Public Health: What It Is and How It Works, Fourth Edition

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Public HealthWhat It Is and How It Works,
Fourth Edition

• Chapter-by-Chapter Power Point Slides
• Links to Internet-based resources

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Chapter 6The Infrastructure of Public Health
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Chapter 6 Will Help You To

• identify the major components of public healths
  infrastructure and key dimensions of each
  component
• identify strategies for assessing and enhancing
  the infrastructure of public health

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Capacity-Process-Outcome Links
Process (Core Functions/Essential Public Health
Services)
Capacity
Outcomes
Outputs
Key Processes
Improved organizational performance Improved
program performance
Improved Outcomes Customer Satisfaction
Increased Value Public Support
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Infrastructure, Ingredients,and Inputs

• Public health infrastructure the resources and
  relationships necessary to carry out public
  healths core functions and essential services in
  the community
• In Capacity-Process-Outcomes model, inputs are
  the structural components of the public health
  infrastructure while processes represent what
  those inputs do

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Human Resources in Public Health

• Key element of public healths infrastructure
• Size of the public health workforce unclear
  because of lack of consensus as to meaning of
  term public health worker
• Best guess as to size 600,000
• Beyond size, distribution, composition,
  skills/competencies, and impact are key
  considerations

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Full Time Equivalent (FTE) Workers of
Governmental Health Agencies, 1995-2005Source
Data from U.S. Bureau of the Census, Public
Employment and Payroll Data.
Year Fed FTE State FTE Local FTE SL FTE FSL FTE
1995 125,048 160,031 208,588 368,619 493,667
1998 119,846 166,930 219,655 386,585 506,431
2001 122,999 172,414 251,399 423,813 546,812
2002 124,979 176,345 252,326 428,671 553,650
2003 124,828 176,868 253,888 430,756 555,584
2004 127,933 174,301 249,857 424,128 552,061
2005 125,163 178,465 246,300 424,765 549,918
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Full Time Equivalent (FTE) Workers for State and
Local Health Agencies per 10,000 Population,
Selected Years 1994-2005, U.S.Source Data from
U.S. Bureau of the Census, Public Employment and
Payroll Data.
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Public Health Work-Doing System
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Mean Salary for Full Time Equivalent Workers of
State and Local Health Agencies, Selected Years,
1994-2005, U.S. Source Data from Bureau of the
Census, Public Employment and Payroll Data.
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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).
• Which approach is likely to be most effective?

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Organizational Resources

• Largely discussed in Chapter 4 includes
  governmental and non-governmental organizations
• Non-governmental contributions estimated at
  one-fourth to one-third or more!
• Leadership
• Coalitions and Consortia
• Community Health Partnerships

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The MAPP Model
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Turning Points Performance Management
Collaborative Four components of a performance
management system
Source Turning Point Performance Management
Collaborative, From Silos to Systems Using
Performance Management to Improve the Publics
Health , March 2003.
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Information Resources

• Assessment data and information
• Surveillance systems
• Information for planning
• Evidence-based policy and decisions

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Actual Causes of Death, 2000(Source Mokdad et
al, JAMA 2004)
Tobacco 435,000
Poor diet physical activity 400,000
Alcohol 85,000
Microbial agents 75,000
Toxic agents 55,000
Motor vehicle 43,000
Firearms 29,000
Sexual Behavior 20,000
Illicit drug use 17,000
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Fiscal Resources

• Total health expenditures 2.0 trillion
• Public health expenditures within total health
  expenditures about 60-70 billion
• 1/3 from federal sources
• 2/3 from state and local sources

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Healthy People 2010Infrastructure Objectives

• 17 objectives
• Data and information systems
• Skilled workforce
• Effective public heath organizations
• Resources
• Prevention research
• Progress uncertain as of 2006

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Discussion

• Because of your interest in a public health
  career you have been asked to provide input into
  the development of a training package to orient
  new members of your local Board of Health to
  their duties.
• What themes or messages would you suggest for
  this video? How would you propose presenting or
  packaging these messages?

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Discussion

• Review the progress of the past century related
  to safer and healthier foods (Safer and Healthier
  Foods in the Century of Progress in Public Health
  case study) and a recent report on public
  perceptions about food safety.
• Then follow the chronology of CDC and USDA
  reports regarding an outbreak of cases of
  listeriosis in the Mid-Atlantic States.
  Specifically, review CDC's press releases from
  mid-September through mid-October 2002,and USDA's
  press releases from 2001 dated October 2, October
  9, October 13, and October 17.
• Finally, review the news article dated October 15
  titled and "Consumer Groups Accuse US of
  Negligence in Food Safety.
• Based on this information and the DHHS-USDA
  Listeria Action Plan, do you agree or disagree
  with accusations that USDA and CDC did not
  protect the public from this risk in a timely
  manner?

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Discussion

• What characteristics distinguish a public health
  professional from a professional working in a
  public health agency?

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Discussion

• After reviewing The Past and Future of Public
  Health Practice, identify the public health
  practitioner (past or present) that you most
  admire and the reasons or criteria that led you
  to this choice.

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Additional Resources

• Community Strategies for Health. American Public
  Health Association
• Healthy People 2010 Public Health Infrastructure
  Objectives Washington DC USDHHS-PHS 2000
• Principles of Community Engagement. CDC Public
  Health Practice Program Office Atlanta GA 1997
• Public Health Data Standards Tutorial (modules
  4-9). Public Health Data Standards Consortium
• Public Health Infrastructure (report to Congress
  in PDF format) CDC2001
• Public Health Workforce An Agenda for the 21st
  Century (PDF format). USDHHS-PHS Washington DC
  1997
• Public Health Workforce Enumeration 2000 (PDF
  format). USDHHS-HRSA Rockville MD 2000