Category Archives: Public-private partnerships
Rockingham County, N.C., is one of several counties profiled in videos produced for the 2014 report of the County Health Rankings, a joint project of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, and released yesterday. The Rankings shows how communities across the country are doing and how they can improve on their health.
Rockingham evolved from a wealthy county to a poor one very quickly after losing two major industries only a couple of decades ago. The community suffers from high general smoking rates, high obesity rates and high rates of smoking during pregnancy. When the 2010 County Health Rankings were released, Rockingham was ranked at 71 out of 100 counties on health measures. The community's poor standing served as a wake-up call.
One new program set to begin this spring is the Nurse-Family Partnership, a decades-old, evidence-based community health program that serves low-income women pregnant with their first child.
Nurse-Family Partnership is based on the work of David Olds, MD, a professor of pediatrics, psychiatry and preventive medicine at the University of Colorado Denver. While working in an inner-city day care center in the early 1970s, Olds was struck by the risks and difficulties in the lives of low-income children and over the next decades tested nurse home visitation for low income families in randomized controlled trials in Elmira, New York, Memphis, Tennessee and Denver. Results have shown that the program improved pregnancy outcomes; improved the health and development of children; and helped parents create a positive life course for themselves. There are now Nurse-Family Partnership programs in 43 states, the U.S. Virgin Islands and six Indian tribal communities.
In the Nurse-Family Partnership programs, the mothers receive ongoing visits from the nurses in their homes from the first trimester until the baby is two years old. Program goals include:
- Improve pregnancy outcomes by helping the new mothers engage in good preventive health practices, including comprehensive prenatal care from their healthcare providers, improving their diets and reducing their use of cigarettes, alcohol and illegal substances.
- Improve child health and development by helping parents provide responsible and competent care.
- Improve the economic self-sufficiency of the family by helping parents develop a vision for their own future, plan future pregnancies, continue their education and find work.
According to Heather Adams, executive director of the Rockingham County Partnership for Children, there are about 5,000 children under the age of five in Rockingham County. Over half live in poverty and are born to mothers under the age of 20 and many of the children are in single parent households.
“The County Health Rankings really gave us some concrete data to show us what we knew anecdotally was really true,” said Adams. “Nurse-Family Partnership really rose to the top as a really strong program that could help meet some of our needs.”
As part of its County Health Rankings coverage, NewPublicHealth recently spoke with Elly Yost, MSN, PNP, director of nursing practice at the Nurse-Family Partnership national office in Denver, Co. Yost is a pediatric nurse practitioner who previously worked in hospitals and community practice settings.
This week the National Association of Counties (NACo) will hold the fourth Healthy Communities Initiative Forum, in San Diego, bringing together county health directors and staff to share best practices to improve community health. The NACo Healthy Counties Initiative supports innovative public-private partnerships to enhance community health.
Ahead of the conference, NewPublicHealth spoke with Linda Langston, president of NACo and Supervisor of Linn County, Iowa, who will be attending and presenting at the conference.
NewPublicHealth: Tell us about the Healthy Counties Initiative.
Linda Langston: I was the first chair of the initiative when it came into being four years ago. We modeled it after what we had done with our Green Government initiative—we had local government elected officials and staff connected to various areas of health, and then we also populated the committee with some of our corporate sponsors that were ultimately working toward very similar kinds of goals and trying to figure out how we could work affectively together.
We're also helping people understand upcoming issues and ideas they may know about.
NPH: What are the key health issues that counties face in 2014 and how is NACo generally helping counties with those issues?
Langston: Many counties are responsible for safety-net services and virtually every county in the nation has a jail. We’ve learned that many people, including many federal legislators, don’t understand the difference between jails and prisons. Jails are unique to local government, at the county level, and are often where people who have been arrested but can’t afford bail wait until their trial dates. Our challenges include providing health care in the jails, as well as connecting those released to health services in the community, with a goal of continuity for such services as mental health care and treatment for substance abuse.
We are also employers and very often, particularly in small-to-medium-sized counties, we are the largest employer in the area. So we have a lot of employees who need our best efforts, such as looking at how to incentivize people to make good decisions about their own health. And, of course, we also have the community public health responsibility. So we're pretty effectively placed to deal with all things related to health.
Bithlo, Fla. is a town of 8,000 that is just 30 minutes outside Orlando and not much farther from the “happiest place on Earth” — but is beset by poverty, illiteracy, unemployment and toxic dumps that have infiltrated the drinking water. The water is so bad that it has eroded many residents’ teeth, making it that much harder for them to find jobs. Streets filled with trash, frequent road deaths and injuries from a lack of transportation options and safe places to walk, and dropping out before 10th grade were all the norm.
