Health & Human Services,
Public Sector,
Chief Growth Officer
In 2008, Walt Ekard, the Chief Administrative Officer for San Diego County, asked Nick Macchione, the newly-promoted director of the county’s Health and Human Services Agency, to address a complex and significant question: “How do we help San Diego become a healthier region for the entire county, representing more than three million residents?” Macchione responded by engaging his staff and an array of county, city, and community partners to develop a health strategy, which elected officials used as a launching point for what would become Live Well San Diego, a multi-pronged “vision for a region that is building better health, living safely, and thriving.” To achieve these goals, the county team planned to employ a variety of core strategies, including strengthening the service delivery system, effecting policy and environmental change, supporting positive choices, and improving the culture from within one’s organization. They also identified areas of influence (e.g., health and knowledge) to be measured by a set of key indicators. Above all, the fate of this initiative would hinge on the ability of the county team to establish trust and build an ecosystem that spanned organizational and jurisdictional boundaries, moving beyond politics. Macchione emphasized, “It’s about relationships. It’s about beliefs. It’s about integrity. It’s about legitimacy. It’s all about improving lives.”