Nebraska Develops a Responsive Public Health System

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Field of Work: Strengthening the public health system

Problem Synopsis: According to an Institute of Medicine (IOM) report, The Future of Public Health, by 1988, the nation had lost sight of its public health goals, and allowed public health to fall into disarray. The report noted that America's public health system was expected to do too much with too few resources. It also stated that capabilities for effective public health actions were inadequate, and the health of the public was "unnecessarily threatened as a result."

In 1997, local public health departments in Nebraska served only 18 of the state's 93 counties. Local public health departments were located primarily in small rural counties and generally had few staff and limited funds, making it impossible for them to provide most essential public health services.

Synopsis of the Work: Turning Point: Collaborating for a New Century in Public Health, a national program of the Robert Wood Johnson Foundation (RWJF) and the W.K. Kellogg Foundation, defined its mission as to "transform and strengthen the public health system in the United States to make the system more effective, more community-based and more collaborative." The two foundations partnered to support 22 states and 41 local communities in those states. RWJF also supported five National Excellence Collaboratives that allowed states to work together on important public health infrastructure challenges.

From 1997 to 1999, the Nebraska Community Health Partners Stakeholder Group, a broad-based partnership, developed a public health improvement plan that focused on building public health infrastructure at the regional level through multicounty, community-based public health departments.

Key Results: In 2000, Nebraska Turning Point awarded grants to build or establish four multicounty, community-based public health departments. That same year, to facilitate the state's public health infrastructure work, the Nebraska Department of Health and Human Services established the Office of Public Health (now called Office of Community Health Development), which housed Nebraska Turning Point staff.

Having a public health improvement plan enabled Nebraska Turning Point to successfully advocate for funding for public health infrastructure from state tobacco settlement funds. When the state legislature passed the Nebraska Health Care Funding Act in 2001, it appropriated $5.7 million annually to establish regional public health departments throughout the state.

By 2004, 16 regional public health departments covered every county in the state, providing the core functions of public health; by 2006, these departments provided nearly all of the essential public health services, as well as services not available through the Nebraska Health and Human Services System.

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