January 2001

Grant Results

SUMMARY

From 1994 to 1996, the Public Health Foundation, Washington, contracted with each of the three associations that comprised the Joint Council of Governmental Public Health Agencies — representing city, county, state, and territorial public health agencies — to examine the role of public health agencies in the face of increasing dominance by managed health care organizations.

Key Results

  • The Joint Council published Promoting Quality Care for Communities: The Role of Health Departments in an Era of Managed Care. In the report, the Joint Council outlined how health departments could continue to take an active part in ensuring quality health care to communities while working with managed care organizations.
  • The Joint Council made a study of resource needs, which concluded that funding for state and local health departments would need to double in order for departments to perform their core functions effectively.
  • The Joint Council made "mini-grants" of up to $4,000 apiece to six state and local health organizations for "marketing" public health efforts.
  • The Joint Council printed and distributed the report For A Healthy Nation: Returns on Investment in Public Health. The report, which was produced by the USPHS, notes that:
    • Life expectancy in the past 50 years has increased 30 years, largely because of public health strategies for disease and injury prevention. Only five of those years are due to improvements in clinical medicine.
    • Investment in public health leads to substantial future savings in medical care, but funding for public health has steadily declined. In 1992, its funding accounted for less than 1 percent of the aggregate amount spent on U.S. health care.

Funding
The Robert Wood Johnson Foundation (RWJF) provided a $182,585 grant to this effort between January 1994 and February 1996.

 See Grant Detail & Contact Information
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THE PROBLEM

The proposed reform of the American health care system during the early 1990s presented significant challenges and opportunities for the nation's public health agencies. While the health care reform debate focused on controlling costs and expanding access to care, it largely overlooked the role of the nation's public health system, a fragmented, incomplete array of city, county, state, and private agencies that failed to work in a coordinated fashion.

Over the previous few decades, the public health infrastructure had been severely weakened — despite documented evidence that public health and health promotion/disease prevention efforts have led to improvements in health status and economic benefits. No one was certain whether health care reform would weaken this infrastructure or provide an opportunity to strengthen it.

Some policymakers suggested that reforms could relieve many agencies of their responsibility to provide care to underserved groups, allowing them to concentrate on so-called "core" public health services, including epidemiology and data collection, assessing community health needs, and administering health promotion/disease prevention projects.

In 1991, three national public health associations created the Joint Council of Official Public Health Agencies to strengthen the voice of public health. (The group was later renamed the Joint Council of Governmental Public Health Agencies.) The associations involved represented city (U.S. Conference of Local Health Officers or USCLHO), county (National Association of County Health Officials or NACHO), and state and territorial (Association of State and Territorial Health Officials or ASTHO) public health agencies.

At the time of this grant, the Joint Council had received funding to develop recommendations on training of public health workers and other issues from the federal Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). This project was expected to complement the HRSA grant.

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THE PROJECT

This grant from RWJF was designed to help public health agencies better respond to anticipated changes in their role as a result of proposed state and federal reform efforts. PHF, a national nonprofit organization established in 1981, serving as the administrator for the project, contracted with each of the three associations that comprised the Joint Council to fulfill a number of functions of the project. (During the grant period the two associations representing city and county health agencies merged to form the National Association of County and City Health Officials or NACCHO.)

At a three-day planning meeting, members of the Joint Council established goals for the project, including:

  1. To define the role of public health departments in ensuring accountability in a reformed health care system.
  2. To assist public health departments in using the media to market public health.
  3. To determine funding levels needed to perform functions of public health effectively (for a roster of attendees, see Appendix 1).

With the failure of federal health reform in summer 1994, however, project personnel were forced to alter the goals of the project, and chose instead to examine the role of public health agencies in the face of the increasing dominance of health care by managed care. After discussion with RWJF, the Joint Council established a Committee on Quality in Public Health to study the roles of public health and managed care (for a roster of committee members, see Appendix 2).

It also established a work group of federal, state, and local officials to estimate the resources necessary for public health agencies to perform their "core" duties fully (for a roster of the work group, see Appendix 3). In addition to these projects, grant funds were also used to:

  1. Make grants to state and local health organizations to "market" public health (for a roster of advisory group members, see Appendix 4).
  2. Print and distribute a USPHS report on the value of public health.
  3. Conduct three meetings each year of the Joint Council to address pressing public policy concerns.

