Hello Healthy Counties!

I am Nick Macchione and currently serve as Vice-Chair of the Healthy Counties Advisory Board (HCAB).  Since its inception as a NACO Presidential initiative by Commissioner Lenny Eliason I have proudly served in the various roles of member, vice-chair and chair of the HCAB.

Now in my 15th year as Director for Health and Human Services Agency (HHSA) with the County of San Diego, I lead an agency with a $2.8 billion budget with a talented workforce of 7,200 employees that annually supports 1.1 million of the County’s 3.3 million people with health, housing and human services.  Before joining the County in 1997, my 30-year career includes clinical and executive experience leading large, complex service health and human service delivery systems in various settings in the New York metropolitan area. Along with dual master’s degrees from Columbia University and New York University and a professional certification from Harvard University specializing in executive leadership, management and health policy, I am board-certified in healthcare management and hold two national fellowships in community health and public health leadership.  It is also my great fortune to be a recipient of the Malcolm Baldrige Foundation’s 2018 Harry Hertz Leadership Award Recipient.  At San Diego State University’s Graduate School of Public Health, I serve as the John Hanlon Executive Scholar.

Today, I want to reflect on our County’s journey with Live Well San Diego (LWSD), a nationally recognized large-scale, population health strategy founded in 2010 and focused on improving life expectancy and social well-being so that all San Diegans have the full opportunity to be healthy, safe and thriving.

Most recently, we have expanded its approach, making it a cornerstone of our health equity response to COVID-19 and a driving factor in reshaping behavioral health delivery to better reach all communities from children to seniors.

This all began with a well-known public health fact, that many of our communities are plagued by preventable deaths stemming from chronic diseases that arise from changeable behaviors.  When the LWSD vision was developed, it was founded on the startling national statistic three behaviors (poor nutrition, lack of physical activity and tobacco use) were contributing to four diseases (heart disease/stroke, cancer, type-2 diabetes and respiratory conditions) that resulted in over 50% of the deaths in the nation. In San Diego County, these diseases were responsible for 57% of all deaths in 2007. Recognizing that county government could not solve this alone, LWSD is a vision for a region that through a collective impact model aligns the efforts of individuals, organizations, and government entities to ensure all residents are building better health, living safely and thriving. And as a result, since LWSD’s implementation we have reduced the four chronic disease deaths to under 50%.

Community work is complex, and its inherent tendency to work in silos leads to duplicated efforts. A key component to achieving the LWSD vision was partnerships. Since its inception, there are now nearly 520 recognized LWSD partners spanning a multitude of sectors. Leveraging these partnerships, community collaboratives were created to provide a central point for planning and organizing action. These groups, called LWSD Community Leadership Teams, bring together public health agencies, local governments, school districts, health care organizations and professionals, and community-based organizations to promote policy, environment and systems changes that create safe, healthy and equitable communities. These activities help to inform the regions’ Community Health Improvement Plan which details key priorities, strategies, resources, projects and programs that are leveraged.

For example, the LWSD South Region Leadership Team (SRLT) serves over a half million ethnically, linguistically, and socioeconomically diverse residents across a geographic region that includes the US-Mexico border with the busiest land border crossing along the Mexican border. With HHSA serving as the backbone, the stakeholders represent a wide variety of sectors, with many holding a rich history within the community. Their collaborative work was driven by the LWSD vision and rooted in the Five Areas of Influence (Health, Knowledge, Standard of Living, Community and Social). This team had a history of successful partnership and interventions including supporting several Resident Leadership Academy where residents are engaged in a curriculum-based model to develop grassroots community improvement projects.  SRLT’s success resulted in an appetite by others throughout the county to embrace and replicate their work in community excellence.

The Communities of Excellence (COE) 2026 Framework leverages principles of performance excellence of the Baldrige Performance Excellence Framework for high-performing organizations and applies them to communities. In 2017, the SRTL was selected as the first pilot community for the COE 2026. As such, it started with developing a community profile to better understand needs and identify strengths. Next, it established a systematic repeatable process to help the community form a strategic plan, communicate effectively, and obtain feedback. As an example, a focus on vaping and smoking prevention and secession has led to updated wellness policies from the largest cities and medical center in the community.

With the Coronavirus (COVID-19) pandemic in 2020, the experience using the COE framework positioned the SRLT to naturally approach this emergency through a collaborative and inclusive health equity lens. Work groups, and shared programs and services were temporarily placed on hold to focus on COVID-19 mitigation strategies.  During this time, the focus became the Framework for our Future COVID-19 Equitable, Data – Driven Response. Being agile, the team began efforts to inform the population of COVID-19 prevention guidelines, testing, and vaccination efforts through linguistic and culturally appropriate methods. Collaboration involved equitable approaches to non-pharmaceutical intervention education, COVID-19 sector guidelines, connecting residents to resources, contact tracer recruitment, and COVID-19 testing and vaccinations. Long standing relationships, previous collaboration, and established processes tested our agility and proved valuable to quickly shift focus, prioritize, and deploy new strategies.

As our region moves toward pandemic recovery, the value provided by the foundation of LWSD and COE could not be clearer.  Our experience with COE and Baldrige has allowed us to collectively and collaboratively succeed in reaching and helping our community at a time of great need to live well.

Live Well,

Nick Macchione