NSU Public Health and State Agencys Structure Discussion

NSU Public Health and State Agencys Structure Discussion

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CHAPTER 5 Organization of the Public Health System Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. Learning Objectives ▪ To identify the responsibilities of the major federal agencies composing the public health infrastructure ▪ To recognize new trends in oversight of public health programs ▪ To be familiar with the different types of administrative relationships that states have with local health departments ▪ To define a local health department and its key functions and responsibilities Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ To distinguish the major roles of federal, state, and local governmental entities, as well as nongovernmental organizations, in creating and implementing public health policies and programs Chapter Overview ▪ Public health system is a constellation of organizations, both governmental and private, that contribute to the delivery of core public health services for a defined population ▪ In some communities these systems are well defined and coordinated; in other communities, the systems are fragmented and diffuse Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Understanding organizational and structural characteristics is required Governmental Organizations ▪ Organization flows directly from the limited federalist system of government ▪ Agencies are important actors because of their ability to formulate and implement a policy agenda and allocate health resources across public priorities ▪ Federal agencies use a variety of policy and administrative instruments Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Responsibilities evolve in response to needs/demands Figure 5.1: HHS Organizational Chart Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Reproduced from U.S. Department of Health and Human Services. U.S. Department of Health and Human Services organizational chart. [Online] Available at: http://www.hhs.gov/about/orgchart/. Accessed 2020. Health and Human Services (HHS) ▪ National Institutes of Health (NIH) ▪ Food and Drug Administration (FDA) ▪ Indian Health Service (IHS) ▪ Substance Abuse and Mental Health Services Administration Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Health Resources and Services Administration (HRSA) Federal Policy and Administrative Instruments ▪ Health resource allocation ▪ Information production and dissemination ▪ Policy advocacy and agenda setting Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Regulatory development and enforcement Centers for Disease Control and Prevention (CDC) ▪ CDC Offices: – Surveillance, Epidemiology, Laboratory Services – Noncommunicable Diseases, Injury and Environmental Health – Infectious Diseases Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Administers programs to prevent and control specific disease, injury, and disability risks through epidemiologic surveillance, investigation, research CDC Organization ▪ CDC’s major organizational components respond individually in their areas of expertise and pool their resources and expertise on cross-cutting issues and specific health threats Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The CDC is one of the major operating components of the Department of Health and Human Services Figure 5.2: Centers for Disease Control and Prevention Organizational Chart Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Reproduced from Centers for Disease Control and Prevention. Department of Health and Human Services Centers for Disease Control and Prevention (CDC) chart. http://www.cdc.gov/maso/pdf/CDC_Chart_wNames.pdf. Accessed 2019. Coordinating Center for Environmental Health and Injury Prevention ▪ National Center for Injury Prevention and Control (NCIPC) prevents death and disability from nonoccupational injuries, including those that are unintentional and those that result from violence Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH-ATSDR) provides national leadership in preventing and controlling disease and death resulting from the interactions between people and their environment Coordinating Center for Health Information and Services ▪ National Center for Public Health Informatics (NCPHI) provides national leadership in the application of information technology in the pursuit of public health ▪ National Center for Health Marketing (NCHM) provides national leadership in health marketing science and in its application to impact public health Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ National Center for Health Statistics (NCHS) provides statistical information that guides actions and policies to improve the health of the American people Coordinating Center for Health Promotion ▪ National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) prevents premature death and disability from chronic diseases and promotes healthy personal behaviors. ▪ Office of Genomics and Disease Prevention provides national leadership in fostering understanding of human genomic discoveries and how they can be used to improve health and prevent disease Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ National Center on Birth Defects and Developmental Disabilities (NCBDDD) provides national leadership for preventing birth defects and developmental disabilities and for improving the health and wellness of people with disabilities. Coordinating Center for Infectious Disease (1 of 2) ▪ National Immunization Program (NIP) prevents disease, disability, and death from vaccine-preventable diseases in children and adults ▪ National Center for HIV, STD, and TB Prevention (NCHSTP) provides national leadership in preventing and controlling human immunodeficiency virus infection, sexually transmitted diseases, and