NewPublicHealth is speaking with directors of several health departments who recently were accredited by the Public Health Accreditation Board. Eleven health departments received the credential so far. We recently spoke with Mary Selecky, director of the Washington State health department, one of the first two state health agencies receive national accreditation status. Ms. Selecky recently announced her plans to retire from the health department.

>>Also read our interview with Terry Cline, health commissioner of Oklahoma, which also was recently accredited by PHAB.

NPH: How do you think accreditation will improve delivery of public health services and care in Washington State? Now that the health department is accredited, do you feel as though you are leaving the department in even better shape than it was?

Mary Selecky: Accreditation is really a quality improvement tool, and the standards that have been set by the Public Health Accreditation Board force you to examine whether you have the right processes in place for continuous, sustained quality improvement. And if you have found that you are not quite up to par in an area, then the processes help you ask what you will do to improve your performance in that area? The process helps you increase your performance, your effectiveness, and your accountability.

Public health touches people every single day—everybody in the state, from the moment they get up until they go to bed at night and even while they’re sleeping. This credential shows us that we have effective programs and measures in place to meet the needs of our communities. Drinking water systems are a good example. We regulate 16,000 drinking water systems, and I have a lot of drinking water engineers who are out in communities checking on water systems. I have to know that they’ve got a common set of operating procedures to assure the public that we’re looking out for their interests and when they turn on their tap from a municipal water system, that the water’s safe to drink. You can only do that when you have some procedures in place and that goes for the engineers, for laboratories or programs to make sure they are operating well in the community. Accreditation touches every part of the department.

NPH: How will you be promoting and explaining accreditation to policymakers?  

During opening remarks at this year’s Keeneland Conference, hosted by the National Coordinating Center for Public Health Systems and Services Research (PHSSR) based at the University of Kentucky in Lexington, Professor Douglas Scutchfield, director of the Center, proudly announced that three of the first health departments to be accredited by the Public Health Accreditation Board (PHAB) earlier this year were in Kentucky. Accreditation had its own track during the conference scientific sessions, including a presentation from Jessica Kronstadt, MPP, PHAB’s director of research and evaluation.

NewPublicHealth caught up with Kronstadt to talk about her presentation on some very early findings from an internal evaluation of the accreditation process.

>>Read more on national public health department accreditation.

NewPublicHealth: What information is PHAB seeking to gain from an evaluation of the accreditation process?

Jessica Kronstadt: Just as we’re asking health departments to engage in quality improvement, PHAB is very much committed to engaging in quality improvement of the accreditation program. So these evaluation efforts will really help us understand what is working well in our accreditation program, and what the experience was like from the perspective of the health departments and the site visitors. This evaluation will allow us to continue to improve the accreditation process.

The last session of the Keeneland Conference focused on translation and dissemination of public health systems and services research, with the critical goal of more efficient and effective delivery of public health services and improving population health. NewPublicHealth spoke with Ross Brownson, PhD, of the Prevention Research Center at Washington University in St. Louis. Dr. Brownson has received funding from the Robert Wood Johnson Foundation to explore evidence-based decision making at local health departments.

NewPublicHealth: How far back does evidence-based public health go?

Ross Brownson: The formal underpinnings of evidence-based public health were developed in the late 1990s, so at least the formal literature has been around for probably about 15 years. Of course, research on effective interventions has been around for many more decades. The newer field of public health services and systems research is much newer, just within the last five years or so, and these different bodies of research are now converging.

The early research focused a lot on identifying evidence-based interventions. The newer research is more on the process of evidence-based public health—regardless of the intervention, how do you develop and implement an evidence-based health department?

We identified five domains that are really important:

• leadership of the agency;
• ability to develop, formalize and maintain good partnerships within the community;
• workforce training and development;
• focus on organizational climate and culture; and
• effective financial and budgeting processes.

The ultimate goal is to make the population healthier and we know that the way to improve the overall health of the public is largely through state and local governmental public health. To reach that ultimate goal you want to have the most effective health department possible and also make the most efficient use of resources. We’re always in a time of tight resources, but probably now more than ever. That calls on us to be as effective and efficient as we can be in the delivery of public health services.

NPH: How will you disseminate these best practices and this evidence base to state and local public health officials?

Today’s plenary speaker at the 2013 Keeneland Conference is William Roper, MD, MPH, dean of the school of medicine, vice chancellor for medical affairs and CEO of the UNC Health Care System at the University of North Carolina at Chapel Hill. Earlier in his career, Dr. Roper was senior vice president of Prudential HealthCare, president of the Prudential Center for Health Care Research, director of the Centers for Disease Control and Prevention and administrator of the Health Care Financing System, the precursor to the Center for Medicare and Medicaid Services.

