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Programs & Organizations > Chronic Disease Prevention > A Guide For Local Health Departments > A Message from Contra Costa's Public Health Director

Preventing Chronic Disease

A Message from Contra Costa's Public Health Director

As public health departments enter the 21st century, we find ourselves confronting new health issues that require different skills from our staff and new approaches from our organizations. In 1900, the leading causes of death were tuberculosis, pneumonia, diarrhea, and other infections. Throughout the 20th century, public health officials typically focused on the control of communicable disease, applying the disciplines of epidemiology, sanitary engineering and microbiology. Public health made tremendous strides, but the approach was limited by a focus on scientific expertise applied to outcomes defined by professionals.

Today, chronic disease has replaced infectious disease as the leading killer in the United States and the single biggest threat to quality of life. Low-income, ethnically diverse communities disproportionately suffer the impacts of chronic diseases such as cancer, heart disease and stroke. Community public health issues likewise include domestic violence, childhood obesity, drug abuse, and environmental toxins, all entwined in complex ways and often related to chronic disease risk factors.

To effectively address these issues, local health departments cannot act alone. We must form partnerships with mobilized communities, as part of a spectrum of strategies to improve public health. It hasn't worked to go into communities and tell people to stop smoking, exercise, and eat five-a-day servings of fresh fruits and vegetables. These messages fail to capture the interest of communities confronting more urgent issues like violence, substance abuse and poverty. We must engage communities directly and respond to their immediate concerns before asserting our own public health agenda.

Local health departments must also shift our focus from educating individuals to change their lifestyles toward developing strategies that address the social, environmental and economic context. We must address the broad risk factors common to many chronic illnesses: poor nutrition, limited physical activity, tobacco, chronic stress, environmental contamination, and low socioeconomic status.

At Contra Costa Health Services, we have developed a model for chronic disease prevention that focuses on organizing many segments of the community. In partnership with residents and community agencies, we collectively set priorities and seek solutions for a healthier neighborhood. This Guide, based on our experience, offers strategies health departments can use to do the same. You can select from these strategies, and modify them over time, depending on your circumstances and resources.

As you experiment with this approach, we invite you to tell us about your experience. Our hope is to help promote dialogue as we work together to reduce chronic disease. Please send your comments to Mary Anne Morgan, Director of Public Health Collaborations, CCHS, 597 Center Ave, Suite 115, Martinez, California, 94553.


Wendel Brunner MD, PhD, MPH
Director of Public Health
Contra Costa Health Services

Content provided by the The Community Wellness & Prevention Program of Contra Costa Health Services.

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