OVERVIEW OF LOCAL PUBLIC HEALTH

1. OVERVIEW OF LOCAL PUBLIC HEALTH Presented by Terri Henkels, Director Polk County Health Department representing the Iowa Counties Public Health Association Introduce Self and TopicIntroduce Self and Topic

2. Local Public Health in Iowa Local public health in all 99 counties 98 county boards of health 2 city boards of health (Council Bluffs, Ottumwa) 1 district board (Siouxland) Iowa Demographics 63 counties with a population <20,000 27 counties with a population of 20,000 – 50,000 3 counties with a population of 50,000 – 100,000 6 counties with a population >100,000 The size of public health at the local level differs but no matter what the demographics, local public health’s role is to protect the health of the public. The distinguishing attribute of public health practice when compared to medical practice is public health’s central focus on the health of a population. Public health practice focuses on the health of aggregates or groups, family, or community. A key feature of public health practice is the acknowledgment that health is greater than the biological determinants of individual health; public health practice also embraces a host of behavioral, social, economic, and environmental factors that affect the health of a community.The size of public health at the local level differs but no matter what the demographics, local public health’s role is to protect the health of the public. The distinguishing attribute of public health practice when compared to medical practice is public health’s central focus on the health of a population. Public health practice focuses on the health of aggregates or groups, family, or community. A key feature of public health practice is the acknowledgment that health is greater than the biological determinants of individual health; public health practice also embraces a host of behavioral, social, economic, and environmental factors that affect the health of a community.

3. Definition of Public Health Organized community effort aimed at the prevention of disease and promotion of health. What we, as a society, do collectively to assure the conditions in which people can be healthy. In 1988 the Institute of Medicine defined public health as “an organized community effort aimed at the prevention of disease and promotion of health. And What we, as a society, do collectively to assure the conditions in which people can be healthy.In 1988 the Institute of Medicine defined public health as “an organized community effort aimed at the prevention of disease and promotion of health. And What we, as a society, do collectively to assure the conditions in which people can be healthy.

4. CORE PUBLIC HEALTH FUNCTIONS ASSESSMENT – knowing what needs to be done POLICY DEVELOPMENT – being part of the solution ASSURANCE – doing what needs to be done or making sure it happens Public Health has 3 core functions: We monitor health status, we conduct community assessments and improvement plans and set health priorities for the community. We also evaluate the effectiveness of population based services. We develop policies that support community health efforts, enforce laws and regulations that protect health. We link people to services and assure provision when otherwise unavailable. We assure a competent public health workforce, inform and educate people and mobilize community partnerships to identify and solve health problems. Public Health has 3 core functions: We monitor health status, we conduct community assessments and improvement plans and set health priorities for the community. We also evaluate the effectiveness of population based services. We develop policies that support community health efforts, enforce laws and regulations that protect health. We link people to services and assure provision when otherwise unavailable. We assure a competent public health workforce, inform and educate people and mobilize community partnerships to identify and solve health problems.

5. 10 Essential Public Health Services Monitor health status to identify and solve community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships and action to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Assure competent public and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems. In 1994, the US Public Health Service agencies and other major public health organizations developed the framework for Essential Services in public health. This is a guiding framework for the responsibilities of local public health systems. When you reflect on the essential services and your own community you will make the connection that no matter what the demographics of your county, it is essential that the local boards of health and health departments mobilize community partnerships – it is the only way we can meet desired outcomes. The 10 essential public health services are also the framework driving the national public health standards and future plans for accreditation which we should see in the next couple of years. Initially accreditation will be voluntary. In the future, accreditation could be tied to federal funding. In 1994, the US Public Health Service agencies and other major public health organizations developed the framework for Essential Services in public health. This is a guiding framework for the responsibilities of local public health systems. When you reflect on the essential services and your own community you will make the connection that no matter what the demographics of your county, it is essential that the local boards of health and health departments mobilize community partnerships – it is the only way we can meet desired outcomes. The 10 essential public health services are also the framework driving the national public health standards and future plans for accreditation which we should see in the next couple of years. Initially accreditation will be voluntary. In the future, accreditation could be tied to federal funding.

6. Local Board of Health Composition & Responsibility Consists of 5 members One member must be a licensed physician Serves 3-year terms Appointed by the county board of supervisors Has jurisdiction over public health matters Accountable for meeting state standards for service delivery and achieving desired outcomes Directly oversees public health staff Provide certain mandated public health services This is the composition for all Iowa Local Boards of Health. READ COMP. Local board of health are the governing boards in their county or district for public health. They establish the framework for public health. They provide local public health vision, mission and advocacy and encourage community involvement in selecting public health priorities AND they provide direct oversight of public health staff and may contract with other entities for certain public health services and have responsibility for fiscal oversight and their outcomes. This is the composition for all Iowa Local Boards of Health. READ COMP. Local board of health are the governing boards in their county or district for public health. They establish the framework for public health. They provide local public health vision, mission and advocacy and encourage community involvement in selecting public health priorities AND they provide direct oversight of public health staff and may contract with other entities for certain public health services and have responsibility for fiscal oversight and their outcomes.

