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Top Ten Reasons Why We Face Challenges in Public Health Today

Top Ten Reasons Why We Face Challenges in 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. Instructions. Be Here on Time Capture the Institute’s Theme:

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Top Ten Reasons Why We Face Challenges in Public Health Today

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  1. 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

  2. Instructions • Be Here on Time • Capture the Institute’s Theme: • “Meeting the Public Health Challenge through Strategies to Protect and Improve the Health of Communities” • Don’t Forget There Are Three Tracks • Emphasize Infrastructure but Don’t Go Overboard on the Public Health Workforce • Be Upbeat • Be Provocative

  3. Provocative? • What’s provocative about: • Preparedness? • Community Health Improvement? • Environmental Health? • Public Health Infrastructure? • Provocative like George Carlin’s “7 words you can’t say on TV”? • Maybe we’re already provoked and looking to pick a fight.

  4. Why Are We Here? • Don’t 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?

  5. Top Ten ReasonsWhy We Face Challengesin Public Health Today

  6. Reason # 10 • All the easy problems have already been solved.

  7. Actual Causes of Death, 2000(Source: Mokdad et al, JAMA 2004)

  8. = Confirmed anthrax case associated with site = Suspect anthrax case associated with site = Environmental samples positive Anthrax Attack 2001: Mail Flow Network… Pataki’s Office (NY) CBS (NY) ABC (NY) Bellmawr Distribution plant (NJ) W. Trenton PO (NJ) Times Sq. PO (NY) Princeton PO (NJ) Ansonia PO (NY) Radio City 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) NYC001-47 Home ENT Hospital (NY) 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 Vilnius, Lithuania US Embassy in Lima, Peru US Embassy in Yekaterinburg, Russia November 7, 2001

  9. SARS Transmission Spring 2003 2 family members 2 close contacts 4 family members Guangdong Province, China 10 HCWs 4 HCWs* Hospital 2Hong Kong Canada F A A F G † G † 3 HCWs K † K † Ireland 156 close contacts of HCWs and patients A Hospital 3 Hong Kong H H I Hotel MHong Kong L§ J I United States E 99 HCWs (includes 17 medical students) J D B M§ Hospital 1 HK C C D E B Germany 0 HCWs Singapore HCW HCW B Vietnam Hospital 4 Hong Kong 34 HCWs 28 HCWs 2 family members 37 HCWs HCW 37 close contacts 4 other Hong Kong Hospitals Unknown numberclose contacts HCW Bangkok

  10. TX-2GR NJRS, BPTS, SM TX-3RS, SMDM TX-6TS, SMDM WI Human cases:17 confirmed22 probable/suspect IL‡ Human cases:8 confirmed4 probable/suspect 42 PDs traced 14 PDs traced IN Human cases:7 confirmed9 probable/suspect IL-1§GR, DM IA†GR, DM 24 PDs traced IL-2DM TX-10DM TX-4DM TX-5DM TX-8DM TX-7DM TX-9DM JapanDM MNDM WIDM 200 prairie dogs (PDs) at facility 1 PD traced MO Human cases:2 confirmed 1 PD traced SCNo human cases 11 PDs traced KS Human cases:1 confirmed MINo human cases Rodent Shipment Ghana MonkeypoxOutbreak 2003 TEXAS 50 Gambian giant rats (GR)53 rope squirrels (RS) 2 brushtail porcupines (BP) 47 tree squirrels (TS)100 striped mice (SM)~510 dormice (DM)

  11. Reason # 9 • When you’re a hammer, the whole world looks like a nail…

  12. When you’re a hammer… • Specialization • Categorical Approaches • Silos Instead of Systems • Poor Charlie’s Democratic Principles

  13. Reason # 8 • We don’t have a plan…

  14. LHD Participation in Community Health Assessment (CHA)

  15. Participation in CHA by State

  16. Participation in CHA: Comparison with 1999 Infrastructure Study

  17. LHD Participation in Community Health Improvement Planning (CHIP) Participation in past three years *Of those LHDs that have participated in CHIP

  18. Participation in CHIP: Comparison with 1999 Infrastructure Study

  19. Tools for CHA & CHIP *independently or in combination with other tools

  20. LHD Role in Community Health Planning

  21. Assess System Inputs Programs and Services consistent with mandates and community priorities Workforce Information Organization & Relationships Facilities Funding Address Assure Process (Core Functions/Essential Public Health Services) Capacity Outcomes Capacity-Process-Outcome Links Key Processes Outputs Improved organizational performance + Improved program performance Improved Outcomes & Customer Satisfaction Increased Value & Public Support

  22. Reason # 7 • You get what you pay for?

  23. Get what you pay for?

  24. Actual Causes of Death, 2000(Source: Mokdad et al, JAMA 2004)

  25. 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 • Don’t know

  26. Adjusted total public health spending (in millions) from federal and state/local sourcesUS, 1960-2000

  27. Per capita public health expenditures from federal and state/local sources, US, 1960-2000

  28. Reason # 6 • We whine too much

  29. When’s 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

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

  31. Reason # 5 • Assumptions, assumptions, assumptions!

  32. 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 • Don’t Know

  33. 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 • Don’t Know

  34. FTE Workers (per 100,000 pop.) of State and Local Governmental Health Agencies, U.S.(Public Employment Census Data, Selected Years)

  35. FTE Workers (per 100,000 pop.) of State and Local Governmental Health Agencies, Texas(Public Employment Census Data, Selected Years)

  36. 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.

  37. Reason # 4 • Be careful what you ask for … you just may get it!

  38. 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

  39. 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 (that’s where the workers are now and where they will be tomorrow).

  40. Public Health Work-Doing System

  41. 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)

  42. Reason # 3 • But, that’s not what they taught me in public health school!

  43. Reason # 2 • That ain’t my job! Nobody told me I had to do that.

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