tuberculosis Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ National Center for Infectious Diseases (NCID) prevents illness, disability, and death caused by infectious diseases in the United States and around the world Coordinating Center for Infectious Disease (2 of 2) ▪ Coordinating Office for Terrorism Preparedness & Emergency Response provides strategic direction for the Agency to support terrorism preparedness and emergency response efforts ▪ National Institute for Occupational Safety and Health (NIOSH) ensures safety and health for all people in the workplace through research and prevention Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Coordinating Office for Global Health provides national leadership, coordination, and support for CDC’s global health activities in collaboration with CDC’s global health partners Other Agencies of the U.S. Public Health Service (1 of 6) ▪ The Maternal and Child Health Bureau within the HRSA administers an array of services and programs designed to increase the timely delivery and uptake of prenatal, infant, and child health services in order to ensure the health of children and their families Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The HRSA administers $12 billion in federal programs designed to expand public access to health care professionals and facilities, particularly in underserved areas Other Agencies of the U.S. Public Health Service (2 of 6) – Reduce infant mortality – Provide comprehensive care for women before, during, and after pregnancy and childbirth – Reduce adolescent pregnancy – Improve childhood vaccination coverage – Meet the nutritional and developmental needs of children and their families Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The Bureau administers grants to states through the Maternal and Child Health Services Block Grant, which supports programs designed to: Other Agencies of the U.S. Public Health Service (3 of 6) ▪ The Agency for Healthcare Research and Quality (AHRQ) administers a much smaller research enterprise by comparison to NIH ▪ The Agency’s sponsored research generally focuses on the organization, delivery, and financing of health services—which includes prevention and public health services but often emphasized medical care services ▪ Issues of healthcare quality and accessibility are additional research areas with particular relevance to public health activities Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The nation’s leading agency for funding and administering health research and demonstration initiatives is the NIH Other Agencies of the U.S. Public Health Service (4 of 6) ▪ Through its information dissemination activities, the agency maintains strong relationships with major health profession organizations and health care financing organizations ▪ The FDA functions as the nation’s largest consumer protection agency by administering regulatory programs to ensure the safety of food, cosmetics, medicines, medical devices, and radiation-emitting products Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The Agency is especially active in the development of clinical practice guidelines and strategies for evidence-based clinical practice grounded in sound scientific research Other Agencies of the U.S. Public Health Service (5 of 6) ▪ The HHS maintains several offices at the departmental level that are designed to coordinate public health activities across the major agencies and units within the department ▪ These offices help the department as a whole to realize opportunities for crossagency collaboration in addressing major public health issues that span multiple areas of operation and expertise ▪ The Office of the Surgeon General, perhaps the most widely known departmental office, serves as the nation’s leading spokesperson for public health issues Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ CMS administers medical care financing programs that include the Medicare program for disabled and elderly individuals, and the Medicaid and SCHIP programs for low-income families and children Other Agencies of the U.S. Public Health Service (6 of 6) ▪ The Office of Disease Prevention and Health Promotion works to coordinate federal preventive health programs across the department, including the effort to develop and monitor national health promotion and disease prevention objectives for the nation through the Healthy People 2000 and Healthy People 2010 programs Source: U.S. Department of Health and Human Services, Health People 2000: National Health Promotion and Disease Prevention Objectives (Washington, DC: U.S. Government Printing Office, 1991.) U.S. Department of Health and Human Services, Healthy People 2010, Conf. ed. (Washington, DC: U.S. Government Printing Office, 2000). Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The surgeon general also oversees the Commissioned Corps of the U.S. Public Health Service, a collection of more that 6,000 federal health professionals who provide first-response intervention in the event of national public health emergencies Other Federal Agencies with Public Health Responsibilities (1 of 3) ▪ Environmental Protection Agency ▪ Department of Housing and Urban Development ▪ Department of Education ▪ Department of Labor Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Department of Agriculture Other Federal Agencies with Public Health Responsibilities (2 of 3) ▪ Among the best-known public health programs administered by this department is WIC ▪ The EPA develops and enforces a wide array of environmental health and safety programs Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The Department of Agriculture sponsors an array of health-related programs involving nutritional support, migrant health, food safety, and the prevention of occupational exposure to pesticides Other Federal