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RESULTS

  • The Joint Council published Promoting Quality Care for Communities: The Role of Health Departments in an Era of Managed Care. In the report, the Joint Council outlined how health departments could continue to take an active part in ensuring quality health care to communities while working with MCOs. The report described historical strengths of public health and provided guidelines for using these strengths to create a strong central role for itself in a changing health care environment. Some of the observations and recommendations were:
    • State and local health departments have a long history in monitoring, enforcing, and providing technical assistance necessary to preserving the health of communities. All levels of government have a legal responsibility for the safety, health, and well-being of the community, and state governments have statutory mandates to preserve the public's health that include regulatory and licensing responsibilities MCOs.
    • Health departments should expand their quality assurance activities because their expertise can benefit MCOs and the community. MCOs can learn important lessons from health departments about how to deliver population-based services such as disease control. State and local health departments also have expertise in epidemiology — including methods for collecting, measuring, and analyzing data — that would be useful to MCOs as they develop their own quality assessment tools.
    • In order to be seen as credible players, health departments will need to be viewed by other stakeholders as legitimate and competent. Legitimacy is gained in part by demonstrated competence — which health departments can do by applying their expertise in areas such as epidemiology and data collection to the development of health system performance indicators.
    • To become more involved in assessment and monitoring activities, health departments will need to follow certain guidelines. These include:
      1. developing a greater understanding of MCOs.
      2. building on health initiatives already underway.
      3. acting in partnership with other private and public stakeholders.
      4. making data collection and dissemination a priority.
      5. devising plans for selected issues that are of high priority to local communities.
      6. being the initiator of discussions about potential projects since many MCOs may not be familiar with the resources and expertise health departments have to offer.
  • The Joint Council made a study of resource needs, which concluded that funding for state and local health departments would need to double in order for departments to perform their core functions effectively. State and local health departments currently spend $6.4 billion, but would require $11 billion to perform core public health services effectively. These services are:
    • preventing epidemics
    • protecting the environment, workplaces, housing, food, and water
    • promoting healthy behaviors
    • monitoring the population's health status
    • mobilizing community action for health and for responding to disasters
    • assuring quality, accessibility, and accountability of medical care
    • reaching out to link high-risk, disadvantaged populations to needed services
    • providing medical care when needed
    • securing a skilled public health workforce
    • conducting research for new insights and innovative solutions
    • leading the development of sound health policy and planning.
  • The Joint Council made "mini-grants" of up to $4,000 apiece to six state and local health organizations for "marketing" public health efforts. The initiative sought to foster the development of public information and marketing materials about public health to increase awareness of its role, especially to the media, policymakers, and potential opinion leaders. Public health departments in Arkansas, Idaho, Georgia, Illinois, Arizona, and Minnesota received grants (for descriptions of their projects, see Appendix 5).
  • The Joint Council printed and distributed the report For A Healthy Nation: Returns on Investment in Public Health. The report, which was produced by the USPHS, notes that:
    • Life expectancy in the past 50 years has increased 30 years, largely because of public health strategies for disease and injury prevention. Only five of those years are due to improvements in clinical medicine.
    • Investment in public health leads to substantial future savings in medical care, but funding for public health has steadily declined. In 1992, its funding accounted for less than 1 percent of the aggregate amount spent on US health care.
    • Although health care reform could enhance the focus and involvement of the medical care delivery system on population-wide concerns, public health has the fundamental obligation to do so. It has the perspective, research base, incentives, and leverage to carry out these basic responsibilities.

Communications

A U.S. Public Health Services report, For A Healthy Nation: Returns on Investment in Public Health, was released at a press conference, and more than 2,000 copies were distributed to members of Congress, senior government health officials, national health associations, private health organizations, and others. Coverage of the report appeared in Faulkner & Gray's Medicine and Health and other professional and trade publications. A Joint Council report, Promoting Quality Care for Communities: The Role of Health Departments in an Era of Managed Care, was distributed. (See the Bibliography for more details.)

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GRANT DETAILS & CONTACT INFORMATION

Project

Public Health's Role in Preparing for Health Care Reform

Grantee

Public Health Foundation (Washington,  DC)

  • Amount: $ 182,585
    Dates: January 1994 to February 1996
    ID#:  023110

Contact

Jordan H. Richland, M.P.H.
(202) 898-5600

Web Site

http://www.phf.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Participants at the Joint Council Planning Retreat, February 11-13, 1994

Susan S. Addiss, M.P.H., M.U.R.S.
Commissioner
Connecticut Department of Public Health and Addiction Services

Christopher Atchison
Association of State and Territorial Health Officials

Willa Fisher
National Association of County and City Health Officials

Jane Ford
United States Conference of Local Health Officers

Liza Greenberg, R.N., M.P.H.
Association of State and Territorial Health Officials

Robert Harmon
Meeting Facilitator

B.J. Harris
United States Conference of Local Health Officers

Kathy Jourdan
Public Health Foundation

Mary Kendrick
United States Conference of Local Health Officers

Roz Lasker, M.D., M.P.H.
Office of the Assistant Secretary of Health
U.S. Department of Health and Human Services
(now at the New York Academy of Medicine)

Doug Lloyd
U.S. Health Resources and Services Administration

John Lumpkin
Association of State and Territorial Health Officials
(now a senior vice president at the Robert Wood Johnson Foundation)

Mary McGlothlin
Director
Washington County Health Department, Minnesota

Paul Nannis
Director
Milwaukee Health Department, Wisconsin

Nancy Rawding, M.P.H.
Executive Director
National Association of County and City Health Officials

Jordan H. Richland, M.P.H.
Deputy Director
Public Health Foundation
(now executive director of the American College of Preventive Medicine)


Appendix 2

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Committee on Quality in Public Health

