Category Archives: Public Health Departments
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.”
Public health institutions across the country are joining the 10.5 million users on the virtual pinboard website, Pinterest, to share important health information and images. Topics such as women’s health, healthy living, emergency preparedness and public health history are a few of the boards on the CDCgov page. Harvard School of Public Health focuses more on healthy eating, recommended readings and inspirational quotes. Users are able to categorize topics and pictures anyway they want, allowing every institute’s page to be unique.
Users of the online scrapbook view content, “re-pin” photos to their pages, add comments to images and “like” user’s content. Pages encourage users to leave comments on the images that they like most or would like to see more of. Pinterest is the third-fastest growing social network, with 80 percent of users being women and 50 percent mothers, according to TechCrunch. The site is another way for public health professionals to stay at the center of the public health conversation and interact with their key audience on the most recent public health issues. The dissemination of information continues to grow as more people participate in the sorting, collecting and sharing of public health information.
Take a look at some of the other public health institutions that are joining Pinterest: American Public Health Association (APHA), Ohio State's College of Public Health and Association of Public Health Laboratories (APHL).
Public health department accreditation is a key topic on the Association of State and Territorial Health Officials (ASTHO) annual meeting agenda this year. John Wiesman, DrPH, MPH, Secretary of Health for the state of Washington, will participate in a discussion on the issue during the meeting. He speaks with authority, as Washington, along with Oklahoma, is one of only two states recently accredited by the Public Health Accreditation Board.
>>Follow our ASTHO Annual Meeting coverage throughout the week.
In advance of the meeting, NewPublicHealth spoke with Wiesman about the benefits of accreditation to public health departments and the communities they serve.
NewPublicHealth: What are benefits of public health accreditation to share with directors of state health departments who have not yet applied for the credential?
John Wiesman: Honestly, I think accreditation gives you bragging rights in the sense that you’re saying “our organization values quality and outcomes.” For example, you can add that to a grant for a question that asks about quality processes. That states your commitment and that a national organization found that to be true. And it gives you bragging rights with fellow cabinet officers and the governor. To be able to say you are an accredited health department means something and you can value that.
Another critical thing is that for the local public health agencies in your state, the process of going through accreditation and developing a state health improvement plan gives you an opportunity to talk about how you want to improve health in your state and get everyone on the same page. So it’s a way to build relationships with health departments in the state and showcase priorities you want to work on together. In that sense, the process of applying for accreditation goes a very long way.
NPH: What benefit has the state health department accreditation brought to local health departments in your state who are considering applying for the credential?
Wiesman: We have learning collaborative in the state as well as some grants that allow us to work with local health departments on quality improvement to become accreditation-ready. And by having gone through the accreditation process ourselves as a state health department, we bring added credibility to the table and can answer many of their questions, and our firsthand experience gives things more meaning. I think it’s absolutely important for state health departments to become accredited if you want others to do that as well.
For the last several years there’s been a bit of a tradition at the annual meeting of the Association of State and Territorial Health Officials (ASTHO), with the incoming president introducing a year-long “President's Challenge” to focus the attention of state health officers on a critical national public health issue.
José Montero, MD, outgoing president of ASTHO and director of the New Hampshire Department of Health and Human Services, chose the reintegration of public health and health care. The starting point for the challenge was a report by the Institute of Medicine, Primary Care and Public Health: Exploring Integration to Improve Population Health. In his announcement, Montero emphasized the need to take a systems approach to health care transformation in order to achieve lasting improvements in population health.
Throughout the past year, both state health departments and other public health organizations have added their integration projects to a project list maintained by ASTHO. This includes the State of New Hampshire Department of Public Health, which has collaborated with a community health center network and others to use electronic health records to link providers and tobacco quitline services, with the goal of cutting smoking rates.
>>Follow our ASTHO Annual Meeting coverage throughout the week.
Just ahead of the 2013 ASTHO annual meeting, NewPublicHealth spoke with Montero about the importance of the challenge he put forward for his fellow state health officers and next steps.
NewPublicHealth: What participation have you seen by the state health departments in your President's Challenge on reintegration of public health and health care?
José Montero: The specific metric that I used was to have states and the District of Columbia send stories that illustrate levels of partnership and integration. During the past year, the visibility of the topic has grown dramatically. In addition, ASTHO has an ongoing partnership that has brought together more than 50 different organizations for the same purpose. We meet regularly, working together on how to advance the agenda of better coordination and integration, and every day we identify new people who want to participate, and I think that has been an amazing result. I don’t want to claim that all of this is because of the ASTHO initiative. There were a lot of things that were out there already. But this was a timely call, and all of those who were working on it are joining efforts to make it happen.
The annual meeting of the Association of State and Territorial Health Officials (ASTHO) begins tomorrow in Orlando, Florida. Attendees at the ASTHO annual meeting head to the same sessions and listen to the same speakers over three days, which helps create a common fluency with critical public health issues. It also creates cohesion among state health officers, who often work with each other during public health crises and learn from each others’ successful approaches to dilemmas such as budget cuts and entrenched chronic disease.
>>Follow our ASTHO Annual Meeting coverage throughout the week.
Ahead of the meeting, NewPublicHealth spoke with ASTHO’s long-time executive director, Paul Jarris, MD, about the key issues participants will engage in during the 2013 ASTHO meeting.
NewPublicHealth: What are key themes at this year’s annual meeting?
Dr. Paul Jarris: There are a number of major health issues on the agenda for the conference, including an update on Healthy Babies are Worth the Wait, last year’s ASTHO presidential challenge. Together with the Health Resource Services Administration (HRSA) there’s an intention to roll out Healthy Babies learning collaboratives across the country, and we’ll be sharing successes of the initiative from the past year.