7. State Codes Governing Local Boards of Health and Local Public Health Iowa Code Chapter 137 – Local Boards of Health Other Miscellaneous Codes (see last slide for resources to a comprehensive list) 641 Iowa Administrative Chapter 77 and 78 – Roles and responsibilities of local boards of health 641 Iowa Administrative Code – Public Health These are critical Iowa laws for BOS, BOH and Public Health Administrators. There is a resource we will talk about later that is available that actually lists These are critical Iowa laws for BOS, BOH and Public Health Administrators. There is a resource we will talk about later that is available that actually lists

8. Ten Great Public Health Achievements in the US Immunizations Motor Vehicle Safety Safer workplace Control of Infectious disease Decline in deaths from coronary heart disease and stroke Safer and healthier foods Healthier mothers and babies Family Planning Fluoridation of drinking water Recognition of tobacco use as a health hazard Over the course of the 20th century these achievements listed in this slide were identified by the Centers of Disease Control and Prevention. Public health is credited with adding 25 years to the life expectancy of people in the United States in the last 100 years. “Yet, ask the average person what public health is and their reply might be limited to: "healthcare for low-income families." Over the course of the 20th century these achievements listed in this slide were identified by the Centers of Disease Control and Prevention. Public health is credited with adding 25 years to the life expectancy of people in the United States in the last 100 years. “Yet, ask the average person what public health is and their reply might be limited to: "healthcare for low-income families."

9. Local Public Health Current Issues and Challenges Modernization Act of Public Health in Iowa – What should every Iowan reasonably expect from local and state public health? New Responsibility of Emergency Preparedness Response Health Care Reform and Public Health Sustainable Funding - to ensure quality in public health services, utilization of evidence-based programs and measurable outcomes and highly trained workforce Local Public Health Faces Many Current and Future Challenges. The modernization of public health is a partnership between local and state public health working to advance the quality and performance of public health in Iowa. Through the Modernizing Public Health in Iowa initiative, the partnership is defining basic standards of service delivery to all Iowans. Iowa is not alone. At least 21 states are engaged in setting their own standards or in developing performance improvement initiatives to improve and protect the health of the public within their own boundaries. In Iowa over the next couple of years voluntary state accreditation for local health departments will begin. Since 9/11 Public Health has had a major shift in how we conduct emergency preparedness planning and response to bioterrorism, public health emergencies and community disasters. Over the past 10 years public health has had a visible role in being first responders to many local events throughout Iowa such as floods, tornadoes, food borne outbreaks, mumps epidemic, and an 18-month long pandemic influenza. This shift is permanent and comes with a lot of community expectations and responsibility for the local boards of health and local health departments. In the future, we may experience decreased funds from the national level to support improving our abilities to respond and improving our response plans. Sustainability for public health’s role in emergency preparedness and response is critical to good outcomes. The role of public health in health care reform is not clearly defined. Much of the focus and funding are targeted to insurance coverage and clinical care. You may see public health developing new approaches to creating conditions that would prevent chronic disease and decrease the exacerbation of existing chronic disease. This would complement the care given at the medical clinic.  Local public health will have a more concentrated focus on such things as improving meals in the schools, helping employers develop workplace wellness programs, supporting local elected officials in their efforts to encourage access to safe walking and biking trails, access to affordable healthy foods and ensuring people are living in safe and healthy homes. Health Care Reform did set up a Public Health Trust Fund but in the whole scheme of the funding it is only a small portion of the appropriated dollars and many of the initiatives listed in the Trust Fund are currently unfunded. Will these funds make their way to the local level and will it be enough to sustain the work that needs to be done at the local level. We are all watching to see how this plays out.   Over the past 10 years or so there has been an ever increasing and extremely high expectation that public health will have adequate administrative and program policies, embrace quality improvement, utilize evidence-based programming and have measurable outcomes as well as a highly skilled workforce. These will be important and significant improvements for public health but will also take appropriate levels of funding. Local Public Health Faces Many Current and Future Challenges. The modernization of public health is a partnership between local and state public health working to advance the quality and performance of public health in Iowa. Through the Modernizing Public Health in Iowa initiative, the partnership is defining basic standards of service delivery to all Iowans. Iowa is not alone. At least 21 states are engaged in setting their own standards or in developing performance improvement initiatives to improve and protect the health of the public within their own boundaries. In Iowa over the next couple of years voluntary state accreditation for local health departments will begin. Since 9/11 Public Health has had a major shift in how we conduct emergency preparedness planning and response to bioterrorism, public health emergencies and community disasters. Over the past 10 years public health has had a visible role in being first responders to many local events throughout Iowa such as floods, tornadoes, food borne outbreaks, mumps epidemic, and an 18-month long pandemic influenza. This shift is permanent and comes with a lot of community expectations and responsibility for the local boards of health and local health departments. In the future, we may experience decreased funds from the national level to support improving our abilities to respond and improving our response plans. Sustainability for public health’s role in emergency preparedness and response is critical to good outcomes. The role of public health in health care reform is not clearly defined. Much of the focus and funding are targeted to insurance coverage and clinical care. You may see public health developing new approaches to creating conditions that would prevent chronic disease and decrease the exacerbation of existing chronic disease. This would complement the care given at the medical clinic.  Local public health will have a more concentrated focus on such things as improving meals in the schools, helping employers develop workplace wellness programs, supporting local elected officials in their efforts to encourage access to safe walking and biking trails, access to affordable healthy foods and ensuring people are living in safe and healthy homes. Health Care Reform did set up a Public Health Trust Fund but in the whole scheme of the funding it is only a small portion of the appropriated dollars and many of the initiatives listed in the Trust Fund are currently unfunded. Will these funds make their way to the local level and will it be enough to sustain the work that needs to be done at the local level. We are all watching to see how this plays out.   Over the past 10 years or so there has been an ever increasing and extremely high expectation that public health will have adequate administrative and program policies, embrace quality improvement, utilize evidence-based programming and have measurable outcomes as well as a highly skilled workforce. These will be important and significant improvements for public health but will also take appropriate levels of funding.