Agencies with Public Health Responsibilities (3 of 3) ▪ The Department of Education maintains programs to address the health education and health services needs of students ▪ The Department of Labor administers programs to promote health and safety in the workplace Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The Department of Housing and Urban Development administers programs to address the health and social problems of populations residing in public housing facilities, homeless shelters, and economically disadvantaged communities State Health Agencies (1 of 9) – Free-standing – Organizational unit within a larger superagency ▪ In 45% of states, health agency is located within a superagency structure ▪ Most states do not consolidate public health responsibilities ▪ 50% states statutorily require the senior health official to have a medical degree Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Organization generally follows two basic models: State Health Agencies (2 of 9) ▪ In these states, the health agency does not occupy a cabinet-level representation for public health issues along with other issues within its purview ▪ An example of this organizational model is found in North Carolina’s Department of Health and Human Services Source: M. Matalit et al., Transforming State Health Agencies To Meet Current and Future Challenges (Washington, DC: National Governors Association, 1997.) Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ In other states, the health agency is organized within a superagency structure that also includes agencies that administer non–health-related activities such as social services and environmental programs State Health Agencies (3 of 9) ▪ Rather, these functions are typically distributed across an array of separate departments and agencies Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Regardless of the organizational model used, most states do not consolidate all public health responsibilities within a single governmental agency State Health Agencies (4 of 9) ▪ A key feature in the organization and operation of state health agencies is the administrative relationship between the state agency and the local public health agencies that operate within the state Source: G.H. DeFriese et al., “The Program Implications of Administrative Relationships between Local Health Departments and State and Local Government,” American Journal of Public Health 71, no. 10 (1981):1,109-1,115. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Consensus has yet to be reached concerning the optimal organizational structure for a state health agency, as states aggregate and disaggregate their state health agencies continually—usually in response to leadership changes at the governor or cabinet levels State Health Agencies (5 of 9) ▪ State health agencies rely heavily on local public health agencies to implement health administrative authority over the operation of these local agencies ▪ State agencies may establish operating rules for the local agencies and make key decisions regarding agency staffing, financing, and organization ▪ Such centralized administrative relationships exist in 10 states Source: G.H. DeFriese et al. “The Program Implications of Administrative Relationships between Local Health Departments and State and Local Government,” American journal of Public Health 71, no. 10 (1981):1,109-1,115. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ This relationship varies substantially from state to state, depending largely on the governmental powers that are delegated to local governments under state constitutions and state legislation State Health Agencies (6 of 9) ▪ With home rule authority, local governments can adopt their own local constitutions and exercise a broad range of governmental powers usually reserved for states, such as the levying and collection of taxes to support local programs and services Source: U.S. Centers for Disease Control and Prevention, Public Health Practice Program Office, Profile of State and Territorial Public Health Systems: United States, 1990 (Atlanta, GA: 1991). Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Two-thirds of the states extend home rule authority to local governments or grant these governments the option of assuming this authority State Health Agencies (7 of 9) ▪ In two other states (Vermont and Hawaii), the state agency operates regional offices that function as local public health agencies Source: U.S. Centers for Disease Control and Prevention, Public Health Practice Program Office, Profile of State and Territorial Public Health Systems: United States, 1990 (Atlanta, GA: 1991). Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Three of these states (Delaware, Rhode Island, and Alaska) do not contain any local public health agencies and are therefore served only by the state health agency State Health Agencies (8 of 9) ▪ This shared authority model exists in 7 states Source: G.H. DeFriese et al. “The Program Implications of Administrative Relationships between Local Health Departments and State and Local Government,” American journal of Public Health 71, no. 10 (1981):1,109-1,115. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Other states operate with a third type of administrative relationship in which local health agencies are subject to the shared authority of both the state agency and the local government State Health Agencies (9 of 9) ▪ The mixed authority model predominates among states that extend home rule authority to some local governments but not others Source: U.S. Centers for Disease Control and Prevention, Public Health Practice Program Office, Profile of State and Territorial Public Health Systems: United States, 1990 (Atlanta, GA: 1991). Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ In the remaining 16 states, state health agencies maintain decentralized relationships with local health agencies in some jurisdictions within the state while exercising centralized administrative control over agencies in other jurisdictions Figure 5.3: Washington State Department of Health Organizational Chart Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Washington State Department of Health. www.doh.wa.gov/AboutUs/ProgramsandServices/OrganizationChart.aspx Figure 5.4: Organizational Chart for North Carolina’s Department of Health and Human Services Division of Public Health Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Reprinted from North Carolina Department of Health and Human Services. https://www.ncdhhs.gov/about/overview. Accessed March 31, 2020. State Agencies Contributing to Public Health ▪ Human services ▪ Labor ▪ Insurance ▪ Transportation ▪ Housing ▪ Agriculture ▪ Governor’s office Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Environmental protection Standards to Improve Community Health and Safety (1 of 2) ▪ Protect people from health problems and hazards ▪ Give people information make healthy choices ▪ Engage community to identify and solve ▪ Develop public health policies and plans ▪ Enforce public health laws and regulations ▪ Help people receive health services Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Monitor health status and understand health issues Standards to Improve Community Health and Safety (2 of 2) ▪ Evaluate and improve programs and interventions ▪ Contribute and apply evidence base for public health Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Maintain a competent public health workforce Local Governmental Agencies in Public Health Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Local governmental public health agencies retain the most direct and immediate responsibility for performing public health activities at the community level Operational Definition of a Local Health Department ▪ Source: www.naccho.org ▪ An LHD is defined as the public health government entity at the local level, including locally governed health department; a state-created district department serving a multi-county area or any other level Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Governmental public health departments are responsible for creating and maintaining conditions that keep people healthy Figure 5.5: Percentage Distribution of LHDs, by Type of Geographic Jurisdiction Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Data from National Association of County and City Health Officials. 2010 National Profile of Local Health Departments. Washington, DC: NACCHO; 2011 Figure 5.6: Percentage Distribution of LHDs, by Size of Population Served Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Data from National Association of County and City Health Officials. 2010 National Profile of Local Health Departments. Washington, DC: NACCHO; 2011 Figure 5.7: Percentage of Total Annual LHD Revenues, by Revenue Source Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Data from National Association of County and City Health Officials. 2010 National Profile of Local Health Departments. Washington, DC: NACCHO; 2011 A Functional Local Health Department (1 of 5) ▪ Investigates health problems and health threats ▪ Prevents, minimizes, and contains adverse health effects from communicable diseases, disease outbreaks from unsafe food and water, chronic diseases, environmental hazards, injuries, and risky health behaviors Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Understands the specific health issues confronting the community, and how physical, behavioral, environmental, social, and economic conditions affect them A Functional Local Health Department (2 of 5) ▪ Collaborates with other local responders and with state and federal agencies to intervene in other emergencies with public health significance (e.g., natural disasters) ▪ Implements health promotion ▪ Engages the community to address public health issues Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Leads planning and response activities for public health emergencies A Functional Local Health Department (3 of 5) ▪ Coordinates the public health system’s efforts in an intentional, noncompetitive, and nonduplicative manner Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Develops partnerships with public and private healthcare providers and institutions, community-based organizations, and other government agencies (e.g., housing authority, criminal justice, education) engaged in services that affect health to collectively identify, alleviate, and act on the sources of public health problems A Functional Local Health Department (4 of 5) ▪ Serves as an essential resource for local governing bodies and policymakers on up-to-date public health laws and policies ▪ Provides science-based, timely, and culturally competent health information and health alerts to the media and to the community ▪ Provides its expertise to others who treat or address issues of public health significance ▪ Ensures compliance with public health laws and ordinances, using enforcement authority when appropriate Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Addresses health disparities A Functional Local Health Department (5 of 5) ▪ Facilities research efforts, when approached by researchers, that benefit the community ▪ Uses and contributes to the evidence base of public health ▪ Strategically plans its services and activities; evaluates performance and outcomes; and makes adjustments as needed to continually improve its effectiveness, enhance the community’s health status, and meet the community’s expectations Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Employs well-trained staff members who have the necessary resources to implement best practices and evidence-based programs and interventions