Transcript Moving Towards a Regional Public Health System in NH

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?
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What Does Public Health Look
Like in NH Today?
Each of New Hampshire’s 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
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2004 New Hampshire
Public Health Network
“Assuring the health and safety of all NH residents”
o
14 Coalitions
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118 Towns
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50% of NH towns
o
o
70% of the NH population
covered
5-11 communities per coalition
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All Health Hazard Regions
 Organized to plan for
and respond to public
health emergencies
 19 Regions
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And more maps for other services
 Community health centers
 Tobacco coalitions
 WIC services
 HIV prevention
 Etc, etc, etc.
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Why Regionalization?
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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
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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
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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
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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.
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How does public health differ
.
from health care?
Individual vs. Populations
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Example- Smoking
 Health care response
 Public Health Response
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Treat an individual for
smoking related health
problems – asthma,
pneumonia, heart disease,
cancer, etc.
Counsel to quit smoking
Provide nicotine replacement
therapy
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Study the effects of tobacco
– Surgeon General’s report
Labeling of cigarettes
Public information
campaigns
Promote policies such as
non-smoking workplaces
Enforcement of laws such as
limiting tobacco sales to
minors
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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

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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
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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
 That’s $2 in return for every $1 invested in
the first 1-2 years

Prevention for a Healthier America:Investments in Disease Prevention Yield Significant Savings,
Stronger Communities. Trust for America’s Health July 2008 www.healthyamericans.org
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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 children’s 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 America’s Health, August 2008
www.healthyamericans.org
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Example - Obesity
Health Care Response
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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
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The 10 Essential
Public Health Services
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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
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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.
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The Role of Government in
Public Health
 Assessment – Takes into account all relevant factors to the
extent possible, based on objective factors, without selfinterest
 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
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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
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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
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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
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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
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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
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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
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Revised Tool
Lead organization : Regional Partners : State
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What is the Governance
Assessment?
Focuses on figuring out who’s responsible or held accountable;
not doing the work but overseeing it;
 Who’s overseeing performance of the public health entities
who are partners.
 Who’s 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.
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Governance Assessment
in Two Parts
Part I: Examining Readiness to Serve in a Governance
Function:
 The first part of the assessment provides a tool to measure
the region’s 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
region’s Public Health Council to choose as a lead public
health entity (type of entity).
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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
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What Won’t 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
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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
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Questions?
Joan Ascheim
NH Dept of HHS, Division of Public Health
Services
[email protected]
1-800-852-3345 ext. 4110
Lea Lafave
Community Health Institute/JSI
603.573.3335
[email protected]
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