Social factors and public efforts to impact healthcare play as much a role in keeping communities healthy as doctors and hospitals do, Dr. Umair Shah, executive director of the Harris County, Texas Public Health and vice president of the National Association of County & City Health Officials, told county leaders on the first day of the National Association of Counties legislative conference.

Shah defined public health as when “we work together as a society to assure the conditions in which people can be healthy,” and said that counties should involve as much as the community as they can in their public health efforts, whether that means collaborating with schools, the police force or private entities.

Public health initiatives also work to recognize and alleviate the social and economic conditions that impact health and the vitality of communities.

“It’s not just what happens in the hospital. It’s what we do in the community,” Shah explained. For example, if a doctor tells an obese patient to lose weight, the number of public parks, trails, and access to healthy food in the patient's community will determine his or her success.

Today, only 3 to 4 percent of healthcare spending goes towards public health initiatives, while the rest goes towards the hospital system and treating diseases. Shah explained that investing in public health alternatives may cost counties more in the short-term, but would lower their healthcare spending in the long run.