Local Health Department Standards (1 of 11) Monitor health status and understand health issues facing the community – Obtain and maintain data that provide information on the community’s health (e.g., provider immunization rates; hospital discharge data; environmental health hazard, risk, and exposure data; community-specific data; number of uninsured; and indicators of health disparities such as high levels of poverty, lack of affordable housing, limited or no access to transportation, etc.) – Develop relationships with local providers and others in the community who have information on reportable diseases and other conditions of public health interest and facilitate information exchange Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. Local Health Department Standards (2 of 11) 2. Protect people from health problems and health hazards – Investigate health problems and environmental health hazards – Prevent, minimize, and contain adverse health events and conditions resulting from communicable diseases; food-, water-, and vector-borne outbreaks; chronic diseases; environmental hazards; injuries; and health disparities Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com – Conduct or contribute expertise to periodic community health assessments – Integrate data with health assessment and data collection efforts conducted by others in the public health system – Analyze data to identify trends, health problems, environmental health hazards, and social and economic conditions that adversely affect the public’s health Local Health Department Standards (3 of 11) Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com – Coordinate with other governmental agencies that investigate and respond to health problems, health disparities, or environmental health hazards – Lead public health emergency planning, exercises, and response activities in the community in accordance with the National Incident Management System, and coordinate with other local, state, and federal agencies – Fully participate in planning, exercises, and response activities for other emergencies in the community that have public health implications, within the context of state and regional plans and in a manner consistent with the community’s best public health interest – Maintain access to laboratory and biostatistical expertise and capacity to help monitor community health status and diagnose and investigate public health problems and hazards – Maintain policies and technology required for urgent communications and electronic data exchange Local Health Department Standards (4 of 11) Give people information they need to make health choices – Develop relationships with the media to convey information of public health significance, correct misinformation about public health issues, and serve as an essential resource – Exchange information and data with individuals, community groups, other agencies, and the general public about physical, behavioral, environmental, social, economic, and other issues affecting the public’s health – Provide targeted, culturally appropriate information to help individuals understand what decisions they can make to be healthy – Provide health promotion programs to address identified health problems Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 3. Local Health Department Standards (5 of 11) Engage the community to identify and solve health problems – Engage the local public health system in an ongoing, strategic, community-driven, comprehensive planning process to identify, prioritize, and solve public health problems; establish public health goals; and evaluate success in meeting the goals – Promote the community’s understanding of, and advocacy for, policies and activities that will improve the public’s health – Support, implement, and evaluate strategies that address public health goals in partnership with public and private organizations – Develop partnerships to generate interest in and support for improved community health status, including new and emerging public health issues – Inform the community, governing bodies, and elected officials about governmental public health services that are being provided, improvements being made in those services, and priority health issues not yet being adequately addressed Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 4. Local Health Department Standards (6 of 11) Develop public health policies and plans – Serve as a primary resource to governing bodies and policymakers to establish and maintain public health policies, practices, and capacity based on current science and best practices Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 5. Local Health Department Standards (7 of 11) Enforce public health laws and regulations – Review existing laws and regulations and work with governing bodies and policymakers to update them as needed – Understand existing laws, ordinances, and regulations that protect the public’s health – Educate individuals and organizations on the meaning, purpose, and benefit of public health laws, regulations, and ordinances and how to comply – Monitor, and analyze over time, the compliance of regulated organizations, entities, and individuals – Conduct enforcement activities – Coordinate notification of violations among other governmental agencies that enforce laws and regulations that protect the public’s health Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 6. Local Health Department Standards (8 of 11) Help people receive health services – Engage the community to identify gaps in culturally competent, appropriate, and equitable personal health services, including preventive and health promotion services, and develop strategies to close the gaps – Support and implement strategies to increase access to care and establish systems of personal health services, including