Category Archives: Public Health Departments
Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Azmina Lakhani, MD, MPH, about what helped lead her to the field and where she hopes to go from here.
NPH: What’s your educational background in public health?
Azmina Lakhani: I went to the Illinois Mathematics and Science Academy for high school, and then I did medical school, undergraduate and public health all at Northwestern University in Chicago. I received a BA in psychology and global health as an undergrad and then for the next five years I attended medical school and earned a Master’s in Public Health, as well.
NPH: This seems like something that you went into knowing full well that this is what you’re interested in. What was it that encouraged you to pursue a degree and a career in public health?
Lakhani: I had sort of been interested in health care in general in high school, and I wasn’t really sure whether I was going to do research or clinical work or public health work, but in college I really started becoming interested in public health. First through global health, I started learning about different health care systems abroad and doing some volunteer work in Ecuador and Mexico City. That’s really when I got interested in health care delivery systems and also how one can have a greater influence on health.
I appreciate the clinical side. I’m a family medicine resident in training currently, so I love working one-on-one with patients. I also see a lot of value in making an impact on a larger scale—whether that’s how someone gets their health care, what insurance systems we have in place, or the traditional public health things that you think of such as vaccines—that have a really large impact on people. But I think for a shorter answer to your question, I really got interested in college and then built on that in medical school while I was getting my MPH.
NPH: Within the field of public health, what’s your primary interest? What really speaks to you? The global approach?
Lakhani: I think public health is just so awesome because it has so many different facets, and to be honest, I don’t have one particular interest in terms of public health. During my year at the Chicago Department of Public Health (CDPH) I worked on a project called PlayStreets. It’s a very simple idea where we close down streets in the city—neighborhood streets—to allow children with little access to public spaces to have a place to play. The whole intent is to get people out there, meeting their community members, and, in the long term, trying to reduce childhood obesity. It’s kind of a lofty goal, but I am interested in making resources available to people so they can take control of their own health on a broader scale and PlayStreets was one example of that.
Job loss at local health departments continues unabated, according to the 2013 edition of the National Association of County and City Health Officials (NACCHO) Profile of Local health Departments. The total number of employees in local health departments has fallen to 162,000 last year from 190,000 in 2008.
However, the report also highlights program gains:
- Nearly half of health departments not yet accredited plan to apply, have submitted a formal application or have submitted a statement of intent to apply for public health accreditation from the Public Health Accreditation Board.
- The percentage of local health departments who have completed the three key accreditation prerequisites — community health assessment, community health improvement plans and an agency-wide strategic plan — has grown from 20 percent in 2010 to 30 percent in 2013.
- Facebook use has grown from 20 percent in 2010 to 44 percent last year.
- Twitter use has grown from 13 percent in 2010 to 18 percent last year.
- YouTube use has grown from 6 percent in 2010 to 12 percent last year.
- In 2013, 56 percent of local health departments were engaged in some type of quality improvement (QI) activity, up from 45 percent in 2010.
Infographics, public health news and innovative efforts to improve community health were the topics of the most widely read posts on NewPublicHealth this year.
Take a look back at our most popular posts:
- The Robert Wood Johnson Foundation’s Commission to Build a Healthier America will release new recommendations on early childhood education and improving community health on Monday January 13. Earlier this year, new city maps to illustrate the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.
- Three of the infographics created for the NewPublicHealth series on the National Prevention Strategy, a cross-federal agency emphasis on public health priorities, were among the most popular posts of 2013. Stable Jobs = Healthier Lives, the most widely viewed NPH infographic, tells a visual story about the role of employment in the health of our communities. One example: Laid-off workers are 54 percent more likely to have fair or poor health and 83 percent more likely to develop a stress-related health condition.
- Better Transportation =Healthier Lives, another 2013 infographic, tells a visual story about the role of transportation in the health of our communities. Consider this important piece of the infographic as we head into 2014: The risk of obesity increases 6 percent with every additional mile spent in the car, and decreases 5 percent with every kilometer walked.
- Top Five Things You Didn’t Know Could Spread Disease was the best read of the very well read stories on NewPublicHealth during Outbreak Week—an original series created by NPH to accompany the release in late December of Outbreaks: Protecting Americans from Infectious Disease, a pivotal report released by the Robert Wood Johnson Foundation and Trust for America’s Health.
- Better Education=Healthier Lives, another widely viewed—and shared—infographic on NewPublicHealth, shared the critical information that more education increases life span, decreases health risks such as heart disease and—for mothers who receive more years in school—increases the chance that her baby will die in infancy.
- How Healthy is Your County? In 2014 the Robert Wood Johnson Foundation will release the fifth County Health Rankings, a data set more and more communities rely on to see improvements—and room for change—in the health of their citizens. NewPublicHealth’s 2013 coverage of the County Health Rankings & Roadmaps included posts on the six communities that won the inaugural RWJF Roadmaps to Health Prize for their innovative strategies to create a culture of health by partnering across sectors in their communities.
