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A Regional Public Health System in NH

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Title: A Regional Public Health System in NH


1
A Regional Public Health System in NH
  • What Do We Have Now?
  • Why Regionalize?
  • How Do We Make a Case for Regional
  • Public Health in a State Like NH?
  • What Would Change?

2
What Does Public Health Look Like in NH Today?
  • Each of New Hampshires 234 cities and towns
    are required by law to have a health officer
  • Only five New Hampshire communities maintain
    public health departments of various size
    no county health departments
  • At the State level, DHHS is the lead public
    health agency. The Department of Environmental
    Services, Department of Education, and
    Department of Safety also play key roles
  • In almost all New Hampshire communities,
    non-governmental organizations provide a
    significant sub-set of public health services

3
2004 New Hampshire Public Health Network
Assuring the health and safety of all NH
residents
  • 14 Coalitions
  • 118 Towns
  • 50 of NH towns
  • 70 of the NH population



    covered
  • 5-11 communities per coalition

4
All Health Hazard Regions
  • Organized to plan for and respond to public
    health emergencies
  • 19 Regions

5
And more maps for other services
  • Community health centers
  • Tobacco coalitions
  • WIC services
  • HIV prevention
  • Etc, etc, etc.

6
(No Transcript)
7
Why Regionalization?
8
Potential Benefits of Regionalization
  • Study in the AJPH, March 2006 examined
    performance of public health agencies, size and
    resources
  • It noted that small public health agencies may
    benefit by combining resources and operations
  • But gains may diminish with size too big is not
    good (but NH is small in both geography and
    population)

Mays, G, McHugh, M et al. AJPH, March 2006 Vol.
96, No. 3
9
Regionalization Goal
  • Overall Goal A performance-based public health
    delivery system, which provides all 10 essential
    public health services throughout New Hampshire
  • Provide high quality public health based on
    national standards

10
Why do we need regional public health in one of
the healthiest states?
  • What is killing us and making us sick today are
    chronic illnesses (heart disease, cancer,
    respiratory disease, injuries)
  • Many of the contributing factors to these are
    preventable tobacco, diet, physical activity,
    alcohol consumption
  • Well-run community based public health programs
    can prevent these problems
  • Money can be saved

11
What is Public Health ?
  • The study and practice of managing threats to the
    health of a community or population
  • The public health approach is applied to
    populations ranging from a handful of people to
    the whole human population
  • Priorities are to prevent (rather than treat) a
    disease or injury through the study of cases
    promoting healthy behaviors preventing the
    spread of disease and addressing policy issues.

12
.
How does public health differ from health care?
  • Individual vs. Populations

13
Example- Smoking
  • Health care response
  • Treat an individual for smoking related health
    problems asthma, pneumonia, heart disease,
    cancer, etc.
  • Counsel to quit smoking
  • Provide nicotine replacement therapy
  • Public Health Response
  • Study the effects of tobacco Surgeon Generals
    report
  • Labeling of cigarettes
  • Public information campaigns
  • Promote policies such as non-smoking workplaces
  • Enforcement of laws such as limiting tobacco
    sales to minors

14
Public Health Goes to You
  • Unlike personal health care services, in many
    cases the public does not have to travel to
    receive public health services
  • Public health staff go out to do investigations
  • Public health staff analyze diseases by
    populations
  • Public health education campaigns are delivered
    where people go or access information (radio,TV,
    billboards, schools, workplaces, etc.)
  • So public health regions do not need to align
    exactly with hospitals or doctors offices service
    areas

15
Public Health Saves Money
  • 10 per person per year in proven community-based
    disease prevention (improvements in physical
    activity, nutrition and preventing smoking) could
    yield saving of 2.8 billion in health care costs
    in 2 years
  • Thats 2 in return for every 1 invested in the
    first 1-2 years
  • Prevention for a Healthier AmericaInvestments in
    Disease Prevention Yield Significant Savings,
    Stronger Communities. Trust for Americas Health
    July 2008 www.healthyamericans.org

16
Obesity for example
  • 23.6 population is obese, 61.8 are overweight
    or obese significant increase from 2005-2007
  • NH ranks 35th in the nation, despite having the
    lowest poverty rate
  • Worst in New England ¹
  • For the first time in 2 centuries our childrens
    life expectancy is potentially less than ours
    (2-5 years) due to obesity and related factors
    (diabetes, heart disease, kidney failure, cancer)

F as in Fat How Obesity Policies are Failing in
America 2008, Trust for Americas Health, August
2008 www.healthyamericans.org NEJM March 2005
17
Example - Obesity
  • Health Care Response
  • Treatment for conditions such as heart disease,
    high blood pressure, diabetes, cholesterol
  • Nutritional counseling
  • Bariatric surgery
  • Public Health Response
  • Working with schools to provide healthy lunch
    menus
  • Working with community coalitions to develop
    walkable communities
  • Assist in developing policies for physical
    activities in schools

18
The 10 Essential Public Health Services
19
The Proposed Approach
  •  The DPHS and Regionalization Initiative
    workgroup envision one lead public health agency
    per region. It must be linked a governmental
    entity that is responsible to coordinate or
    directly provide the 10 essential services. The
    lead agency may subcontract or create memoranda
    of understanding for some essential services
  • Regions based on existing ones (many are quite
    similar) and take into account geographic
    features, existing public health services and
    population size
  • Two levels of public health (primary and
    comprehensive) that acknowledge existing
    resources and capacity to carry out public health
    services. Comprehensive Manchester and
    Nashua
  • Primary everywhere else

20
Approach
  • Will be based on national standards for what a
    public health agency should look like and how it
    should perform
  •  Will be an evolutionary process some may not
    meet all components of a primary agency from the
    beginning but will move there in time.
  •  Will require changes to state law.