preventive and health promotion services, in partnership with the community – Link individuals to available, accessible personal healthcare providers (i.e., a medical home) Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 7. Local Health Department Standards (9 of 11) Maintain a competent public health workforce – Recruit, train, develop, and retain a diverse staff – Evaluate LHD staff members’ public health competencies, and address deficiencies through continuing education, training, and leadership development activities – Provide practice- and competency-based educational experiences for the future public health workforce, and provide expertise in developing and teaching public health curricula, through partnerships with academia – Promote the use of effective public health practices among other practitioners and agencies engaged in public health interventions – Provide the public health workforce with adequate resources to do their jobs Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 8. Local Health Department Standards (10 of 11) Evaluate and improve programs and interventions – Develop evaluation efforts to assess health outcomes to the extent possible – Apply evidence-based criteria to evaluation activities where possible – Evaluate the effectiveness and quality of all LHD programs and activities and use the information to improve LHD performance and community health outcomes – Review the effectiveness of public health interventions provided by other practitioners and agencies for prevention, containment, and/or remediation of problems affecting the public’s health, and provide expertise to those interventions that need improvement Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 9. Local Health Department Standards (11 of 11) – When researchers approach the LHD to engage in research activities that benefit the health of the community: o Identify appropriate populations, geographic areas, and partners o Work with them to actively involve the community in all phases of research o Provide data and expertise to support research o Facilitate their efforts to share research findings with the community, governing bodies, and policymakers – Share results of research, program evaluations, and best practices with other public health practitioners and academics – Apply evidence-based programs and best practices where possible Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 10. Contribute to and apply the evidence base of public health Organizational Structure (1 of 2) ▪ These boards vary widely in their structure and function ▪ Nearly two-thirds of the nation’s local health departments serve jurisdictions of less than 50,000 residents Source: National Association of County and City Health Officials, National Profile of Local Health Departments (Washington, DC: NACCHO, 2006.) Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The vast majority of local public health agencies (74%) operate in tandem with a local board of health Organizational Structure (2 of 2) ▪ By comparison, departments serving the nation’s largest jurisdictions—those with more than 500,000 residents—make up only 6% of all local health departments but they serve 54% of the U.S. population ▪ The remaining 32% of departments operate in jurisdictions of between 50,000 and 500,000 residents and collectively serve 37% of the U.S. population Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Collectively, these departments serve only 10% of the total U.S. population Nongovernmental Public Health Organizations ▪ Ambulatory care providers ▪ Health insurers and managed care plans ▪ Nonprofit agencies ▪ Philanthropic foundations ▪ Universities Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Community hospitals and health systems Inter-Organizational Efforts ▪ Motivations for engaging in varied and range from economic gain to community health improvement ▪ IOM urged a “health in all policies” approach – Health is an important consideration in decision-making by diverse governmental and private actors Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Relationships improve quality, efficiency, and accessibility as in other fields of practice Future Outlook ▪ Broader view of what constitutes public health-promoting policies ▪ Expanding data collection capabilities and measurement efforts Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Additional financial investment required Discussion Questions (1 of 3) ▪ How has governmental oversight of public health programs changed in the last several decades? ▪ What are some of the mechanisms through which the federal government funds and oversees state and local public health efforts? Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Discuss the concept of public health as a public good. What does this suggest about the responsibility for funding and overseeing public health programs? Discussion Questions (2 of 3) ▪ What might be some of the benefits and disadvantages of the two major types of state health agency organizational structures? ▪ How does home rule authority affect a state health agency’s ability to direct public health activities in local jurisdictions? Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ How has CDC’s scientific agenda changed in recent years? Discuss what factors you think may be driving this change. Discussion Questions (3 of 3) ▪ How do nongovernmental organizations contribute to public health efforts? ▪ What might be some of the challenges in pursuing a “health in all policies” approach? ▪ How do you think maintenance of the U.S. public health infrastructure might be achieved in an era of fiscal restraint? Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Do you think clinical primary care functions should be distinguished from more traditional public health agency responsibilities?