- The Five Deadliest Outbreaks and Pandemics in History, was our seventh best read post of the year. Read it again and ask: Are we prepared as a nation for the next big outbreak?
- What does architecture have to do with public health? Visit the Apple Store in New York City’s SoHo neighborhood, Texas’ Red Swing project, or....view our post from earlier this year.
- Less than a month after the shootings in late 2012 at Sandy Hook elementary school in Connecticut, the Harvard School of Public Health held a live webcast town hall meeting on gun violence on the legal, political, and public health factors that could influence efforts to prevent gun massacres. And toward the end of 2013, NewPublicHealth sat down with former Surgeon General David Satcher, MD, MPH, to talk about the role of research in preventing gun violence.
- NewPublicHealth covered the release of a report by Trust for America’s Health that found that most states are not implementing enough proven strategies to prevent prescription drug abuse. But the year ended with some better news on the critical public health issue. An NPH news roundup post reported on a study funded by the National Institutes of Health which found that rates of prescription drug abuse by high school students have dropped slightly.
Close runners up included How Do You Transform a Community After a Century of Neglect?, which looked at how Bithlo, Fla. is working to bring much-needed services to its main street through the “Transformation Village” initiative, as well as ‘Unprecedented Destruction’: Ocean County Public Health Continues to Respond to Hurricane Sandy, which brought together a NewPublicHealth video and a Q&A to illustrate how public health officials and departments worked together to help their regions recover from the devastating superstorm. Also in the top 20 for year was an interview with New York State Health Commissioner Nirav R. Shah, MD, MPH, on the release of the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State.
When it comes to movies, sometimes the most realistic scenarios are also the scariest. The dramatic, often global and always fatal spread of infectious disease is now a well-worn movie trope—but because it could happen it remains scary every time. The good news (in addition to them just being movies, so no need to grip the theater armrest so hard!) is these silver screen attempts at showing the story behind the spread and containment of infectious disease help to highlight the importance of public health. Without the many integrated public health systems that touch our lives daily and protect us in emergency situations, we’d be much more susceptible to all the many types of outbreaks that plague Hollywood characters.
Well, maybe not all of them...
As part of Outbreak Week, we’ve compiled a list of some of the scariest outbreaks to terrify movie watchers. What do you think they got right? (And spoilers below...)
The scariest part of this outbreak is realizing how quickly disease can spread—and through interactions you may not even realize. It also highlights the wide range of reactions people can have to a disease spreading through a population. Several days pass before doctors and administrators at the U.S. Centers for Disease Control and Prevention realize the extent or gravity of this new infection. First they need to identify virus, then they can start working toward a means of combating it, a process that will likely take several months. As the contagion spreads to millions of people worldwide, people panic and society breaks down.
World War Z
A mysterious infection turns entire human populations into rampaging, mindless zombies. After barely escaping the chaos, United Nations Investigator Gerry Lane is persuaded to go on a mission to investigate the disease. What follows is a perilous global trek where Lane must brave horrific dangers and long odds to find answers before civilization falls. What at least the book gets right is the vast number of organizations and government groups that must come together to respond to an outbreak.
28 Days Later
How scary would it be to wake up after being in a month-long coma only to find your city completely deserted, with cars left empty and seemingly nothing but silence? One look at the film’s barren London streets will show you. Then think about how you’d feel if you found out that this emptiness was caused by rage virus-infected animals released by group of animal rights activists in protest of animals being used for medical research. And the virus was still out there...
An unknown virus wiped out five billion people in 1996. By 2035, only 1 percent of the population was still surviving, forced to live underground. A convict reluctantly volunteers to be sent back in time to 1996 to gather information about the origin of the epidemic (which he's told was spread by a mysterious "Army of the Twelve Monkeys") and locate the virus before it mutates, so that scientists from his time can study—and hopefully cure—the disease.
As a toxin begins to turn the residents of Ogden Marsh, Iowa into violent psychopaths, Sheriff David Dutton tries to make sense of the situation while he his wife, and two other unaffected townspeople band together in a fight for survival. Eventually military support is brought in to attempt to contain the outbreak.
(Image source: WikiCommons, Sailko)
It was 10 years ago that the Institute of Medicine Committee on Assuring the Health of the Public in the 21st Century's released a report calling for an accreditation process for the nation’s public health departments. That recommendation led to the creation of the Public Health Accreditation Board (PHAB), which earlier this year named the first eleven departments to receive accreditation—there are now 22 accredited health departments.
