Trust: An Essential Ingredient for Becoming the Chief Health Strategist

Trust Becoming Chief Health Strategist

Boots on the Ground addresses the practice of public health from the perspective of those working in LHDs and will provide an informal platform for public health leaders across the country to share their stories of how public health is accomplished in real life, in real time. The series is intended to showcase the work done by LHDs and to celebrate the successes that occur every day within an LHD. Ideally, the series will provide lessons learned to advance the practice of public health and to keep LHDs at the center of health improvement efforts in their communities. In addition, the column will serve as a forum for public health practitioners to share stories of management, such as how a quality improvement initiative resulted in operational changes within the LHD.

As discussed in the first column of “Boots on the Ground,” it is critical that health departments remain at the center of health improvement efforts in the communities they serve. Much has been written about Public Health 3.0 and the role that local government leaders can play as the “Chief Health Strategists” in their communities.1  Taking on such a role requires that local health departments work closely with a wide range of partners on a wide range of issues.

Trust is an essential ingredient for all governmental public health leaders to be able to meet the goal of being perceived of, and accepted as, the chief health strategist, but how can leaders achieve that level of trust? There are so many elements that play into creating a culture of trust. Today, we are going to explore how creating trust within the organization can help to bolster a foundation for creating trust outside of the organization.

In preparation for accreditation, the Onondaga County Health Department (OCHD) partnered with Syracuse University’s Program for the Advancement of Research on Conflict and Collaboration (PARCC) for assistance with strategic planning. The director of PARCC, Catherine Gerard, patiently worked with us as we embarked on a deliberative journey, using the strategic planning process not only to check off the necessary pre-requisite for accreditation, but to truly better understand who we were and how we served our community. With respect to having a better understanding of who we were, we chose to adapt the Federal Employee Survey, administered by the US Office of Personnel Management, as part of our SWOT (strengths, weaknesses, opportunities, and threats) analysis. The 86-question anonymous survey was provided to the approximate 300 health department employees. To optimize participation and protect anonymity, the survey was conducted by PARCC which sent out, received, and analyzed the surveys, providing only aggregated data to health department leadership. At the division/bureau level, the leadership team incentivized participation by inspiring a friendly competition for highest response rates (with the reward of a pizza party, paid for by the leadership team’s personal funds) to the division/ bureau with the highest response rates. Supervisors were encouraged to facilitate participation by reminding staff to set aside work time to respond to the survey. With a 94% overall response rate, several pizza parties were awarded! Most importantly, however, with such a high response rate, we were able to confidently assess the health department’s workforce and to identify opportunities to take action to address concerns identified in the survey. Conducting the survey not only allowed the leadership team to appreciate how the workforce viewed the culture of the organization, but it also created opportunities to increase trust by acting on our promise to, to the best of our ability, respond to concerns that were identified in the survey. For example, in response to a finding that the lack of flexible work hours was a significant concern for many employees, the leadership team worked with the county’s personnel department and the labor unions to optimize flexibility within the constraints of local government policies.

Creating trust within an organization can have an impact on the community; evidence supports that having an engaged, committed workforce is associated with increased customer satisfaction and improved services. In public health, these outcomes are critical to establishing trust in the community. Consider the myriad of ways in which the public health workforce interacts with the community: a lead inspector may be in an individual’s home, testing for lead; working with fellow local government colleagues in codes enforcement to re-evaluate enforcement policies for landlords with repeated violations; or partnering with local community organizations to conduct trainings for lead-safe home renovations. All public health workers, many of whom have extensive interactions with the public, represent the organization in which they work and therefore have the opportunity to promote, or harm, the reputation of the health department and thereby influence trust. Having an engaged, committed, and of course highly competent, workforce is a health department’s greatest strategy to build and sustain trust. The OCHD’s survey was able to indirectly assess the level of engagement because, as PARCC reported, the survey included several questions that covered most, if not all, of the conditions likely to lead to employee engagement.

In reflecting on some of the feedback from the survey as well as from anecdotal narratives that emerged after the survey results were shared with employees, it became clear that willingness to listen, humility to learn from what was heard, and commitment to responding to what was learned, preferably by implementing a meaningful, systematic approach to problem solving, were crucial factors that facilitated trust and engagement among the workforce. These same factors are crucial for a local health department to establish trust and engagement within the community it serves.


  1. DeSalvo KB, Wang YC, Harris A, Auerbach J, Koo D, O’Carroll P. Public Health 3.0: A Call to Action for Public Health to Meet the Challenges of the 21stCentury. Prev Chronic Dis 2017;14:170017.

As with community health improvement, we are stronger if we work together. If you are interested in sharing your story, please contact Dr. Cynthia Morrow at

Author Profile

Cynthia Morrow
Dr. Cynthia Morrow is the health district director for the Roanoke City and Alleghany Health Districts in Virginia and the co-Domain leader for Health Systems Science at the Virginia Tech Carilion School of Medicine. Previously, she was the Commissioner of Health for Onondaga County, NY and the Lerner Chair for Health Promotion at Syracuse University. Her prior academic positions include Professor of Practice in the Department of Public Administration and International Affairs at Syracuse University and an assistant professor with the Center for Bioethics and Humanities as well as with the Department of Public Health and Preventive Medicine at Upstate Medical University. She is a consulting editor for the Journal of Public Health Management and Practice and is also a co-editor/co-author of five books, including Essentials of Public Health, Fourth Edition (2020); Public Health: What it is and How it Works,7th Edition (2020); Bioethics, Public Health, and the Social Sciences for the Medical Professions (2019); JPHMP’s 21 Public Health Case Studies on Policy & Administration (2018); and Public Health Administration: Principles for Population-Based Management (2008). She is a graduate of Swarthmore College (BA) and Tufts University School of Medicine (MD, MPH).