Improving Public Health’s Infrastructure: the Key to Transforming Public Health

Dennis Lenaway, PhD, MPHOffice of the Chief of Public Health PracticeCenters for Disease Control and Prevention

Colorado Public Health Association Annual Conference

September 16, 2008

“The public health infrastructure has suffered from neglect…”

“Weaknesses in the governmental public health infrastructure were clearly demonstrated in the Fall of 2001.”

Institute of Medicine 2003

Why focus on Infrastructure?

Public Health Challenges

Public Health Challenges

Emerging Diseases (SARS, Pandemic Flu)

Re-emerging Diseases (XDR-TB)

Food Safety

Bioterrorism

Natural Disasters

Obesity

Aging Population

Health Disparities

Global Warming

Health Care Crisis

Health Care Crisis

Aging Population

Re-emerging Diseases

Emerging Diseases

Obesity

Health Disparities

Access to Quality Health Care

Health Insurance Costs

Uninsured and Underinsured

Federal, State and Local Silos

PublicHealth

HealthCare

EmergencyManagement

Education LawEnforcement

Leadership & Workforce Development

Portfolio Management

Community Engagementand Health Planning

Public Health Systems

Public Health Agencies

Key Elements in Public Health

Leadership

Workforce

Resources

Assets Functions Capacity Interventions Impact

3 CoreFunctions

and10 EPHS

Programsand

Activities

HealthiestNation

QI

Infrastructure

Office of the Chief of Public Health Practice

Setting Agency Standards Public Health Accreditation Board

Setting System Standards National Public Health Performance Standards Program

Engaging with Communities MAPP

Managing our Resource Portfolio Senior Management Officials Strategic Management Agreements Public Health Apprenticeship Program

Excellence in Public Health Practice Council

A new non-profit organization dedicated to the development and implementation of a national voluntary accreditation program for state, local and tribal public health departments

Launched in May 2007 Co-funded by CDC and RWJF

Public Health Accreditation Board

Public Health Accreditation Board

Goal Improve and protect the health of the public by

advancing the quality and performance of State, local, and tribal public health departments

Strengthening systems,

improving the public’s health

Optimal model standardsBuilds partnershipsCompliments accreditationUsed by 24 states and over 1,000 localities

A State, local or governance assessment and quality improvement process that focuses on the entire public health “system”

NPHPSP

NPHPSP State Instrument Use (Thru September 2008, n = 24 states)

*Also includes sites using field test versions of the NPHPSP State Public Health System Performance Assessment.

NH

WA

OR

NV

CA

ID

MT

AK

UT

AZ

WY

CO

NM

ND

SD

NE

KS

TX

OK

LA

AR

MO

IA

MN

MS

OH

WI

INIL

MI

ME

KY

NY

PA

WVVA

NC

GA

TN

AL

FL

SC

VT

MA

RI

CT

HI

NJ

DE

MD

NH

MA

RI

CT

NPHPSP Local Instrument Use (Thru September 2008)

Moderate Use(33% - 66%)

Significant Use (67% or greater)

Limited Use(1% - 32%)

*Also includes sites using field test versions of the NPHPSP Local Public Health System Performance Assessment.

WA

OR

NV

CA

ID

MT

AK

UT

AZ

WY

CO

NM

ND

SD

NE

KS

TX

OK

LA

AR

MO

IA

MN

MS

OH

WI

INIL

MI

ME

KY

NY

PA

WVVA

NC

GA

TN

AL

FL

SC

VT

NJ

DE

MD

NH

MA

RI

CT

HI

New Version 2.0 Instruments

State Local Governance

• Mobilizing – community engagement

• Action – implementation of a Health Improvement Plan

• Planning – built on strategic planning concepts

• Partnerships – the public’s health is more than the concern of the health department

• A community-wide strategic planning tool for improving public health.

• A method to help communities prioritize public health issues, identify resources for addressing them, and take action.

What is MAPP?

“If you want to travel fast, go alone.

If you want to travel far, go together."

Old African Proverb

Portfolio Management Program

PMP Priorities

Shared Leadership Dialogue and collaboration at an executive level between CDC and it’s public health partners

Alignment of CDC Goals Integration of CDC’s Health Protection Goals to drive performance, supporting continued investment relevant to health impact

Improved Business Services

Enhance efficiencies and encourage increased flexibility in the use of CDC funding without compromising agency accountability

Senior Management Officials

• Senior Management Officials– Definition/role

– (how many)

Washington DCWashington DC

KarenWhite

Mike Hughes

VACANT

Steve Boedigheimer

Brock Lamont

Candice Nowicki

Melanie Duckworth

H. Mac McCraw

DuionaBaker

Bobbie Erlwein

Joe Henderson

BillGallo

Strategic Management Agreements (SMAs)

An agreement negotiated by the Portfolio Management Program with the CDC Director and the State Health Commissioner as Principals. Engage and align state strategic planning efforts to CDC Goals Establish agreed upon priorities Advance efforts aimed at achieving specific health outcomes Leverage and maximize CDC and state investments Promote program flexibility linked to accountability.

First SMAs being drafted with Arkansas & California - 2008

Public Health Apprenticeship Program (PHAP)

Purpose: to develop highly qualified candidates for employment with state and local health departments and CDC to meet the public health system challenges of the 21st century.

PHAP provides a career pathway for entry-level public health workers that includes: Knowledge of the components, roles and functions of the public

health system Front-line service in public health practice in multiple programs Skills in public health program implementation

2007 - 10 Apprentices placed in Florida Local Health Departments2008 - 35 Apprentices placed in Florida, Texas, Georgia, North Carolina and Arkansas

Excellence in Public Health Practice Council

Provides a forum for a coordinated, enterprise-wide approach to addressing public health practice issues at CDC

Workgroups have developed recommendations on Practice Issues including:Public Health Infrastructure DevelopmentPerformance of Public Health SystemsTranslating Science into Practice

Competencies for Public Health professionalsEpidemiologists

Credentialing and certification National Board of Public Health Examiners (2005)Existing programs in nursing, environmental health,

laboratories

Workforce Development

Leadership Development

National Public Health Leadership Institute

State and Regional Public Health Leadership Institutes

National Public Health Leadership Development Network

Governmental Leadership Programs for Health Officials

Association of Public Health Laboratories and CDC’s National Center for Environmental Health

Transforming the Public Health System

Building the platform towards a Healthiest Nation