phd overview mel kohn md mph acting public health director march 2009 l.
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PHD Overview Mel Kohn, MD MPH, Acting Public Health Director March 2009

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PHD Overview Mel Kohn, MD MPH, Acting Public Health Director March 2009. DHS Public Health Division (PHD). Themes Public health is an excellent investment, particularly in difficult economic times

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DHS Public Health Division (PHD)

  • Themes
  • Public health is an excellent investment, particularly in difficult economic times
  • Oregon’s current public health system faces serious challenges including lack of investment in chronic disease and injury prevention, lack of local health department capacity, and over-reliance on federal funding

PHD mission and goals


Protect, preserve and promote the health of all the people of Oregon

  • Goals
  • Prevent epidemics and the spread of disease
  • Protect against environmental hazards
  • Prevent injuries
  • Ensure the safety of all Oregonians receiving health care
  • Promote and encourage healthy behaviors
  • Develop policies and plans that support individual and community health efforts
  • Respond to disasters and assist communities with recovery efforts
  • Ensure health services are effective for all communities, especially those experiencing health disparities
  • Provide prevention and nutrition services to children
  • Assess and monitor the health status of Oregonians

PHD key activities

Each year the Public Health Division:

  • Ensures safe drinking water in 3,600 public water systems
  • Distributes more than 880,000 doses of vaccine
  • Investigates 200 disease outbreaks
  • Performs more than 8 million laboratory tests
  • Issues 200,000 birth, marriage and death certificates
  • Licenses and inspects more than 18,000 food facilities and trains more than 61,000 food workers
  • Oversees 44 school-based health centers in 19 counties
  • Certifies 8,000 emergency medical technicians (every two years)

The value of public health

  • Health has value in and of itself
  • A healthy workforce supports economic development and attracts business
  • Healthy kids learn better
  • We must address drivers of the need for health care if health care reform is to produce a sustainable business model

Local public health in Oregon

  • Primary responsibility for protecting public health resides at the county level
  • Many services delivered by 34 county health departments
    • Minimal services required in statute and rule, but many counties provide additional services
    • Counties receive some state support, but proportion of budget supplied by state varies substantially
  • Recent assessment of local public health capacity using national standards showed Oregon has only 57 percent of a fully functional public health system

Federal investments

  • Federal Funds account for 70 percent of PHD budget
  • Federal Funds usually tied to specific diseases and activities
    • Limits flexibility and innovation
  • Oregon is 41st in state investment in public health system
  • Stimulus funds
    • Drinking water
    • Immunizations
    • “Prevention and Wellness Fund” for chronic disease prevention
    • Nutrition and Health Screening (WIC) data systems
    • Health information technology

Major budget drivers

  • The rise in the burden of chronic disease and injuries
  • The continued toll of tobacco and marketing of new tobacco products
  • The health impacts of global warming
  • The increasing numbers of Oregonians without health insurance
  • The health effects of the economic downturn
  • Changes in health needs as Oregon’s population becomes more diverse
  • Large disease outbreaks and natural disasters
  • Changes in federal policy and funding
  • Increases in costs of medical supplies and medical insurance

Improving service quality

Transformation Initiative

  • Process improvement efforts to transform and streamline operations
  • Empowering staff, strengthening accountability, improving service delivery
  • Streamline dynamic data collection and dissemination via the Web

Information technology

  • Enterprise Content Management System pilot to improve public health Internet capacity
  • Public Health Information Network messaging and directory to provide secure messaging to CDC and data exchange across applications
  • Oregon Vital Records Event System to provide an integrated and secure Web system to process vital records
  • Family Net Immunization Project to combine existing immunization registry and county data systems to enable future integration required by CDC

Significant GF investments (2007-2009)

  • Reproductive health: $9.1 million
  • Per capita local health department support: $8.6 million
  • Communicable disease control: $8 million
  • School-based health centers: $5.5 million
  • Safe drinking water: $4.8 million
  • Perinatal and child health: $2.8 million
  • Communicable disease testing: $2.5 million
  • Immunizations: $2.2 million
  • Emergency medical services: $1.9 million


Roll-up of one Policy Option Package from 2007-2009

  • Ensure safe drinking water; 2007 POP 105-47 ($0.1 million OF)

Limited duration continuation in the Office of Family Health

  • 6 positions, 6.00 FTE ($0.9 million FF)

