Shirley, MPA, MPH, is the director of the Multnomah County Health Department and immediate past president of the National Association of County and City Health Officials

Public health plays a vital role in providing a health equity lens to implementation of the Affordable Care Act. APHA member Lillian Shirley, MPA, MPH,  director of the Multnomah County Health Department and immediate past president of the National Association of County and City Health Officials, shares how Oregon has been working with community stakeholders and local health leaders to meet the needs of an entire population. It is this vision, Shirley says, that will guide them through full and successful implementation of the health reform law.

This is the third in a series of guest contributions on the ACA’s impact to coincide with the law’s three-year anniversary.

The Affordable Care Act has revolutionized key relationships in the Pacific Northwest, erasing state lines, county boundaries and hospital market shares to create an unprecedented partnership for the public good.

Beginning in 2010, public health leaders from four counties around metropolitan Portland began working with local hospital directors to respond to the ACA and public health accreditation.

We realized the only way to effectively assess the community health needs in real time was to bring everyone to the table. That meant convening staff from 14 different hospitals and health systems in Oregon and Washington — professionals who compete fiercely against one another. These historic rivals would need to work together and with public employees from four county health departments to assess the needs of more than 2 million people in the Portland region.

County health department staff were quickly identified as critical to this evaluation, both as the prevention experts and for our ability to plan in the interest of the entire population. Local public health leaders also bring an equity lens and cultural competence to community involvement and strategic planning.

Multnomah County Health Department was selected to serve as the legal convener. The Oregon Association of Hospitals and Health Systems provided critical startup assistance and the work group was formed. Together, we chose the name Healthy Columbia Willamette, for the two mighty rivers whose confluence defines the Portland region.

Our goal is to prioritize the community health needs, enable joint efforts to implement and track improvement activities, and improve the health of the population. We are using a modified version of the National Association of County and City Health Official’s Mobilizing for Action through Planning and Partnerships — or MAPP — assessment model.

Using this model allows Healthy Columbia Willamette to tap community wisdom and experience, including interviews with more than 100 stakeholders such as ambulance companies, 911 dispatchers, social services and housing providers. Plans call for listening sessions and a strength assessment with other community members.

We are committed to monitoring how we’re doing. Transparency is a local public health value, and Healthy Columbia Willamette is now building an online data dashboard to help engage and inform the community. Our website goes live April 1.

This collaboration has strengthened Oregon’s own health reform efforts, as county health departments partner with these same hospitals, and with area health plans, in new coordinated care organizations. We truly are working together. Balancing financial realities with the public good is not easy. But we are seeing old problems with new eyes.

Won’t it be powerful if we can apply this same unified momentum, energy and creativity to a single confounding issue like childhood obesity? Imagine how we could help a community of children growing up at the confluence of this time, and these efforts, thrive. This is our vision for implementing the Affordable Care Act here in Oregon.

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