Top Ten Reasons Why We Face Challenges in Public Health Today

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Top Ten ReasonsWhy We Face Challengesin Public
Health Today

• 3rd Annual Summer Institute
• Texas Public Health Training Center
• Houston, Texas
• July 10, 2006
• Barney Turnock MD, MPH
• UIC School of Public Health

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Instructions

• Be Here on Time
• Capture the Institutes Theme
• Meeting the Public Health Challenge through
  Strategies to Protect and Improve the Health of
  Communities
  
• Dont Forget There Are Three Tracks
• Emphasize Infrastructure but Dont Go Overboard
  on the Public Health Workforce
  
• Be Upbeat
• Be Provocative

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Provocative?

• Whats provocative about
• Preparedness?
• Community Health Improvement?
• Environmental Health?
• Public Health Infrastructure?
• Provocative like George Carlins 7 words you
  cant say on TV?
  
• Maybe were already provoked and looking to pick
  a fight.
  

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Why Are We Here?

• Dont have all the answers
• Previous performance not necessarily an
  indication of future
  
• Lessons of past successes often misapplied
• Churchill and Max Deus
• Binghamton by way of Elmira?

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Top Ten ReasonsWhy We Face Challengesin Public
Health Today
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Reason 10

• All the easy problems have already been solved.

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Actual Causes of Death, 2000(Source Mokdad et
al, JAMA 2004)
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Anthrax Attack 2001 Mail Flow Network
Patakis Office (NY)
ABC (NY)
CBS (NY)
Bellmawr Distribution plant (NJ)
W. Trenton PO (NJ)
Times Sq. PO (NY)
Princeton PO (NJ)
Radio City PO (NY)
Ansonia PO (NY)
New York Post (NY)
Kuser Road Business
Morgan Central Postal Facility (NY)
Other Post Offices
48 local Post Offices including
Rockefeller Ctr PO (NY)
Distribution plants including (Bulk Mail Ctr,
Dominic V Daniels, Hackensack, Central NJ,
Performance, Monmouth, Newark Main, Patterson,
West Jersey)
Local Businesses including
Boulevard PO (NY)
NBC (NY)
Lenox Hill PO (NY)
ENT Hospital (NY)
NYC001-47 Home
Carteret Hub Spoke Facility (HSF) (NJ)
All DC City Mail for Zips 20000-20099
Southwest PO Station
Hamilton Processing Facility (NJ)
Truck to Atlanta, GA
Friendship PO Station
?
56 USPS Facilities including
West Palm PO Main Branch (FL)
Brentwood Mail Facility (DC)
Dulles PO Branch
Pentagon PO Branch
Lantana PO (FL)
Stamp Fulfillment Kansas City, MO
Green Acres PO (FL)
Walter Reed Complex
177 Federal Agencies including
Landover (Justice)
Blue Lake PO (FL)
Lake Worth PO (FL)
Supreme Court
P-St. Mail Sorting (DC)
BATF
Boca Main Substation (FL)
Dirksen Bldg
Ford Bldg
DC VAMC
State Department SA-32 (VA)
Anacostia mail room
State Department SA-3 (DC)
AMI Building (FL)
Hart Bldg
Longworth Bldg
US Embassy in Yekaterinburg, Russia
US Embassy in Lima, Peru
US Embassy in Vilnius, Lithuania
November 7, 2001
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Rodent Shipment Ghana
Monkeypox Outbreak 2003
TEXAS 50 Gambian giant rats (GR)53 rope squirrel
s (RS) 2 brushtail porcupines (BP) 47 tree
squirrels (TS)100 striped mice (SM)510 dormice
(DM)
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Reason 9

• When youre a hammer, the whole world looks like
  a nail

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When youre a hammer

• Specialization
• Categorical Approaches
• Silos Instead of Systems
• Poor Charlies Democratic Principles

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Reason 8

• We dont have a plan

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LHD Participation in Community Health Assessment
(CHA)
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Participation in CHA by State
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Participation in CHA Comparison with 1999
Infrastructure Study
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LHD Participation in Community Health Improvement
Planning (CHIP)
Participation in past three years
Of those LHDs that have participated in CHIP
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Participation in CHIP Comparison with 1999
Infrastructure Study
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Tools for CHA CHIP
independently or in combination with other tools
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LHD Role in Community Health Planning
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Capacity-Process-Outcome Links
Process (Core Functions/Essential Public Health S
ervices)
Capacity
Outcomes
Outputs
Key Processes
Improved organizational performance
Improved program performance
Improved Outcomes Customer Satisfaction
Increased Value Public Support
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Reason 7

• You get what you pay for?