NewPublicHealth spoke with Dr. Roper on his way to the Keeneland Conference about the drive to better use data, instead of anecdotes and personal beliefs, to drive decision-making.

NewPublicHealth: What were some of the early efforts you were involved in that set the stage for the field of public health services and systems research we know today?

Dr. Roper: I didn’t do this by myself; I did it with a lot of other people, but one of the critical early efforts was the publication of Medicare mortality information on all American hospitals beginning in 1986 and continuing for a number of years thereafter. Another was creation of the Agency for Healthcare Policy and Research in 1989, which has since been renamed the Agency for Healthcare Research and Quality. Another was the launching of the Prevention Effectiveness Initiative at CDC in the early 90s. And then subsequently, work that I’ve done at the University of North Carolina, first at the School of Public Health and then at the School of Medicine using the tools of health services research broadly in health care and in public health.

NPH: What are some of the fruits of those efforts? 

Today, New York State Health Commissioner Nirav R. Shah, MD, MPH, released 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. The plan is a blueprint for local community action to improve health and address health disparities, and is the result of a collaboration with 140 organizations, including hospitals, local health departments, health providers, health plans, employers and schools that identified key priorities.

Dr. Shah, the architect behind today’s prevention agenda, was confirmed as New York State’s youngest Commissioner of Health two years ago. The state’s governor, Andrew Cuomo, had three critical goals: reduce the state’s annual Medicaid growth rate of 13 percent, increase access to care and improve health care outcomes.

Shah, a former Robert Wood Johnson Foundation Physician Faculty Scholar and Clinical Scholar, has already made important inroads in all three goals and the prevention agenda builds on that. NewPublicHealth spoke with Dr. Shah about prevention efforts already underway in the state, and what it takes to partner health and health care to achieve needed changes in population health.

NewPublicHealth: How does improving the social determinants of health help you achieve your goals in New York State?

Dr. Shah: New York’s Medicaid program covers 40 percent of the health care dollars spent in the state. We were growing at an unsustainable rate, and we needed a rapid, but effective solution. So, we engaged the health care community, including advocates, physician representatives, the legislature, unions, management, and launched a process that enables continuous, incremental, but real change toward the Triple Aim—improved individual health care, improved population health and lower costs.

Collectively, these efforts resulted in a $4 billion savings last year in the State’s Medicaid program, increased the Medicaid rolls by 154,000 people, and resulted in demonstrable improvements in quality throughout the system.

NPH: What opportunities do you see for public health and health care to work together in New York State?

While this is the first year that the American Public Health Association has used “return on investment” as the theme for National Public Health Week, which runs through April 7, it’s far from the first time that public health practitioners have made the case to policymakers that the work of public health can save lives and money.

Research on the impact of public health services includes the critical fact that spending just $10 per person in programs aimed at smoking cessation, improved nutrition and better physical fitness could save the nation more than $16 billion a year, according to the Trust for America’s Health. That’s a nearly $6 return for every $1 spent.

Over the last two years, NewPublicHealth has reported frequently on the value of investing in public health. Some of our favorite ROI articles, reports and other resources include:

• >>UPDATE: Trust for America's Health released Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts today. The report examine public health funding and key health facts in states around the country, finding inadequate and cut funding and wide variation in health outcomes by state and county.
  
• Making the Case for Prevention: A Q&A with James S. Marks, Senior Vice President, Robert Wood Johnson Foundation, about the great potential for investing in prevention.
  
• National Prevention Resources Starter Guide:
  A collection of resources that showcase how different fields can work together and take action to prioritize prevention.
  
• Strategies to Move from Sick Care to Health Care: The  Trust for America's Health identifies high-impact steps that the nation can take to prioritize prevention and improve Americans' health.
• Workplace Wellness Perspectives: A Q&A with two very different businesses—one big, one small; one academic, one industrial—on creating healthier workplaces.
• Employers Join Community Health Movement: A Q&A with Trust for America’s Health and the National Business Coalition on Health about the critical role of employers in community prevention efforts.
• Stories of the value of investing in prevention from Wyandotte County, Kan., and Hernando, Miss.

>>Read more on the value of prevention from RWJF.org.

It’s that time of year when public health enthusiasts rejoice and remind the rest of the world why this field is so critical—this is National Public Health Week, a yearly observance since 1995. For 2013, the theme is "Public Health is ROI: Save Lives, Save Money." According to the American Public Health Association, (APHA), a key organizer of the yearly observance, this year’s theme was developed to highlight the value of prevention and the importance of well-supported public health systems in preventing disease, saving lives and curbing health care spending.