Another major area we’ll be talking about will be the reintegration of public health and health care. A lot of this work has been outgoing ASTHO president Dr. Jose Montero’s presidential challenge for the last year, and there’s been a lot of work going on, including the development of a national collaborative between public health and primary care that ASTHO is supporting. The collaborative involves more than 50 different health care and public health organizations, brought together for the purposes of improving the population’s health.
Incoming president Terry Cline will launch his Presidential Challenge, a major initiative on prescription drug abuse and misuse and overdose. There are more people who die from prescription drug overdose than from motor vehicle accidents in this country—and there’s much that can be done about it. We’ll also have the leadership from the Office of National Drug Control Policy speaking on this critical issue.
The annual meeting of the Association of State and Territorial Health Officials (ASTHO) begins next week in Orlando, Fla., bringing together state health officials and other leaders to talk about the latest critical issues around public health in the United States. NewPublicHealth will be on the ground throughout the meeting covering workshops, sessions and keynote speeches, as well as speaking with program speakers and conference attendees.
Discussions will highlight ways to integrate and coordinate health care and public health, including new opportunities under the Affordable Care Act. We will also explore the new ASTHO President's Challenge around preventing prescription drug abuse, check in on efforts around healthy babies and more. Coverage will also include interviews with thought leaders including Paul Jarris, Terry Cline, José Montero and John Wiesman.
A review of a recent economic surveillance survey by the National Association of County and City Health Officials (NACCHO) finds that despite modest improvement, local health departments in the United States are still struggling to recover from the recent recession. NACCHO administered the survey as part of the National Profile of Local Health Departments in 2012, prior to the 2013 sequester cuts.
Just under 80 percent of the 2,700 local health departments in the country responded to the survey, which included questions about budgets, staffing and program cuts. Close to half of the health departments responding to the survey reported reductions in, or elimination of, services in at least one health department program area for last year, and 27 percent reported budget cuts. Analysis of the survey results also found that local health departments lost 43,900 jobs through layoffs or attrition since 2008. While positions remained stable last year, many local health departments have been unable to fill positions that were cut in previous years.
The survey also found that certain program areas have been especially hard hit by budget cuts, including immunization (22 percent of local health departments faced cuts ); emergency preparedness (15 percent); and maternal and child health (15 percent).
“While workforce reductions and program cuts may have slowed in some areas of the country in 2012, on the whole, the budgets of our nation’s local health departments are not keeping pace with the general recovery,” said NACCHO Executive Director Robert M. Pestronk. “In fact,” added Pestronk, who previously served as the director of Genesee County health department in Michigan, “continuing annual draconian cuts associated with sequestration will further erode local health departments’ capacity to serve and respond. If keeping people healthy and safe is a priority, then we should rebuild local response capacity and health security, not keep cutting it.”
Examples of the impact budget cuts have had on health departments include:
- The Boston Public Health Commission (BPHC) was forced to limit its support of prenatal care services due to a five percent cut in federal funds for the Healthy Start Initiative. Other cuts resulted in the Health Commission losing community health worker positions that provided home visits to young families; case management for children and teens at risk of truancy; and services at school-based health centers.
- Because of statewide budget cuts to local health departments in Maryland in 2009, the state’s Frederick County Health Department eliminated a third of its nursing positions. Before those cuts that health department held three flu clinics simultaneously, but now supports one clinic at a time, which has reduced the number of residents getting vaccines and keeps the department from achieving its public health emergency preparedness goals.
>>Read NACCHO's release on the new survey.
New York City is currently developing a pilot public health program known as NYC Macroscope — the first domestic effort to aggregate electronic health record (EHR) data into a surveillance tool to inform public health decisions. The population health surveillance system will compile electronic health records from primary care practices to help city health officials monitor—and respond to—the real-time prevalence of conditions that impact public health. The project is the result of a partnership between the New York City Health Department and the CUNY School of Public Health, with support from the Robert Wood Johnson Foundation’s Pioneer Portfolio, and additional support from the de Beaumont Foundation, Robin Hood and the New York State Health Foundation.
NewPublicHealth spoke with Carolyn Greene, MD, Deputy Commissioner of the NYC Department of Health and Mental Hygiene’s Division of Epidemiology, about the plans and goals for the program.
NewPublicHealth: Tell us about NYC Macroscope and how it will work.
Carolyn Greene: NYC Macroscope is going to be New York City’s first electronic health record surveillance system. We have a program here at the health department called Primary Care Information Project (PCIP), and it’s one of the nation’s largest distributed electronic health record networks. PCIP began in 2005. It concentrated on primary care practices in high need areas where the Health Department really wanted to encourage providers to use electronic health records. The program has been extremely successful and they’ve completed many different activities to improve the quality of clinical care.
But in recent years, we’ve been asking the question: Can we use electronic health records for more than just patient care? Can we, in fact, use electronic health records to monitor the health of the population? Here at the Health Department, we have many different ways to conduct population health surveillance. We have surveys that we conduct by telephone, we have disease registries that we host, and we have our vital statistics registry on deaths and births. All these data are very important. But they are costly, resource-intensive and they often have a time lag from when the data are collected to when we can actually find the results from the data, so the advantages of an electronic health record surveillance system are many.
One advantage is that the architecture is already there. If you already have the electronic health records in place, you don’t have to find additional resources to collect the data because you’re already collecting the data through the EHR architecture. Other advantages are that potentially you can collect data in real time and potentially at low cost.
NPH: Do you see any potential disadvantages?
Greene: I think the first one is we always have to ask how representative the data will be in terms of representing the population as a whole. First of all, electronic health records only collect data on people who are in care and, because sicker patients go to the doctor more frequently, there’s a greater likelihood that we may be picking up more information on sicker patients. So we have questions about how representative are the data.