Maurice Mullet, M.D.
Holmes and Knox County Health Departments, Ohio

Patrick Lenihan
Chicago Department of Health

Joshua Lipsman, M.D., M.P.H.
Alexandria Health Department, Virginia

Judith Sartucci, R.N., M.S.
Connecticut Department of Health

Elizabeth Ward, R.N., M.N.
Washington Department of Health
(now with the Foundation for Health Care Quality)

Martin Wasserman, M.D., J.D.
Maryland Department of Health and Mental Hygiene

Report author: Karen Troccoli, M.P.H.
National Association of County and City Health Officials


Appendix 3

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Work Group on Resources Needed to Support Core Public Health Functions

H. Douglas Adams
Director, Division of Administration
Missouri Department of Health

Susan S. Addiss, M.P.H., M.U.R.S.
Commissioner
Connecticut Department of Public Health and Addiction Services

Michael A. Barry
Public Health Foundation

Eric T. Baumgartner, M.D., M.P.H.
Louisiana Office of Public Health
(now with HRSA Community Access Program)

Richard M. Biery, M.D., M.P.H.
Director of Health
Kansas City Health Department, Missouri

James T. Dimas
Public Health Foundation

Sheldon B. Elman, M.P.A.
Director of Administrative Services
Utah Department of Health

Randolph L. Gordon
Acting Director, Division of Public Health Services
Centers for Disease Control and Prevention

Debbie Maiese, M.P.A.
Senior Prevention Policy Advisor
US Office of Disease Prevention and Health Promotion

Robert Pestronk, M.P.H.
Health Officer
Genessee County Health Department, Michigan

Jordan H. Richland, M.P.H.
Deputy Director
Public Health Foundation
(now executive director of the American College of Preventive Medicine)

Frances M. Veverka, R.S., M.P.H.
Delaware Health Department (CFHS), Ohio


Appendix 4

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Advisory Group on Public Health Marketing Initiative

Association of State and Territorial Health Officials

Bill Waters, Ph.D.
Deputy Director
Rhode Island Department of Health

Staff: Liza Greenberg, R.N., M.P.H.
Director of Program Development

National Association of County and City Health Officials

Mary McGlothlin
Director
Washington County Health Department, Minnesota

Staff: Nancy Rawding, M.P.H.
Executive Director

United States Conference of Local Health Officers

Paul Nannis
Director
Milwaukee Health Department, Wisconsin

Staff: B.J. Harris
Executive Director

American Public Health Association

Steven Uranga McKane
WK Kellogg Foundation

Staff: Rachel Dale
Director of Public Relations

National Public Health Information Coalition

Joanna Bell
Director, Public Health Information
Rhode Island Department of Health

Public Health Foundation

Staff: Jordan H. Richland, M.P.H.
Deputy Director


Appendix 5

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Mini-grant Recipients for Marketing Public Health

Arizona
Arizona Department of Health Services and the Arizona Public Health Agency (AzPHA) activities included localizing public health marketing materials developed by AzPHA, holding a policy conference, identifying success stories and photo ops with local health departments, and disseminating material to local and state policymakers. Materials were also distributed at Arizona's second public health week in April 1995.

Arkansas
The Arkansas Department of Health teamed with the NBC affiliate to create a statewide media campaign on the need for public health. To do this, staff prepared a press kit, brochures and a PSA, and used the state's 800 hotline for supplying additional information.

Georgia
Joint efforts of the Georgia Public Health Agency, the Georgia Department of Health Resources, and "Friends of Public Health" built on previous activities, which included videotapes and brochures developed as part of a state comprehensive marketing plan. Other activities included developing fact sheets about core public health services in the state, Q&A sheets, a spokesperson kit, sample letters to the editor, community action sheets and training of community members on communication/dissemination strategies.

Idaho
The Idaho Association of District Health Boards, representing all local health districts in the state, sought to educate policymakers in the state legislature and gubernatorial candidates noting that state funds cannot be used to market public health. Project activities included distribution of a position paper and brochure on the role of public health, personal briefings of policymakers and the media, development of PSAs and success stories and newspaper advertisements.

Illinois
The Illinois Public Health Agency project involved a wide range of public and private public health groups in the state conducting numerous activities. These included: town meetings about public health and health care reform; four to six editorial board meetings in major media markets for the purpose of obtaining editorials and in-person briefings for members of and candidates for the Cook County Board of Commissioners.

Minnesota
The Minnesota Department of Health developed the project jointly with several public health organizations. Materials and activities included developing marketing materials and a manual for public health practitioners that would help them have greater impact in their communities. The kit was distributed at the annual Community Health Conference, attended by 300-400 state and local public health staff and officials.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

U.S. Department of Health and Human Services, Public Health Service. For a Healthy Nation: Returns on Investment in Public Health. Washington: 1994. 2000 copies distributed.

Joint Council Committee on Quality in Public Health. Promoting Quality Care for Communities: The Role of Health Departments in an Era of Managed Care. Washington: June 1996.

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Report prepared by: Janet Spencer King
Reviewed by: Richard Camer
Reviewed by: Robert Narus
Program Officer: Michael P. Beachler