10. Support Systems for Public Health Iowa Counties Public Health Association (ICPHA) Iowa State Association of Counties (ISAC) Iowa Public Health Association (IPHA) National Association of City and County Health Officials (NACCHO) National Association of Local Boards of Health (NALBOH) American Public Health Association (APHA) There are many ways for local health officials to be engaged at the State level and foster a working relationship with leaders in the Iowa Department of Public Health as well as the University of Iowa, College of Public Health and Des Moines University, Master of Public Health programs. ICPHA is an Affiliate Member of ISAC and also affiliated with the National Association of City and County Health Officials (NACCHO) and is also the recognized State Association of City County Health Officials in Iowa. ICPHA provides opportunities for health directors and key staff to meet and network with peers and advocate for public health policies and legislation at the national and state level. ICPHA members have a presence on eighteen state advisory councils, committees or task forces. It also provides opportunities each year to engage with key leaders at the State Public Health Department to communicate on public health policies, funding constraints, funding opportunities, new initiatives, challenges and best practices. ICPHA holds its annual meeting at the Fall School and participates in ISAC’s Spring School. The Iowa Public Health Association has their annual meeting in early April. It is important for local public health personnel to be a part of these local organizations and attend their meetings and conferences. BOS and BOH members would also find these key meetings informative. It is equally as important to stay engaged at the National level so your county has a voice in national policy and identifying public health barriers and needs. There are many ways for local health officials to be engaged at the State level and foster a working relationship with leaders in the Iowa Department of Public Health as well as the University of Iowa, College of Public Health and Des Moines University, Master of Public Health programs. ICPHA is an Affiliate Member of ISAC and also affiliated with the National Association of City and County Health Officials (NACCHO) and is also the recognized State Association of City County Health Officials in Iowa. ICPHA provides opportunities for health directors and key staff to meet and network with peers and advocate for public health policies and legislation at the national and state level. ICPHA members have a presence on eighteen state advisory councils, committees or task forces. It also provides opportunities each year to engage with key leaders at the State Public Health Department to communicate on public health policies, funding constraints, funding opportunities, new initiatives, challenges and best practices. ICPHA holds its annual meeting at the Fall School and participates in ISAC’s Spring School. The Iowa Public Health Association has their annual meeting in early April. It is important for local public health personnel to be a part of these local organizations and attend their meetings and conferences. BOS and BOH members would also find these key meetings informative. It is equally as important to stay engaged at the National level so your county has a voice in national policy and identifying public health barriers and needs.

11. How to Engage In Public Health Get to know your local public health administrator Get to know your local board of health members Become familiar with specific services and programs of your local health department Learn what is being provided by other entities in your county that are relevant to the outcomes of your community’s public health Study your county’s public health needs assessment and improvement plan Become a champion for public health – communicate with your community about the work of public health and advocate at all levels for sustainable funding of local public health Important in your new role, as member of the Board of Supervisors, to READ SLIDEImportant in your new role, as member of the Board of Supervisors, to READ SLIDE

12. Websites of Interest Iowa Counties Public Health Association (ICPHA) www.i-cpha.org Iowa Department of Public Health www.idph.state.iowa.us Prepare Iowa Learning Management System www.prepareiowa.com Iowa State Association of Counties www.iowacounties.org National Association of City and County Health Officials www.naccho.org National Association of Local Boards of Health www.nalboh.org

13. Local Boards of Health Toolkit Current and crucial resources in the toolkit include: Laws relevant to local public health Functions and essential services that local health departments are responsible for providing Program standards for local and state public health Evaluation tools for local public health Presentations on critical topics and resources featuring state and local public health representatives www.public-health.uiowa.edu/UMPHTC/education/BOH/ Sponsored by Iowa Department of Public Health and Upper Midwest Public Health Training Center The Local Boards of Health Toolkit is designed to assist board of health and board of supervisor members with their roles and responsibilities in promoting the mission of public health. The toolkit was released in the spring of 2008 and extensively updated in early 2010The Local Boards of Health Toolkit is designed to assist board of health and board of supervisor members with their roles and responsibilities in promoting the mission of public health. The toolkit was released in the spring of 2008 and extensively updated in early 2010