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From Political Kill Zone to The Great Reset: Restructuring LHDs for Success

This conference explores the historical context and consequences of public health's disengagement from politics, and provides practical answers and strategies for restructuring local health departments (LHDs) to better serve communities.

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From Political Kill Zone to The Great Reset: Restructuring LHDs for Success

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  1. 31st Annual NC Health Directors Legal Conference UNC School of Government April 26, 2012 A National View of LHD Restructuring: Moving From a Political Kill Zone to The Great Reset Gene W. Matthews, JD, DirectorNetwork for Public Health Law – Southeastern Regiona North Carolina Institute for Public HealthUNC Gillings School of Global Public Healthgmatthews@networkforphl.org

  2. Overview: Historical Context Ideas. Experience. Practical Answers • In the early 20th century, public health practice was more closely integrated into the political system • A public health official needed to have an effective political skill set to order quarantines or close public events 2

  3. Overview: Historical Context • In the 1950s and1960s, a “golden generation” of health in the developed world began • Large categorical public health grant programs • Public health changed its orientation

  4. Historical Context  Current Mentality • Public health “non-business model” evolved • Insular and isolated: “We’re science-based, we do good, so give us the resources.” • Dependent on federal funding • Distrustful of engagement with political systems, legislatures, courts, and the private sector • “Apolitical” • Political skill-sets have atrophied

  5. Consequences • Public health is unskilled at competing for shrinking discretionary funding streams • Agriculture, education, & transportation can politically out-compete public health • There is a widening gap between public health leaders and elected officials in understanding the role of population health

  6. Historical Legacy Remains Ideas. Experience. Practical Answers Late 20th century “academic” debate over whether or not public health should avoid political engagement “Narrow” Public Health “Broad” Public Health See Goldberg, DE. Against the very idea of the politicization of public health policy. Am J Public Health. Published ahead of print on November 17, 2011 http://ajph.aphapublications.org/cgi/reprint/AJPH.2011.300325v1 6

  7. 1. 1981 AIDS Era2. 9/11/2001 Preparedness Era3. 2008 Great Economic Recession Ideas. Experience. Practical Answers Three Transformational Moments in Recent U.S. Public Health Memory 7

  8. Significant Political Developments 2007 Economic Downturn Began

  9. Significant Political Developments 2007 Economic Downturn Began 2008 Health Reform “Mandate”

  10. Significant Political Developments 2007 Economic Downturn Began 2008 Health Reform “Mandate” 2010 Deficit Reform “Mandate”

  11. Significant Political Developments PUBLIC HEALTH IN POLITICAL KILL ZONE 2007 Economic Downturn Began 2008 Health Reform “Mandate” 2010 Deficit Reform “Mandate”

  12. Significant Political Developments PUBLIC HEALTH IN POLITICAL KILL ZONE 2007 Economic Downturn Began 2008 Health Reform “Voter Mandate” MOVE!! 2010 Deficit Reform “Voter Mandate” TO NEW PH STRATEGIES

  13. Pat Libbey’s Findings Gap between elected officials and public health leaders in understanding population health Many elected officials focus upon schools, roads and JOBS Yet, they do not view community health as part of their responsibility Ironically, a healthy community is a key factor in business decisions to relocate

  14. Pat Libbey’s Three Questions We have about 2700 LHDs in this country: Do we need 2700 LHDs in the US? Can we afford 2700 LHDs in the US? Is it politically feasible to change current LHD structuring?

  15. Traditional LHD Governance/Organizational Models Ideas. Experience. Practical Answers • Cross jurisdictional sharing arrangements • Merging of LHDs and other agencies into consolidated human services agencies • Creation of quasi-independent public health authorities • Changing or eliminating boards of health 15

  16. Ideas. Experience. Practical Answers Movement Towards Outcome-Based Health Care & Billing Arrangements • Collaboration with FQHCs • Collaboration with hospitals • Alignment with new ACA entities • Adding or removing clinical care 16

  17. Four Recovery Strategies:“Broad Public Health” Ideas. Experience. Practical Answers Restructure to stop the bleeding Make the “jobs case” for elected officials Relearn and reclaim our political skill set Anticipate the “Great Reset” 17

  18. The Great Reset: How New Ways of Living and Working Drive Post-Crash Prosperityby Richard Florida -The Panic of 1873 & the “Long Depression” -The Great Depression -The Great Recession 18

  19. http://www.networkforphl.org/asset/24kcnf/PHLN-InitativeFINAL.pdfhttp://www.networkforphl.org/asset/24kcnf/PHLN-InitativeFINAL.pdf A New Initiative in Development to Assist Public Health Agencies Issue Brief : LOCAL PUBLIC HEALTH GOVERNANCE, STRUCTURE AND CHANGE Gene W. Matthews, JD, DirectorNetwork for Public Health Law – Southeastern Region North Carolina Institute for Public HealthUNC Gillings School of Global Public Healthgmatthews@networkforphl.org

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