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Get what you pay for?
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Actual Causes of Death, 2000(Source Mokdad et
al, JAMA 2004)
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Pop Quiz Question

• Over the past 50 years, total expenditures and
  per capita spending for public health activities
  in the United States has been
  
• Increasing steadily
• Decreasing steadily
• Unchanged
• Dont know

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Adjusted total public health spending (in
millions) from federal and state/local
sourcesUS, 1960-2000
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Per capita public health expenditures from
federal and state/local sources, US, 1960-2000
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Reason 6

• We whine too much

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Whens the Last Time You Heard Someone Say

• The public health infrastructure is not
  crumbling
  
• Public health workers are better prepared than
  ever
  
• Accreditation and Credentialing are good things
  for public health practice
  
• Those Essential Public Health Services are really
  useful

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Reported change in selected LHD functions over
the past three years as a result of efforts to
improve emergency preparedness (N 393)
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Reason 5

• Assumptions, assumptions, assumptions!

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Pop Quiz Question

• Over the past dozen years, the size ( and ratio)
  of the public health workforce in the United
  States has been
  
• Increasing steadily
• Decreasing steadily
• Increasing in the 1990s through 2000 and then
  decreasing
  
• Decreasing in the 1990s through 2000 and then
  increasing
  
• Unchanged
• Dont Know

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Pop Quiz Question

• Over the past dozen years, the size ( and ratio)
  of the public health workforce in Texas has
  been
  
• Increasing steadily
• Decreasing steadily
• Increasing in the 1990s through 2000 and then
  decreasing
  
• Decreasing in the 1990s through 2000 and then
  increasing
  
• Unchanged
• Dont Know

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FTE Workers (per 100,000 pop.) of State and Local
Governmental Health Agencies, U.S.(Public
Employment Census Data, Selected Years)
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FTE Workers (per 100,000 pop.) of State and Local
Governmental Health Agencies, Texas(Public
Employment Census Data, Selected Years)
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Full Time Equivalent (FTE) Workers of
Governmental Health Agencies, 1995-2005Source
Data from U.S. Bureau of the Census, Federal,
State, and Local Governments, Public Employment
and Payroll Data. Available at www.census.gov/govs
/www/apes.html.
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Reason 4

• Be careful what you ask for you just may get it!

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Conventional Wisdom?

• Public Health Workforce is shrinking
• Average age is high (47)
• Public Health workers soon will be retiring in
  large numbers
  
• Recruitment and retention are major issues,
  especially in rural communities
  
• Key disciplines (such as public health nurses and
  epidemiologists) are increasingly scarce
  
• Few public health workers have received formal
  training in public health
  
• Public Health Workforce is not prepared for
  current and future threats

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Approaches to Public Health Workforce
Development Pipeline vs. Willy Sutton

• Conventional Wisdom approach to workforce
  development more schools, increase number of
  graduates, higher proportion of gradates into
  primary public health workforce through
  scholarships and loan repayment programs
  (Pipeline approach)
• Willie Sutton approach to workforce development
  focus on the work organizations (thats where the
  workers are now and where they will be tomorrow).

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Public Health Work-Doing System
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What Should We Do with the Next 230 Million?

• Pipeline Approach scholarships and loan
  repayment programs
  
• Willie Sutton assess, enhance, recognize and
  reward ( i.e., manage)

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Reason 3

• But, thats not what they taught me in public
  health school!

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Reason 2

• That aint my job! Nobody told me I had to do
  that.

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Essential Public Health Services

• Monitor health status
• Diagnose and investigate health problems
• Inform, educate and empower people
• Mobilize communities to address health problems
• Develop policies and plans

• Enforce laws and regulations
• Link people to needed health services
• Assure a competent workforce - public health and
  personal care
  
• Evaluate health services
• Conduct research for new innovations

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Aint my job?

• Coming Soon to a Local Health Department in your
  neighborhood?

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The MAPP Model
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Reason 1

• Baby, its cold outside!

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Now Its Your Turn..

• Any Questions?