Category Archives: Public health agencies
The Affordable Care Act (ACA), which kicks into high gear in January, was front and center at the recent annual meeting of the National Association of County and City Health Officials (NACCHO) in Dallas. U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, addressed the benefits to population health of many of the new law’s provisions and Kathleen Sebelius, Secretary of the Department of Health and Human Resources, which has overall responsibility for the law, spoke about the ACA via video.
For the most part, the role of local health departments under the ACA is still emerging and will become better known as more provisions are implemented and clarified.
To better understand what we know about that role and what will become better known down the road, NewPublicHealth spoke with Michelle Chuk Zamperetti, MPH, Senior Advisor and Chief of Public Health Infrastructure and Systems for NACCHO.
NewPublicHealth: Are there specific provisions under the ACA that apply to local health departments?
Michelle Zamperetti: There are no provisions specifically designated for local health departments but there are many provisions that impact local and state health departments. For example, many will be involved in the outreach and enrollment efforts for the new marketplaces and some will be designated as navigators to help people enroll for health insurance coverage in both the state-run marketplaces and the federally funded exchanges. For example, I recently learned that authorities managing a state-based health insurance exchange were not pleased with some of the navigator program applicants, so they reached out to a local public health director and asked that health department to be the navigator program leader in their region. And even in communities where health departments don’t give direct enrollment assistance—such as filling out paperwork online—we are confident that people with established relationships with their health department may use it as an entry point for finding out about health insurance, and health departments will need to know how to help them enter the system.
In addition to the insurance expansion provisions of the law, there are also important provisions to strengthen the coverage provided through insurance, particularly in the area of clinical preventive services. For health departments that provide direct services, there are opportunities to become in-network providers under the ACA.
NPH: Do you think many health departments will work together with non-profit hospitals, which now have a mandate from the Internal Revenue Service (IRS) to provide some form of community benefit in order to maintain their tax-exempt, not-for-profit status under the ACA?
Public health superstars as well as local health departments took home trophies from Dallas last week after receiving awards at the annual conference of the National Association of County and City Health Officials (NACCHO).
The most cheered awardee was Mary Selecky, the former health secretary of Washington State who retired earlier this year after 34 years in leadership positions at the state and local health departments. Selecky accepted her award brandishing a condom and a small bottle of hand sanitizer—symbols of her tenure. And when Carol Moehrle, district director of Public Health-Idaho North Central District in Lewiston and a former NACCHO president, who helped present the award, asked conference attendees who had been mentored by Selecky to step toward the front of the room, the space in front of the podium filled quickly. Selecky received the Mo Mullet Lifetime of Service award, named for a former executive director of NACCHO who also attended this year’s conference.
Read a recent NewPublicHealth interview with Mary Selecky, reflecting on her years of service in public health.
Local Health Departments of the Year
This year NACCHO also awarded first time prizes to local health departments, with awards given to applicants who showed creativity; innovation; sufficient evidence of outcomes and impact on the community; and collaboration with partners, community members and key stakeholders.
Small Local Health Department Winner: Crook County Public Health Department in Crook County, Oregon with a population of 10,000
Among its many innovations, the department worked with community partners to sponsor a school-based health center run by the local Federally Qualified Health Center and is very engaged in the implementation of the Affordable Care Act.
Medium Local Health Department Winner: Gaston County Health Department, Gaston County, North Carolina
The health department serves a little more than 200,000 residents and is working on ways to use data and data analysis to help improve health and reduce disparities. It also recently merged services with the Gaston County Department of Social Services. Prior to the merger, the health department analyzed the data needs of that agency and explored how it could use mapping to help jointly deliver services more efficiently and effectively. The health department is also training data-focused personnel and creating an informatics division, so the departments can further target outreach and intervention initiatives, and was an early adopter of electronic health records.
With just 83 days to go until health insurance marketplaces open up to allow otherwise uninsured Americans to sign up for health coverage under the Affordable Care Act (ACA), NACCHO Annual has a good number of plenary and other sessions focused on the role of public health in implementing the law.
>>Read more NewPublicHealth coverage of NACCHO Annual.
In his address to the 1,000 plus attendees at this year’s NACCHO conference, Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, talked about what local health departments can do to support ACA. “This is an all hands on deck situation,” said Frieden. “We want to do a lot with improving quality of care, but first we’ve got to get people signed up.”
Frieden ticked off actions that local health departments can take to help support enrollment, including:
- Provide resources to the community on getting insured & the benefits of being insured, including free preventive care.
- Educate every resident served by the department, such as immunization, tuberculosis and STD clinic patients, on how they can enroll.