Writing in a special issue of the Journal of Public Health Management and Practice that is dedicated to public health accreditation, Kaye Bender, PhD, RN, FAAN, and Carole Moehrle, BSN, RN, looked back on the first year, how the inaugural departments were selected and how they see accreditation changing the public health landscape moving forward. Bender is PHAB’s president and CEO, and Moehrle is chair of its executive committee.
“The first year of realizing the goal of accredited health departments has been outstanding, not only from the standpoint of reaching that goal but also from the perspective of experiencing firsthand what the public health community across this country can do when we all work together on a common goal,” they wrote in the article, PHAB: Reflections From the First Year of Accreditation. “As the next years unfold and accreditation changes with the inevitable changes in the public health practice environment, these initial days will long be remembered for establishing a sound foundation upon which to build.
Writing in the same issue, Pamela Russo, MD, MPH, and Paul Kuehnert, DNP, RN, in their commentary, Accreditation: A Lever for Transformation of Public Health Practice, discussed the role that the Robert Wood Johnson Foundation and other organizations played in making accreditation a success. Accreditation, they wrote, is a way for a public health department to demonstrate to its community that it’s committed to accountable, transparent and quality care.
“Those who have perceived health departments as simply administrative sites for a collection of miscellaneous services are beginning to recognize that accredited health departments are mission-driven organizations of excellence that are implementing strategic plans to improve and protect the health of their communities,” wrote Russo and Kuehnert. “Accreditation is rapidly proving itself to be a powerful lever for the transformation of public health practice.”
>>Bonus content: RWJF Senior Program Officer Pamela Russo recently sat down for an interview on the National Association of County & City Health Officials (NACCHO) podcast. Listen to Russo discuss how local partnerships can contribute to and improve community health.
Earlier this week, the Robert Wood Johnson Foundation held its first ever “Culture of Health Hangout,” a new series meant to explore what communities across the country are doing to advance and transform public health. This first foray looked at how public health departments have evolved in recent years, and are continuing to evolve to meet the changing needs of the communities they serve. The panel was moderated by Paul Kuehnert, RWJF senior program officer and Public Health team director.
According to Muntu Davis, Public Health Director and County Health Officer of Alameda County, the core role of public health hasn’t really changed—public health departments and officials continue to gather and analyze data to explain what’s happening to the health of a community. However, what has changed is where they put their focus. Now, in health departments across the country, the focus is not simply on individual decisions, but on social and economic factors that dictate which options are truly available.
“Although it does boil down to an individual choice, if there’s no opportunity there for communities, then ‘health’ is definitely not an easy choice to make,” said Davis.
One of the more innovative approaches his health department has undertaken is utilizing maternal and child health workers to provide, in addition to their traditional work, financial coaching to people who may be of lower incomes. “Studies have shown link between income, wealth and life expectancy,” said Davis, and that’s what makes it important for public health to help support not just the immediate health need but also “the full picture of what might be shaping their health.” These workers are able to provide education and assistance, while also linking them to financial coaching and tools that can help them manage the money they have.
Karen DeSalvo, City of New Orleans Health Commissioner, spoke extensively on the importance of community partnerships when it comes to advancing community health. She said Hurricane Katrina was, in a way, a “catalyst for change” that enabled the entire community to hit the reset button, assess where they were and determine how best to move forward together. One of the first realizations was that the city simply did not have a strong enough local health department.
“It allowed us to begin planning, and to decide to move away from an expensive, hospital-based system to one that was more about prevention and primary care,” she said. “And over the course of years, once we stabilized that infrastructure at the frontline of primary care and moved more toward prevention, the glaring need to have a strong public health department became obvious.”
Watch the live event right here starting at noon EST.
Today at 12 p.m. EST the Robert Wood Johnson Foundation will hold its very first Culture of Health Hangout. The goal of the new Hangout Series is to explore exactly what we all need to do to create a culture of health—and to shine a spotlight on communities that are already on their way. Panelists will talk through some of the complex ways public health is transforming, while also sharing innovative ways that public health departments are stepping up to the challenge.
This first Hangout will discuss the role of public health departments in transforming community health. Topics to be covered include:
- How the role of public health departments has evolved in recent years, and how it could continue to transform in the future
- How the scope of public health department partners is changing over time, and why that kind of broad partnership across sectors is critical for public health
- The particular public health challenges in rural settings
The panelists will include: Jewel Mullen, Connecticut Department of Public Health Commissioner; Muntu Davis, Public Health Director and County Health Officer of Alameda County; Karen DeSalvo, City of New Orleans Health Commissioner; and Michael Meit, Co-Director of the NORC Walsh Center for Rural Health Analysis. Our moderator is Paul Kuehnert, RWJF senior program officer and Public Health team director.
In the face of health care reform, funding challenges, and increased collaboration, public health faces a promising yet unclear future in terms of both financial support and program reach. On Saturday, the Robert Wood Johnson Foundation co-hosted a forum with the American Public Health Association (APHA) in advance of the APHA 2013 Annual Meeting to discuss these issues – and more. Leading minds from the fields of public health, government and business met to get to the bottom of a crucial question: how do we move public health forward?
