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NewPublicHealth launched just over a year ago, as an online destination for information and discussion about public health. We've seen a strong audience of public health practitioners and beyond coalesce around the content, which includes daily news roundups, Q&As with individuals working on the front lines of public health and coverage of critical conferences in public health and beyond, such as this year's Keeneland Conference, the inaugural Health Impact Assessment Meeting and New Partners for Smart Growth.
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Last week’s Keeneland Conference included a session that looked at research in the area of law and legal process. The session was moderated by Scott Burris, JD, director of Public Health Law Research, a program of the Robert Wood Johnson Foundation, based at Temple University.
Burris noted several key presentations during the conference including one by Julia Costich, JD, PhD, who is an associate professor in the Department of Health Services Management at the University Of Kentucky College Of Public Health. Costich presented on the importance of how health agencies enforce the power they have. Burris says there is a huge body of literature from regulatory and governance sources on how effective regulators regulate—and that public health is only beginning to draw on. “That’s really opening a big important door, and we’ll see a lot more about that in future years.”
Jennifer Ibrahim, PhD, MPH, an associate professor of public health at Temple University, looked at how law is being figured out at the local level. Burris said that researchers both at the Public Health Law Research Program and collaborators have conducted research on the relationship between state and local health officers and their lawyers.
National Public Health Accreditation launched last fall, and since then 64 local health departments, three tribal health departments and one state department have submitted applications to the National Public Health Accreditation Board (PHAB). Carol Moehrle, chair of PHAB and director of public health for the Idaho North Central District, spoke about the accreditation process and benefits during a keynote speech at the Keeneland Conference. NewPublicHealth caught up with Carol Moehrle during the meeting.
NewPublicHealth: Are you pleased with the number of applicants you’ve seen so far?
Carol Moehrle: We are pleased. We knew we’d have some early adopters. And to have 68 complete their applications with the last seven months, that’s a great start. We’ve got a long way ahead, but we also know we have many applicants in the queue waiting to apply. We’re hearing lots of good energy, and departments beginning the process now can look to the earlier applicants for best practices, so applying will be easier as time goes on.
NPH: What is the process and timetable for accreditation application review?
Richard J. Umbdenstock, American Hospital Association: Opportunities for Collaboration Between Health and Health Care
The intersection of health and health care was an important theme at this year’s Keeneland Conference—during sessions on recent IOM reports, in hallway conversations, in discussions of Public Health Services and Systems Research that explores the most efficient ways to deliver public health services, and, notably, during the keynote address by Richard Umbdenstock, president and CEO of the American Hospital Association.
In his presentation, Umbdenstock talked about hospitals and public health, "collaborating for communities," and said that as health care providers, hospitals had tended to focus on treating the individual, rather than on prevention for the population. Now, he said, the money is gone and the public cares more about health, meaning it makes less and less sense for either hospitals or public health to be concerned with protecting their turf. “We need to incent health and deglamourize consumption.” Quoting a colleague, Umbdenstock said “what we need to do is create an epidemic of health.”
Umbdenstock spoke frankly when he told the attendees, “hospitals want to improve the lives of their patients, and not just their health care. Rather than wait for an [hospital] admission that won’t be paid, they’d rather get upstream on primary care.”
“Public health departments must be funded and supported so that wellness and prevention touches all and there are enough resources to do that,” said Umbdenstock. “And this is where research can play a big part—collaborative health research. We need to know the most effective collaborative models and the most effective ways to advocate for greater personal and community responsibility.”
NewPublicHealth caught up with Richard Umbdenstock following his talk.
NewPublicHealth: What are you hearing from hospitals about the new IRS community benefit requirement?
Richard Umbdenstock: Some hospitals have had similar responsibilities at the state level and many have had to put out accountability reports to their communities, so for many it’s not a new concept. In addition, hospitals have long been under a microscope and they also understand that community benefit is a wonderful community education tool. If they can tell it in a clear and consistent fashion, there’s a real opportunity for the public to better understand what hospitals and public health departments do.
NPH: Do hospitals and public health understand the critical community roles each one plays?
Richard Umbdenstock: I don’t think there’s any question what public health departments do after you’ve see them spring into action after a disaster, just as a lot of people don’t value what hospitals do until after they’ve been a patient. On a day-to-day basis we can all get so deep in our work that we just don’t see what the other person is doing. What we’re learning is that we all serve the same person.
