.

Pramod Dwivedi:

Awesome. Awesome. Take care.

Anya Morozov:

That’s it for our episode this week. Big thanks to Pramod Dwivedi for joining us today. This episode was hosted, written, edited, and produced by Anya Morozov. You can learn more about the University of Iowa College of Public Health on Facebook, and our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health, have a suggestion for our team. You can reach us at CPH-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.