21
The Role of Government in Public Health
  • Assessment Takes into account all relevant
    factors to the extent possible, based on
    objective factors, without self-interest
  • Policy Development Takes place as a result of
    interactions among public and private
    organizations
  • Assurance Assures that necessary services are
    provided to reach agreed upon goals by
    encouraging the private sector, requiring it, or
    providing services directly

22
A Primary Regional Public Health Agency
  • Staff, funding, and legal recognition to assure a
    fundamental public health presence
  • Performs some level of the 10 essential services
  • Collaborates extensively with system partners in
    the region to coordinate more comprehensive
    services
  • The NH DPHS continues to provide some core
    services (i.e.. lab, disease investigations) to
    these regions
  • Coordinates with local health officers or move
    towards shared health officer among municipalities

23
Proposed Staffing
  • Every region would have
  • Administrator
  • Health educator/marketing staff
  • Nurse (?)
  • Environmental health specialist
  • Support staff
  • Shared across regions
  • Epidemiologist
  • Emergency preparedness coordinator
  • Medical consultant
  • (Shared or in-kind)
  • Financial manager
  • IT support

24
How is this Different than the Public Health
Networks?
  • Proposal that there be a legally-recognized
    regional public health council which
  • Designates a lead public health entity that
  • Is responsible to the council and regional public
    health system partners for
  • Implementing a coordinated approach to provide
    public health services to the public

25
Next Steps-What Do We Have?
  • Assessments to Help Us Determine, Resources,
    Costs, Needs and Approach
  • June 2008- February 2010
  • Financial analysis of all state/local/private
    public health funding with consideration of
    efficiencies from regionalization Patrick
    Bernet, FAU
  •  Assessment of local/regional public health
    system capacity to deliver the 10 essential
    services- with a gaps analysis Lea Lafave, CHI
  •  Assessment of what the link to government could
    look like - Jennifer Wierwille Norton

26
Financial Assessment
  • To gain an understanding of current public health
    expenditures in each region and for the state as
    a whole
  • Will capture state, municipal and private-sector
    funding
  • To try to understand the potential financial
    implications of regionalizing select public
    health services

27
Capacity Assessment
  • Purpose
  • To identify assess and gaps in the region and
    these that may lend themselves to
    regionalization.
  • Process
  • Framework of the National Association of City and
    County Health Officials
  • Essential Service
  • Standard
  • Indicator
  • Revised Tool
  • Lead organization Regional Partners State

28
What is the Governance Assessment?
  • Focuses on figuring out whos responsible or held
    accountable not doing the work but overseeing
    it
  • Whos overseeing performance of the public health
    entities who are partners.
  • Whos assessing the degree to which the partners
    in the region have the necessary authority,
    resources and policies to provide essential
    public health services.
  • Assures that the infrastructure exists to protect
    and promote health in the community.

29
Governance Assessmentin Two Parts
  • Part I Examining Readiness to Serve in a
    Governance Function
  • The first part of the assessment provides a tool
    to measure the regions readiness to serve as
    governing body or Public Health Council to
    oversee the delivery of services and programs.
  • Part II Examining Types of Lead Public Health
    Entities
  • Participants will use part II of the tool to hold
    a facilitated discussion about the different
    options available for the regions Public Health
    Council to choose as a lead public health entity
    (type of entity).

30
What Will Change?
  • Statewide, regional and more formalized
    recognized system, in law that provides a more
    even level of each essential service
  • Coordinates the current fragmented system that
    delivers very different levels of service
  • More efficient use/better coordination of
    existing resources
  • Based on national standards -PHAB

31
What Wont Change?
  • Municipalities retain legal authority for
    enforcing state laws and local ordinances
  • DPHS provides some core services such as lab and
    disease control
  • Local agencies will still receive funds directly
    from DPHS but will need to be part of the
    regional system

32
And the benefits will be
  • Higher quality services at the best possible cost
  • Ability to measure ourselves against national
    standards
  • Better positioning for increasingly competitive
    federal funds

33
Questions?
  • Joan Ascheim
  • NH Dept of HHS, Division of Public Health
    Services
  • jascheim_at_dhhs.state.nh.us
  • 1-800-852-3345 ext. 4110
  • Lea Lafave
  • Community Health Institute/JSI
  • 603.573.3335
  • lea_ayers-lafave_at_jsi.com
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