Fighting Zika, Keeping 4 Million People Healthy and Telling Public Health's 'Story'

A Q&A with Umair Shah, director of one of the nation's biggest public health departments.
by | August 29, 2016
Harris County, Texas, had the first case of the Zika virus in the U.S. back in January. (Gaston De Cardenas/Miami Herald/TNS)

Managing the health of more than 4 million people is undoubtedly a big job. But managing the health in a rapidly expanding, diverse county staring down an emerging, infectious disease? That's a monstrous one.

Umair Shah has been at the helm of Harris County Department of Public Health in Texas since 2013, where he's overseen a website relaunch, a department logo redesign and a number of new technology initatives to bring public health to more people. It appears to be working: Earlier this year, Shah was named president-elect of the National Assocation of County and City Health Officials (NACCHO).

At NACCHO's Health Informatics conference, Shah spoke with Governing about running one of the biggest health departments in the country in the midst of a complex time for health care in the country. This interview has been edited for clarity and length.

How does one run such a huge department without it turning into a giant, bureaucratic mess?

The challenge whenever you're dealing with a large organization in the age of digital media and complex health issues is surrounding yourself with a good team. Make sure that every leader of every team within your department has a "we" mentality.

It's also important to have a team that recongizes the need for innovation and the value proposition around health equity.

You have a dedicated Zika team. If Harris County is hit with locally transmitted cases, what will be the very first actions they take?

We've been saying for months that it's a matter of when, not if. At some point we know that there are going to be cases of local transmission somewhere in Texas.

Fortunately, or unfortunately, depending on how you look at it, we had the very first case of Zika in the U.S. back in January -- so we really had to learn to walk the walk. Because of that, we've been planning for several months.

The first thing we'd do is take a multidisciplinary team - - think epidemologists, enviromental health folks, mosquito contro -- out into the community. They would go and figure out if there are specific areas in that community that are breeding grounds for mosquitos. It would also be important to communicate with the community; make sure they have all of the right information so they aren't unduly panicked.

Does this feeling of inevitability about Zika scare you?

Scary isn't the right word, but it's concerning. If you see what's playing out in Florida, you realize how incredibly fast this situation is evolving. There is so much about Zika we still don't know. Two years ago we weren't even talking about it, and one year ago we had no idea it could be sexually transmitted. We've been working on Zika efforts 24/7 for the past several months, and we still haven't had that first locally transmitted case yet.

What's also concerning is we've spent $1.1 million on these efforts, but the size of our pie hasn't gotten any bigger. We're robbing Peter to pay Paul on this. We have a chronic disease expert who was shifted to the Zika team, and that takes her away from diabetes and hypertension efforts, thus putting the entire county behind in those efforts.

How has being a non-Medicaid expansion state impacted your programming or general efforts in the community?

We really believe that Medicaid expansion is important -- our county judge has even said that. We are leaving dollars on the table that could be used to offset health-care costs.

But having said that, health insurance doesn't make you healthy. It's necessary, but not really sufficient. In order to make people healthy, you have to address all of the factors surrounding the social determinants of health. So yes, no doubt there's an impact because we don't have as many dollars to provide care. But we have to remember that insurance is just one part of health. We too often focus just on "health care" when we should focus on all of "health," which is a much broader conversation.

At this conference you've outlined many things your department has done to gain credibility -- from a website redesign to a smart social media strategy. What other low-cost tools could other health departments use to also maintain relevance?

One big strategy is to think about partners: who's doing things well, what strategies are they using, can you work with them in a public/private partnership. If you can gain a partner with a natural reach, leverage that. I think in public health we forget there are very low-cost things we can do just by having that conversation.

I'm convinced that if you show more people what it is that public health professionals do every single day in the trenches, people will want to invest more in it. Public health is an investment, but an investment requires shining a light on what we do. Public health departments have to get better at telling our story.