- Educate every organization that the health departments connects with, such as schools, courts and businesses, on how stakeholders can enroll.
“Public health will always be local. But we will always need to adapt and evolve to continue to be relevant and effective,” said Thomas Frieden, MD, MPH, Director of the Centers for Disease Control and Prevention (CDC) to the packed crowd of local health department leaders at the opening session of this year’s National Association of County and City Health Officials (NACCHO) Annual Meeting. That means leveraging what’s working well, and keeping a finger on the pulse of what will work even better in the future, according to panelists at yesterday’s session, which was moderated by Dr. Swannie Jett, DrPH, MSc, Health Officer for the Florida Department of Health in Seminole County and included presentations by a number of federal-level public health officials.
>>Follow ongoing NewPublicHealth coverage of NACCHO Annual, including session recaps, interviews with speakers and more.
Jett alluded to a rapid transformation in public health that will change what it means to ensure the health of a nation or a county.
“Public health needs to be at the forefront,” said Jett. “We need to take the lead in our communities. We need to reach out to community partners, and to health officers in other counties and states. We need to bring everyone into the fold in this conversation.”
These kinds of cross-cutting partnerships, with public health playing a central role, were also the subject of a recent op-ed by Frieden on the Huffington Post, sharing success stories from the 2013 Annual Status Report of the National Prevention Strategy. The Strategy envisions a prevention-oriented society where all sectors recognize the value of health for individuals, families, and society, working together to achieve better health for all Americans. Frieden shared some examples of efforts to create healthier places to live happening across the country:
NewPublicHealth is on the ground this week in Dallas at NACCHO Annual, the yearly meeting of the National Association of County and City Health Officials (NACCHO). The meeting theme this year is “Public Health by the Numbers” as city and county health departments face increased pressure for limited resources; an increased focus on both new and traditional public health roles; and government accountability and effectiveness.
NewPublicHealth spoke with Robert Pestronk, NACCHO’s executive director, in advance of the conference.
>> Be sure to follow our NACCHO conference coverage all week long, including stories from key sessions and interviews with speakers and thought leaders.
NewPublicHealth: What are the key issues at this year’s NACCHO conference?
Robert Pestronk: We’re focused on a conference theme of public health by the numbers because the availability and use of data is integral to the performance and operations of local health departments. The use of data and metrics is important for quality improvement in health departments, and for the development and communication of messages about health status and disease status within local communities.
A couple of other things that are new for this year’s annual meeting is that we’re recognizing the role that large cities and metropolitan areas play in modeling and demonstrating public health policy and governmental public health practice work. We have a couple of sessions with presenters from big cities to talk about the work they’re doing. And because the Affordable Care Act is influencing the work and funding and future for local health departments, there are sessions to help local health departments consider the effects from the law. We’ve also got a plenary session on reducing health disparities, which is a line of work that is very important to NACCHO. In fact, NACCHO’s work in this area has stimulated work in other parts of the governmental public health structure at the state and federal level.
NPH: What is the role that local health departments will play when it comes to implementing the Affordable Care Act?
Pestronk: I think that the specific role that local health departments play, like in most situations, will depend upon the kinds of assets that are available in a local community and the extent to which their state is implementing provisions of the law. Local health departments can be helpful informing people about the start of enrollment and helping people understand where they can go to enroll. Part of what NACCHO has been doing over the past year is to share with local health departments the kinds of opportunities that are available for implementing and educating about the health law.
NewPublicHealth has been conducting a series of interviews with health directors impacted by weather disasters this year. Last month marked the official start of hurricane season in the Atlantic. We recently spoke with Mary O’Dowd, health commissioner of New Jersey, which is continuing its recovery and rebuilding after Hurricane Sandy last fall.
>>Read our interview with Oklahoma Health Commissioner Terry Cline on the tornadoes that struck Oklahoma this summer.
NewPublicHealth: How far along are you in the recovery process?
Mary O’Dowd: One of the things that we’ve learned is that recovery takes years not months when you’re dealing with a disaster of the proportion that Superstorm Sandy was for New Jersey. I would say that we’ve made significant progress. Some communities have very little signs of Sandy left, others are still working to rebuild a significant amount of their property and they’re still in the process of demolition of damaged buildings and properties. Great strides have been made, much progress has already occurred, but there still is a lot of work yet to be done.
NPH: What are some of the public health endeavors you’re still engaged in for the response?