In honor of National Public Health Week, NewPublicHealth spoke with Georges C. Benjamin, MD, executive director of the APHA.

NewPublicHealth: Is this the first time that National Public Health Week has focused on the return on investment in public health?

Dr. Benjamin: I think it’s the first time we’ve done so directly. There’s no question that we have always talked about the value of public health and we’ve often talked about savings, but this is the first time we’ve really focused like a laser on that investment.

NPH: What reaction have you seen in states and local communities to this year’s theme?

At this month’s Public Health Preparedness Summit, John Lumpkin, MD, MPH, senior vice president and the director of the Health Care Group at the Robert Wood Johnson Foundation, presented about the National Health Security Preparedness Index. The Index, when completed, will be a single annual measure of health security and preparedness at the national and state levels. The Index will help inform decisions about how to prioritize investments and continual quality improvement of public health preparedness, and will also identify and highlight strengths and novel approaches. With input from many stakeholders, the Association of State and Territorial Health Officials, in partnership with the Centers for Disease Control and Prevention, is coordinating development of the Index.

Prior to joining the Foundation in 2003, Dr. Lumpkin served as director of the Illinois Department of Public Health for 12 years. In an interview at the Summit, Dr. Lumpkin described how the Index will help improve the quality of public health preparedness. He also shared his insights from his first-hand experience in coordinating a sustained response to public health emergencies that extends well beyond the initial response.

NPH: In the aftermath of a disaster such as Hurricane Sandy, how can public health agencies balance their focus on immediate needs such as shelter, food and emergency services, with longer-term challenges such as mental health, housing solutions and resilience?

Dr. John Lumpkin: While the immediate impact of homes being destroyed, people being forced to relocate and lives being lost, is devastating—there is also an ongoing public health impact of a disaster such as Hurricane Sandy, which is tremendous.

>>Watch a video on the ongoing public health response to Hurricane Sandy.

State legislatures recently got underway across the country and many will be considering some critical public health law measures, according to a recent blog post from the Network for Public Health Law.

Critical issues include:

• A smoking ban in Kentucky which could stall in committee
• A bill in Kentucky which could restrict the work of local boards of health.
• A law in Ohio that would require health departments to enter into agreements for shared services and to become accredited.  

>>Bonus Links:

• Read the Network blog post.
• Use the state legislative tracking page from the Association of State and Territorial Health Officials to follow state public health agendas for 2013.

Three years after a devastating earthquake took the lives of 200,000 Haitians, displaced millions more and disrupted the public health infrastructure of the country, two new public health buildings opened yesterday in the country’s capital city of Port-Au-Prince with funding by the CDC Foundation and several partners including the Robert Wood Johnson Foundation, the GE Foundation and Kaiser Permanente. The CDC Foundation was established by Congress to forge partnerships between the Centers for Disease Control and Prevention (CDC) and corporations, foundations and individuals to support CDC's work in the U.S. and abroad.

“‘Building back better’ isn't just a slogan, it's a reality in public health. These buildings represent an important step forward to save lives in Haiti,” said CDC director Thomas Frieden, MD, MPH, at the opening in Port-Au-Prince. "These new buildings have an importance far beyond their physical presence—they will serve as a basis and catalyst for programs that will save literally tens of thousands of lives,” Frieden said.

One building replaces the Haiti Health Ministry, which was destroyed in the earthquake. The second building will house some of the ministry’s surveillance, epidemiology and laboratory staff as well as Haiti-based CDC staff, who are now working side-by-side in the country.

Representatives of the partners critical to the funding of the new buildings were on hand in Port-Au-Prince for the buildings’ ribbon cutting ceremony, including Susan Mende, senior program officer at the Robert Wood Johnson Foundation. “The earthquake in Haiti wrought great destruction and suffering to some of the most vulnerable in society as well as to the health and public health infrastructure so critical to the nation’s health,” said Mende. “The Robert Wood Johnson Foundation made a $500,000 grant to help build a public health laboratory research center to be used by Haiti’s Ministry of Public Health and Population. The Foundation recognizes that a stronger public health system is the network that protects communities, saves lives and directly improves people’s health and well being.”

To learn about the significance of the new buildings and the continuing efforts to improve public health in Haiti, NewPublicHealth spoke with Charles Stokes, president of the CDC Foundation, and Justin Tappero, MD, MPH, Director for the Health Systems Reconstruction Office in the Center for Global Health at CDC. Both were on hand for the ceremonies this week.