In just a short time, a collection of partners and volunteers have begun to reverse some of the decades-old problems Bithlo has faced. And earlier this week, the town that had been forgotten for almost a century was the scene of a hubbub of activity as hundreds of volunteers descended on the town to continue work on “Transformation Village,” Bithlo’s future main street, which will sport a combination library/coffee shop, schools, shops and many other services, all long missing from Bithlo.
Over the last few months, NewPublicHealth has reported on initiatives of the participating members of Stakeholder Health, formerly known as the Health Systems Learning Group. Stakeholder Health is a learning collaborative made up of 43 organizations, including 36 nonprofit health systems, that share innovative practices aimed at improving health and economic viability of communities.
>>Read more on the Stakeholder Health effort to leverage health care systems to improve community health.
One of the Stakeholder Health members is the Adventist Health System, a not-for-profit health care system that has hospitals across the country. Recently, Adventist’s flagship health care provider, Florida Hospital in Orlando, began supporting United Global Outreach (UGO), a non-profit group aimed at building up communities in need, in their four-year-long effort to transform the town of Bithlo.
NewPublicHealth recently spoke with Tim McKinney, executive vice president of United Global Outreach, and Verbelee Neilsen-Swanson, vice president of community impact at Florida Hospital, about the partnerships and commitment that have gone into Bithlo’s transformation into a town that is looking forward to new housing stock, jobs, stores, better education and improved health outcomes for the its citizens.
Earlier this week, the Robert Wood Johnson Foundation held its first ever “Culture of Health Hangout,” a new series meant to explore what communities across the country are doing to advance and transform public health. This first foray looked at how public health departments have evolved in recent years, and are continuing to evolve to meet the changing needs of the communities they serve. The panel was moderated by Paul Kuehnert, RWJF senior program officer and Public Health team director.
According to Muntu Davis, Public Health Director and County Health Officer of Alameda County, the core role of public health hasn’t really changed—public health departments and officials continue to gather and analyze data to explain what’s happening to the health of a community. However, what has changed is where they put their focus. Now, in health departments across the country, the focus is not simply on individual decisions, but on social and economic factors that dictate which options are truly available.
“Although it does boil down to an individual choice, if there’s no opportunity there for communities, then ‘health’ is definitely not an easy choice to make,” said Davis.
One of the more innovative approaches his health department has undertaken is utilizing maternal and child health workers to provide, in addition to their traditional work, financial coaching to people who may be of lower incomes. “Studies have shown link between income, wealth and life expectancy,” said Davis, and that’s what makes it important for public health to help support not just the immediate health need but also “the full picture of what might be shaping their health.” These workers are able to provide education and assistance, while also linking them to financial coaching and tools that can help them manage the money they have.
Karen DeSalvo, City of New Orleans Health Commissioner, spoke extensively on the importance of community partnerships when it comes to advancing community health. She said Hurricane Katrina was, in a way, a “catalyst for change” that enabled the entire community to hit the reset button, assess where they were and determine how best to move forward together. One of the first realizations was that the city simply did not have a strong enough local health department.
“It allowed us to begin planning, and to decide to move away from an expensive, hospital-based system to one that was more about prevention and primary care,” she said. “And over the course of years, once we stabilized that infrastructure at the frontline of primary care and moved more toward prevention, the glaring need to have a strong public health department became obvious.”
Watch the live event right here starting at noon EST.
Today at 12 p.m. EST the Robert Wood Johnson Foundation will hold its very first Culture of Health Hangout. The goal of the new Hangout Series is to explore exactly what we all need to do to create a culture of health—and to shine a spotlight on communities that are already on their way. Panelists will talk through some of the complex ways public health is transforming, while also sharing innovative ways that public health departments are stepping up to the challenge.
This first Hangout will discuss the role of public health departments in transforming community health. Topics to be covered include:
- How the role of public health departments has evolved in recent years, and how it could continue to transform in the future
- How the scope of public health department partners is changing over time, and why that kind of broad partnership across sectors is critical for public health
- The particular public health challenges in rural settings
The panelists will include: Jewel Mullen, Connecticut Department of Public Health Commissioner; Muntu Davis, Public Health Director and County Health Officer of Alameda County; Karen DeSalvo, City of New Orleans Health Commissioner; and Michael Meit, Co-Director of the NORC Walsh Center for Rural Health Analysis. Our moderator is Paul Kuehnert, RWJF senior program officer and Public Health team director.