In the opening session, Paul Kuehnert, Director of the Public Health Team at the Robert Wood Johnson Foundation, explained that the field’s challenge lies in “skating where the puck is going to be.” APHA Executive Director Georges Benjamin echoed that sentiment, nothing that the forum was “an opportunity to figure out where the public is going and then, when the wave comes, be right there to catch it.” The ensuing breakout sessions furthered this overarching theme with panels that discussed both the challenges they’ve faced -- and the opportunities they’ve found for success.
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
Re-Thinking How We Pay for Public Health and Prevention
One panel discussed funding challenges that public health departments face and solutions that have been reached across the country. John Auerbach of Northeastern University’s Institute on Urban Health Research, and former health commissioner of Massachusetts, touched on health care reform as a vehicle for preventive care. “Nearly 75 percent of those insured in Massachusetts have had a preventive care visit in the last 12 months,” he explained. In other words, people who are insured are twice as likely to get care that could actually prevent them from getting sick, instead of having a treat a more serious illness. Auerbach also discussed development of the state’s Prevention and Wellness Trust Fund — a four-year, $60 million public health trust supported by a one-time assessment on health insurers and largest clinical providers. Auerbach stressed that this source of funding was important, particularly because it’s insulated from the variability of public funding and political tides.
By focusing on the critical services and programs that are truly necessary for the public health system to work, the Seattle and King County Health Department has developed a minimum package of public health services needed for all projects to success. David Fleming, Director and Health Officer in the Seattle/King County Health Department, and his staff determined the money needed to fund such a package in both per capita and overall costs. Washington State is now working with RWJF and other stakeholders to determine the feasibility of defining and costing these foundational services at the national level.
Since 2008, local health departments have cut nearly 44,000 jobs, according to a recent survey conducted by the National Association of County and City Health Officials. Although workforce losses and gains were roughly equal in 2012, 41 percent of local health departments nationwide experienced some type of reduction in workforce capacity and 48 percent of all local health departments reduced or eliminated services in at least one program area. Currently, local health departments reporting cuts still exceed the percentage of local health departments reporting budget increases.
California’s Napa County has dealt with its budget cuts by revamping its health department in order to continue to stay on mission.
“I think we've come out the other end of all this as a much stronger health department,” said Karen Smith, MD, MPH, Health Officer and Deputy Director for Public Health at Napa County Health and Human Services. “We moved from what I think of as an ‘old style’ [public health agency] to a department that focuses on our role as a convener/partner, providing expertise and leadership, and helping to craft policy.”
NewPublicHealth recently spoke with Smith about the methods Napa Public Health used—and that other departments might follow—to adapt and improve in the face of budget cuts.
NewPublicHealth: How have budget changes impacted your department over the last five to ten years?
Karen Smith: Napa Public Health started out with a lean health division for the size of the county compared to some of our colleagues, and we remain lean. We have not really decreased services, however. We were able to get out ahead when we saw looming budget constraints.
Napa Public Health is part of the County’s Health and Human Service Agency, which includes social services, as well as mental health, drug and alcohol, child welfare services, comprehensive services for older adults and public health, and our administrative divisions. The previous director had a distinctive approach to budgeting: that the agency has a bottom-line budget and within that we have very detailed division budgets. So I have excruciatingly detailed budgets for every single program within public health, and that was crucial to our being able to respond to the budget shortfalls in creative ways that had limited impact on services.
GUEST POST by Lisa Junker, CAE, Director of Communications at the Association of State and Territorial Health Officials (ASTHO).
The United States is facing a “perfect storm of vulnerability,” said U.S. Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, MPH, yesterday at the 2013 Annual Meeting of the Association of State and Territorial Health Officials (ASTHO)—and state and local public health officials are on the front line of defense.
Frieden began his remarks by encouraging his listeners to “go back to first principles” and keep in mind the first priority of government, which is to keep people safe.
“If the government can’t keep people safe, whether it’s the police or us in public health, we are failing at our number-one responsibility to the public,” Frieden said.
And to keep the U.S. population safe today, public health officials have to keep their eyes open for threats arriving from outside our borders. Infectious diseases, drug resistance, new pathogens, intentional engineering of microbes, and globalization of travel, food and medicines: “If there’s a blind spot anywhere, we’re at risk everywhere,” Frieden emphasized.
He also focused on CDC’s partnership with state and local public health, even during the current tight fiscal atmosphere.
“Overall, our approach has been to double down on support for the front lines [state and local health agencies],” he said. “We all are in this together…We have lots of problems and lots of opportunities, and the more effectively we are connected, the more effectively we can address these opportunities.”