In 2009, the Robert Wood Johnson Foundation, requested the Institute of Medicine (IOM) to convene a committee to consider three major topics in public health: measurement, law and policy, and funding. The last of these reports, which recommends new health targets and changes in how public health is funded and organized, was released last week and has been a key topic of discussion at this week’s Keeneland Conference.
Harvey Fineberg, MD, president of the IOM, delivered a keynote address on these three reports, as well as another recent report on the potential for collaboration between public health and primary care. NewPublicHealth spoke to Dr. Fineberg about the reports and next steps.
>>We're on the ground in Kentucky all week. Follow our coverage for the latest news.
NewPublicHealth: How will the findings from the three-report series on public health be helpful to public health service delivery going forward?
Dr. Harvey Fineberg: I think of these reports as the contemporary trilogy of public health. They each stand on its own and yet are also connected in a vital way.
The first report looks at how we can know where we stand in public health. It emphasizes the importance of a standard core set of indicators. The aim is to make them a guide for policy and practice of public health, and to monitor where we are and what needs to be done.
The second report was on the legal foundation that provides the authority for health agencies to protect the public’s health. It turns out that many of the statutes have been on the books for decades and don’t necessarily have the specifics for dealing with contemporary needs such as the challenge of dealing with obesity or emerging infectious diseases or bioterrorism. The report pointed to the ten essential services of public health which set a standard of practice, and spoke to what state laws would be needed to make the ten core functions operable.
The third report dealt with essentially the resources that would be needed to carry out public health services. And the committee found that we grossly under-invest in public health. They recommended a conservative estimate of doubling the national investment and proposed a fee on dollars that flow through the medical system to be captured and reinvested in prevention, which they said would ultimately protect and improve health.
NPH: How important was the evidence base to the committee in producing the reports?
Debra Joy Pérez, MA, MPA, PhD, assistant vice president for Research and Evaluation at the Robert Wood Johnson Foundation, was a keynote speaker at the Keeneland Conference yesterday and spoke about the evolution of public health services and systems research (PHSSR). NewPublicHealth asked Debra Pérez about that evolution.
>>Follow our continuing coverage of the Keeneland Conference.
NPH: Why is the field of PHSSR a priority for the Robert Wood Johnson Foundation?
Debra Pérez: Right now, I think more than ever we need evidence to provide decision-makers with the evidence for how best to apply limited resources. We know in the last year alone over 40,000 public health jobs were eliminated, so that means that health departments are struggling with staffing and infrastructure issues, and they need evidence to help them best apply the limited resources they have now.
NewPublicHealth: What’s the scope of the conference this year compared to previous years?
The annual Keeneland Conference kicked off today, where more than 300 public health services and systems researchers (PHSSR), public health officials and policy-makers have convened to discuss the latest issues in this growing field of research. PHSSR is aimed at establishing an evidence base to allow public health officials to make smarter, more-informed decisions with regard to resource allocation, staffing, operations and service provision.
NewPublicHealth is on the ground in Kentucky to capture the critical conversations and Q&As from leaders in the field. We spoke with F. Douglas Scutchfield, MD, director of the National Coordinating Center for PHSSR and the Peter Bosomworth endowed faculty in the University of Kentucky College of Public Health, to get his take on where the PHSSR field stands and the anticipated highlights of conference.
NewPublicHealth: What are the critical areas for public health as you head into the Keeneland Conference?
Dr. Scutchfield: I think there are several agendas that will be a backdrop against which Keeneland is taking place. One is a reformed healthcare system, with the Affordable Care Act and its implications for public health and public health’s relations with a variety of other service delivery systems, such as primary care and hospitals.
We will also see the rollout of a new research agenda, published as a supplement to the American Journal of Preventive Medicine,that will give us a new direction to pursue in terms of how we’re going to begin to try improving the infrastructure in the public health system.
NPH: What has been your sense in speaking with colleagues in the field about what kind of research is most in demand for public health leaders and decision-makers right now?
Public health departments have always been on the frontlines of keeping people safe and healthy. But given budget realities, how can they do more with less? And where should they invest to make the most dramatic improvements in people’s health?
The annual Keeneland Conference, which focuses on the increasingly critical field of public health services and systems research (PHSSR), begins today in Lexington, Ky., hosted by the National Coordinating Center for Public Health Services and Systems Research at the University of Kentucky College of Public Health and the Robert Wood Johnson Foundation, and will bring together leading researchers and public health professionals to help begin to answer those questions and more.
This year’s conference features speakers and researchers from across many health and public health fields including Harvey Fineberg, MD, president of the Institute of Medicine, Thomas Frieden, MD, director of the Centers for Disease Control and Prevention, Richard J. Umbdenstock, president and CEO of the American Hospital Association, Ms. Carole Moehrle, chair of the board of directors of the Public Health Accreditation Board.
