Jul 20 2011
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NewPublicHealth Q&A: Judith Monroe

file Judith Monroe of CDC

Do you work in a local health department? Please share stories from your departments here with the Robert Wood Johnson Foundation.

Judith Monroe, M.D., F.A.A. P., Deputy Director of the Office for State, Tribal, Local and Territorial Support (OSTLTS) at the Centers for Disease Control and Prevention, will be speaking about the Patient Protection and Affordable Care Act at the opening session of NACCHO Annual 2011. NewPublicHealth spoke with Dr. Monroe about the strategies the CDC and health departments are implementing to address the challenges and opportunities they’re facing.

NewPublicHealth: Among the budget cuts health departments have had to face, are cuts from CDC. How are you helping states do more with less?

Dr. Monroe: CDC is tightening its own belt so we have to look at any inefficiencies in how we’ve done funding in the past in order to preserve funding to the field. The CDC was cut by $740 million – that’s the lowest budget we’ve had since 2003, and that impacts health departments. But now when we look at funding requests, we’re asking if we’re following the evidence and seeing if the money that went out the door is being allocated as efficiently as it can be.

We’ve been thinking through how to help states. We have an advisory group that includes the leadership of NACCHO and ASTHO (Association of State and Territorial Health Officials) that has become in many ways our think tank about how CDC can improve how it helps health departments. OSTLTS is a connector and it’s our job to connect the best practices.

NPH: What are examples of innovations you’ve heard about from health departments?

Dr. Monroe: One of the things I’m always inspired by is the innovation and resourcefulness of folks in public health. In New Orleans, under the new leadership of Karen DeSalvo, the health department is aligning resources from federal and city sources. And some of the transformation there is moving away from clinical care, and focusing on core public health. And the budget cuts have given us the opportunity to do that, which we should be doing even if the economy were doing fine. And technology is being used as an innovation tool in many departments. In Multnomah County, Ore., the president of NACCHO, Lillian Shirley has replaced some home visits with videoconferencing.

Cross cutting work among agencies is also key. CDC has implemented a grant focusing on performance improvement and quality improvement, with an eye on public health accreditation, which gives departments resources to do cross cutting work. And this is the first such grant. It gives the performance improvement manager a say in what can be done differently. Some departments are also looking at what measures we’re using and how we can improve those.

NPH: What are innovations you’ve been able to launch at OSTLTS?

Dr. Monroe:

--We’ve created relationships across CDC which helps our work in being the bridge between CDC and the health departments.

--We have a monthly call with health directors about the Vital Signs health indicators report released each month. We highlight two health departments and talk about how they’ve dealt with a Vital Signs issue such as infant mortality so that we can all learn from each other. The discussion revolves around who led the effort and what changes occurred.

--Did You Know is a new communications tool from CDC that focuses on one topic to get information into the field, such as HIV.

--Have You Heard is a new communications tool that just launched last week, focusing on facts from the field. The first was on the economic hits departments are facing. We are charging health departments with feeding it. It’s now monthly but can go to weekly. We want to highlight what’s successful but also what hasn’t worked as well and even failures, which present a learning opportunity.

NPH: How can health departments be more collaborative on the ground?

Dr. Monroe: We need to start by listening to a broad base including constituents and legislators. And we need to use stories to get our points across. Stories are entertaining but they also help us remember. I taught in a residency program years ago and told stories about health care delivery in Appalachia where I worked. The course was about being a rural physician. Years later, students who were in those classes can recall specific details of what I said. It’s the power of stories that hit the heart as well as the mind. But start by listening because that is how we build trust.

>>Share your story here on the great work that you’ve been doing .

>>Watch “We Need Everyone at the Table” about Dr. Monroe’s work as a health director in Indiana.

Tags: Accreditation, Centers for Disease Control and Prevention, NACCHO, Public Health Departments, Public health, Public health agencies, Q&A