Enforce Laws and Regulations that protect Health and ensure safety

1. Essential Service #6 : Enforce Laws and Regulations that protect Health and ensure safety

2. Refresher: Why learn about Essential Services? • Improve quality and performance. • Achieve better outcomes – improved health, less preventable death and disease. • Be more efficient with time and money. • Receive national accreditation.

3. Refresher: Why pursue accreditation? • Documents accountability • Encourages continuous Quality Improvement • Sets benchmarks on services • Leads to best practice sharing • Helps to identify gaps in performance

4. Essential Service #6: In “plain English” • Enforce public health laws and regulations. (Or “When we enforce health regulations, are we up-to-date, technically competent, fair and effective?”)

5. What does ES #6 include? • Review, evaluation, and revision of legal authority, laws and regulations • Education about laws and regulations • Advocacy for regulations needed to protect and promote health • Support of compliance efforts and enforcement

6. ES# 6: In the Assurance Core Function

7. Examples of ES #6 • Communicable disease statute and regulations • Food protection laws, inspection processes • Hospital/long term care statute & regulations • Housing codes, e.g., Lead Poisoning Prevention; Radon; septic systems • Indiana Code Title 16-Health • More examples?

8. How do we assess our performance? Four Model Standards: • Planning and Implementation • State and Local Partnerships • Performance Management/Quality Improvement • Public Health Capacity and Resources

9. ES#6 - Planning and Implementation We should ask ourselves, do we: • Review existing and proposed laws? • What is current scientific knowledge? • Are there new Best Practices? • Solicit input on laws from stakeholders? • Legislators • Legal advisors • General public • Persons/entities in the regulated environment.

10. Planning and Implementation, cont Do we: • Review/update state laws to assure appropriate emergency powers? [e.g., isolation & quarantine] • Support compliance among persons/entities in regulated environment? [e.g., food handlers] • Provide written guidelines related to new regulations? [e.g., swimming pool inspections; camp ground inspections; HPV education materials]

11. State and Local Partnerships Do we: • Offer technical assistance to local communities on newly enacted laws and regulations? • Assist local health departments to develop local laws/ordinances?

12. Performance Management/Quality Improvement Do we: • Review whether PH laws are on target & meeting the needs to keep the public healthy & safe? • Make sure enforcement activities effective? • Assure ongoing Quality Improvement by managing the overall performance of enforcement activities?

13. Public Health Capacity and Resources Do we: • Commit adequate financial resources for the enforcement of laws? • Rely on PH system partners to focus their assets on enforcement activities? • Use workforce expertise to effectively review, develop, and enforce public health laws? [e.g., changes in immunization laws; new sanitary systems]

14. How did we do?

15. Results by Model Standard

16. Keys to improvement: Competencies Analytic/Assessment Skills • Define a public health problem that needs a new law or regulation • Collect data to justify the need for new laws Policy Development/Program Planning Skills • Identify, interpret, implement PH laws, regulations, policies • Decide on appropriate course of action

17. Keys to Improvement: Competencies Communication Skills • Communicate new laws and regulations • Solicit input from individuals, organizations • Lead/participate in groups to address new laws • Listen in an unbiased manner; respect points of view of others; promote expression of diverse opinions, perspectives

18. Keys to Improvement: Competencies Cultural Competency Skills • Understand how laws and regulations may affect various cultures [e.g., immunizations; disease registries; food preparation] • Understand forces contributing to cultural diversity, importance of a diverse PH workforce • Interact effectively with persons from diverse backgrounds

19. Keys to Improvement: Competencies Basic Public Health Sciences Skills • Understand how laws and regulations impact determinants of health and illness* [e.g., access to care; genetic screening; setting poverty level] *Biologic, Behavioral, Environmental, Socio/Economic, Access to Care Leadership and Systems Thinking Skills • Use legal and political system to affect change

20. Keys to Improvement: Competencies Financial Planning and Management Skills • Develop and present budgets to implement regulations • Follow laws and manage programs within budget constraints • Monitor program performance in implementing regulations

21. References • CDC National Public Health Performance Standards Program Website: http://www.cdc.gov/od/ocphp/nphpsp/EssentialPublicHealthServices.htm#es2 • Council on Linkages Training Project Website: http://www.trainingfinder.org/competencies/list_ephs.htm#2 • Indiana Public Health System Quality Improvement Report (2007).

22. Discussion: What does your program do to implement Essential Service #6?