At the recent Place Matters: Exploring the Intersections of Health and Economic Justice conference in Washington, D.C., David J. Erickson, PhD, was a key member of a panel called “What Works for America’s Communities?” Dr. Erickson, who is director of the Center for Community Development Investment at the Federal Reserve Bank of San Francisco, has been a key leader in a Healthy Communities collaboration between the Federal Reserve and the Robert Wood Johnson Foundation. The joint effort has convened more than ten conferences around the country and released numerous publications, including an article in Health Affairs about partnerships to improve the wellbeing of low-income people.
>>Read more reporting from the Place Matters conference, in a Q&A with David Williams of the Harvard School of Public Health and the RWJF Commission to Build a Healthier America.
NewPublicHealth spoke with Dr. Erickson at the Place Matters meeting.
NewPublicHealth: Are the Healthy Communities conferences continuing?
David Erickson: We still have what we call “consciousness raising” meetings planned in Ohio, Florida, Louisiana and other cities, and these are initial meetings that get together the health and community development world. But then there is another phase, we call it phase two—how do you operationalize this idea? What do we do tomorrow? Who do I call? How do I structure the transaction? Who’s my partner? And that’s harder to answer so we’re trying to figure that out. So we need phase two meetings to get hospitals together with banks to talk about how they might blend some of their community benefit dollars with community reinvestment dollars to help alleviate some of the upstream causes of bad health [like poverty and poor housing].
NPH: What would be examples of such a collaboration?
Up to 80 percent of family physicians are expected to use electronic health records (EHRs) by the end of this year, and experts across the country are talking about ways to leverage this influx of data to inform better health. A pre-conference workshop at the National Association of County and City Health Officials (NACCHO) Annual Meeting focused on Beacon Communities, which are part of a pilot to demonstrate how meaningful use of EHRs can lead to better health and better health care at a lower cost. The HHS Office of the National Coordinator for Health IT is providing $250 million over three years to 17 selected communities throughout the United States where numerous institutions are sharing data to inform quality improvement and other data-informed efforts.
The NACCHO meeting highlighted Beacon communities that are partnering with public health in different ways to forge data-informed population health activities.
Health departments in North Carolina have been required to do community assessments since 2002 as part of a statewide health department accreditation program and are very experienced with working with this data, whereas hospitals are just now beginning to be required to do similar assessments under the affordable care act, according to John Graham, PhD, PMP, Senior Investigator for the NC Institute for Public Health at the Gillings School for Global Public Health, which plays an integral role in the Southern Piedmont Beacon Community.
“Health assessment planning and communication are tools that can be leveraged to foster more collaboration,” said Graham. “We really try to coordinate public health prevention and health care. We can do a lot with clinical interventions, looking at it from a population health perspective.”
“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:
Howard County has been the healthiest in Maryland since the Country Health Rankings launched in 2010. NewPublicHealth recently spoke with the county’s executive, Ken Ulman, about how the Rankings have helped drive further progress in improving the health of Howard County. Health initiatives introduced by Howard County have included a program that certifies schools as “Healthy Schools,” if they meet criteria in several areas including nutrition and physical activity, and a smoking ban in all county parks.
NewPublicHealth: Howard County has been consistently been ranked the healthiest county in Maryland. What key factors do you credit for that?
Ken Ulman: We start with some advantages. We have the blessings of a highly educated population that cares deeply about their community and have good jobs, and many, though not all, have [adequate financial] resources and access to care. We also have the advantage of having a nonprofit, the Horizon Foundation, based in Howard County that is dedicated to improving the health and wellbeing of people living and working in our county.
So it’s a combination of policy initiatives coupled with a public that really wants to make progress in these areas.
NPH: Have the County Health Rankings helped drive any of your public health and prevention initiatives?
A Buzzfeed article posted in the days after the explosions at the Boston Marathon last week reported on hashtags and Google docs that emerged in the hours after the explosions, and pointed out the need for expanded “disaster and crisis coordination online, beyond hashtags.” The article notes a new San Francisco initiative in collaboration with the design firm IDEO—a social networking website and app to connect people who want to help with those who need it, which will let individuals preregister homes where people in need can find emergency shelter, supplies and useful skills such as First Aid certification. According to the post, “instead of scanning hashtags [in order to offer assistance], people will be able to simply log in to a preexisting community.”
There was a soft launch of the system in January and the organizations are now collecting user feedback.
Jenine Harris, PhD, an assistant professor at the Brown School of Social Work at Washington University in St. Louis, reported on expanded use of social media by local health departments during the recent Keeneland Conference on public health services and systems research held in Lexington, Ky. Dr. Harris says of the San Francisco project that “the more active a social media channel, the more people follow it, so if these channels could be tweeting or retweeting regularly they would probably draw larger audiences.” Harris suggests that health departments could retweet information from their channels and increase visibility.
>>Read the Buzzfeed article.