Key topics at this year’s meeting include the PHSSR research agenda, in development for several years by dozens of contributors from across public health, which Debra Joy Pérez, MA, MPA, PhD, assistant vice president for Research and Evaluation of the Robert Wood Johnson Foundation, will announce during the Keeneland Conference; as well as an introduction to Frontiers, a new online PHSSR journal.
Among several important plenary sessions is one on recent Institute of Medicine recommendations on public health financing and the alignment of primary care and public health. Glen Mays, MPH, PhD, professor at the University of Kentucky, will talk about financing, and Lloyd Michener, chair of the department of family and community health at the Duke University School of Medicine, will talk about primary care and public health. Additional participants during those sessions include Robert Pestronk, executive director of the National Association of County and City Health Officials, Paul Jarris, MD, executive director of the Association of State and Territorial Health Officials, and Judith Monroe, MD, director of the Office for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention.
NewPublicHealth is on the ground in Lexington. Follow our coverage of sessions and plenaries as well as interviews with many conference participants including Debra Perez, Richard Umbdenstock, Professor Douglas Scutchfield of the University of Kentucky, Professor Glen Mays and Dr. Fineberg.
Follow the conversation on Twitter at #PHSSRKC12.
Weigh In: Are you tweeting from Keeneland? Let us know!
For the fifth year, close to 400 researchers, practitioners and policymakers will come together in Lexington, Ky., to share innovative ideas on how to improve the public health system. The conference will take place April 17 to April 19, 2012, and will continue the conversation on the impact of specific public health strategies on the quality and performance of the United States public health infrastructure. The conference also provides an opportunity to share new research that will allow decision-makers to more efficiently use scarce resources to organize, finance and deliver services through the public health system.
Speakers at this year's conference include Harvey Fineberg, MD, MPP, PhD, President of the Institute of Medicine and Thomas Frieden, MD, MPH, Director of the Centers for Disease Control and Prevention.
The call for abstracts is open now through January 9, 2012 at 3 p.m. ET. Questions regarding submission guidelines should be sent to the national program office (email abstracts@publichealthsystems. org).
Learn more about the Keeneland 2012 Conference.
>>Read more about public health services and systems research.
Faces of Public Health is a recurring editorial series on NewPublicHealth featuring individuals working on the front lines of public health and helping keep people healthy and safe. Today’s profile features Danielle Varda, Assistant Professor at the School of Public Affairs, University of Colorado Denver.
Danielle Varda has developed a unique — and potent — public health tool: a software program called PARTNER (Program to Analyze, Record and Track Networks to Enhance Relationships), which demonstrates the progress and benefits of collaboration to funders and others involved in public health services and systems (PHSSR) projects.
“Existing tools were insufficient to measure the effectiveness of collaboration,” says Varda, an Assistant Professor at the School of Public Affairs at the University of Colorado Denver and a guest lecturer at the Colorado School of Public Health in the Department of Health Systems, Management & Policy.
Varda says that stakeholders and funders want public health departments to collaborate with partners such as departments of education and the business community.
“So much of what is happening in public health is happening in a systems framework, so it’s important that everything is interconnected,” says Varda.
Working across boundaries by collaborating in social, political and economic domains brings tremendous value to health departments.
“Traditionally the goal in hiring people in health departments was to find staff with lots of knowledge,” says Varda. “Now an additional key goal is to also hire people who know how to find knowledge, because what you need to know will often be beyond your own specific discipline. It’s a key core competency to be able to find resources and to leverage those resources. That brings a new layer of what’s possible in public health.”
The software program, which the Colorado Department of Public Health and Environment recently used for a social network analysis for a coalition of public health teams, works on the assumption that partnerships and collaborations leads to improved outcomes.
At the 2011 Keeneland PHSSR Conference, held recently in Lexington, Ky., Varda presented PARTNER-derived data on twelve communities. The study looked at factors that contribute to successful collaboration — paying specific attention to how trust and the value that a partner might bring to a collaboration affects outcome.
“We showed that health departments are quite trusting of their partners — such as education and police departments — and that may be because public health is accepting of this shift, of needing partners,” Varda says.
As budget cuts continue at health departments across the country, Varda expects collaboration to be even more important — and for the PARTNER software to be a critical tool.
Editor’s Note: Danielle Varda has received a grant from the Robert Wood Johnson Foundation for work on the PARTNER software program.