A new report funded by the Robert Wood Johnson Foundation (RWJF) and produced by the University of Michigan Center of Excellence in Public Health Workforce Studies offers—for the first time ever—a comprehensive assessment of the state of nursing and nurses in state and local health departments. Enumeration and Characterization of the Public Health Nurse Workforce: Findings of the 2012 Public Health Nurse Workforce Surveys looked at—among other things—size, composition, educational background experience, retirement intention, job function and job satisfaction of nurses.
RWJF recently spoke with Paul Kuehnert, MS, RN, CPNP, team director of Public Health at RWJF, and an alumnus of the RWJF Executive Nurse Fellows program, to discuss the report.
Among the report’s findings is that while public health nurses report high levels of job satisfaction, they’re also concerned with issues such as job stability, compensation and the lack of opportunities for advancement. It also found that about 40 percent of public health departments have “a great deal of difficulty” hiring nurses.
“It should be a high priority to address gaps and take steps to strengthen the public health nursing workforce,” said Pamela G. Russo, MD, MPH, RWJF senior program officer. “Public health nurses are likely to need training to keep pace with the changes as health care reform is implemented and public health agencies focus more on population health. The size, makeup, and preparation of the public health nursing workforce greatly affect the ability of agencies to protect and improve the health of people in their jurisdictions.”
Prepared for a Disaster and Building Back Better: Terry Cline on Public Health’s Response to Oklahoma Tornados
Tornadoes that struck Oklahoma just a few weeks ago have left more than 40 people dead, scores injured and billions in losses, including whole neighborhoods wiped out. The devastating weather of the past year—including superstorm Sandy, which wreaked havoc on the Northeast, especially New Jersey and New York City—has called even greater attention to the critical need for public health departments to be ready to respond at all times. Health departments in the communities and states where disasters happen have to be nimble enough to respond to the expected and the unexpected—as you’ll see from three interviews NewPublicHealth recently conducted with the health commissioners of New Jersey and Oklahoma, as well as with the health director of Oklahoma City, the most recent area to be rocked by severe weather.
And because disasters don’t honor state lines and devastated areas may not have the capacity on their own to handle the myriad of disaster health issues, the manpower and equipment of even far-flung health departments can be critical—making preparedness a year-round, 24/7 responsibility for everyone in public health.
Read the first installment in the series, a conversation with Terry Cline, PhD, the Commissioner of Health in Oklahoma.
NPH: With the recent tornadoes, what were you able to prepare for and what was unexpected?
Terry Cline: Unfortunately, in Oklahoma we have a lot of experience in dealing with disasters and we have what I consider to be a well-oiled machine in place. So overall, I think the response to this tragic situation went very well. The multiple tornados were a bit of a surprise though. It’s not unusual to have several tornados in the same area, but it’s unusual to have two significant tornados and then have one of those go through an urban area. I think a critical impact that was not anticipated was the flooding during the most recent tornado. The bottom line is that you need to have a strong infrastructure in place because Mother Nature has a way of always having the upper hand.
Immediately after the explosions at the Boston Marathon yesterday, both the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) updated their crisis management resources and moved the information to the top of their home pages.
Yesterday, NPR reported that business owners near the blast site are beginning to return and reopen their doors.
"They fled in a panic last week and returned both eager and anxious," said NPR reporter Tovia Smith. The piece describes how business owners returned to find food left half-eaten and rotting, because so many left in such a hurry, and blood splattered in some spots from those who were injured.
To help make sure businesses get the help they need to reopen safely, public health inspectors played a role in visiting every building on every block. "They also stood ready with trauma counselors, pro-bono attorneys and clean-up crews," said Smith.
But the public health response to any disaster goes beyond helping to restore normalcy in the immediate aftermath. An earlier interview with John Lumpkin, director of the Health Care Group at the Robert Wood Johnson Foundation, about the sustained response to Hurricane Sandy also applies here:
We saw with Katrina and are seeing again now with Sandy, [public health officials] are not only concerned with food, air, and water during and immediately after an emergency, but also with ensuring that services related to health care delivery and mental health are provided when and where they’re needed. It’s an interesting statistic, for instance, that the demand for mental health services was higher five years after Hurricane Katrina than it was immediately after the hurricane hit.
The Boston Public Health Commission announced this week, for example, that the organization has opened a new drop-in center to continue to provide emotional support to anyone affected by the Boston Marathon attack.
"While the physical injuries and destruction that resulted from the bombings might be the most visible signs of trauma, many people experience serious emotional distress based on what they saw, heard, and felt during and after the attack. Sometimes these symptoms do not surface immediately," according to the Commission release. "Understanding the deep impacts of this emotional distress, city officials opened the drop-in center as a safe place for people to come together and talk about their experiences over the past week."
>>Read more about building community resilience to recover from disaster.