Transfer Office of Multicultural Health to DHS Director’s Office

  • 6 positions, 5.50 FTE ($0.2 million GF, $0.2 million OF, $0.9 million FF)

Modified EBL

Expenditure reductions due to revenue shortfalls

  • Health care facility inspections and oversight(SB 158, POP 316)

1 position, .75 FTE ($0.13 million OF)

  • Health facilities Certificate of Need (HB 5530, POP 376)

0 position, .63 FTE ($0.14 million OF)

  • Health facilities planning and safety (HB 5530, POP 376)

3 positions, 2.36 FTE ($0.59 million OF)


2009-2011 modified EBL to GRB “build”

* Although officially General Fund, it was the intent of the GRB to fund Policy Option Packages 156 and 261 with new Tobacco Tax receipts. Therefore, the Department will be seeking to make this correction at the Governor's Recommended Budget Reshoot.


GRB proposed reductions

Significant proposed reductions and savings targets

  • Reduces family planning services to low income women ($2.2 million GF, $19.8 million FF; 9:1 federal/state match)
  • Reduces oversight and inspections of public drinking water systems and response to disease outbreaks ($0.4 million)
  • Reduces communicable disease laboratory testing for local health departments ($0.4 million)
  • Reduces funding to local health departments for HIV/STD/TB diagnosis, treatment, medical supplies and drug purchases ($1.0 million)
  • Eliminates public health pilot projects and consolidates health systems planning efforts ($0.8 million)
  • Reduces administrative functions, personal services, services and supplies, and AG costs, and eliminates inflation increases on special payments ($2.0 million GF, $1.9 million OF, $8.3 million FF)

GRB proposed investments

  • POP 156, Local public health system improvement
  • Provides $2 million to local health departments
  • Revenue source: tobacco tax in HB 2122
  • POP 261, Obesity prevention and education
  • Obesity is the leading emerging public health problem we face
  • Obesity causes serious chronic diseases and places substantial burden on the health care system
  • POP supports a comprehensive, multi-component program involving county health departments, schools, businesses, tribes and community-based organizations.
  • Revenue source: tobacco tax in HB 2122

GRB proposed investments

  • POP 316, Health care facility inspections and oversight
  • Ensures inspection at least every three years
  • Broadens program to cover infusion companies and some staffing agencies, contains fee increases included in SB 158
  • Restores expenditure reductions made in package 070 mandated by statute when a fee-financed program cannot support EBL expenditures
  • POP 326, Hospice agency licensing and regulatory oversight
  • Based on 2007 recommendation by the Oregon Department of Justice
  • Moves regulatory oversight of Oregon hospice agencies from the Oregon Hospice Association to DHS
  • Revenue source: fees in SB 161

GRB proposed investments

POP 346, EPA Lead-Based Paint Renovation Repair and Painting (RRP) Rule

  • New EPA rules will require those doing renovation work on pre-1978 housing to be certified
  • Creates a program to meet this requirement in Oregon
  • Revenue source: fees in HB 2134

GRB proposed investments

  • POP 356, Public Health Laboratory fee statutory cap removal
  • Contains OF expenditure limitation to correspond with HB 2133, which removes the statutory cap for establishing fees for tests that cost more than $50
  • Makes it easier for the Public Health Laboratory to offer additional tests of public health significance on a cost-recovery basis, and to raise revenue needed for investments to maintain laboratory accreditation
  • All fee changes must be approved by DAS and ratified by the Legislature
  • An adjustment for this package will be requested at the GRB Reshoot

GRB proposed investments

POP 366, Mortuary Board fee increase

  • Reflects revenue transfer and expenditure limitation changes associated with the death filing fee increase proposed by the State Mortuary and Cemetery Board in HB 2244
  • DHS is required by law to impose and collect a filing fee for each certificate of death, to be used to:
    • Provide oversight of funeral homes and cemeteries
    • Support the Indigent Burial Fund, which is used to reimburse funeral service practitioners for the disposition of a deceased person’s body when no one claims the body

GRB proposed investments

POP 376, SB 333 ratification of fee increases for the Certificate of Need (CN) and the Health Facilities, Planning and Safety (HFPS) programs

  • Have been contingently approved by DAS during the 2007-2009 biennium
  • Will be rescinded July 1, 2009, unless this package and the corresponding legislation in HB 5530 are approved
  • Restores expenditure reductions made to CN and HFPS in package 070 mandated by statute when a fee-financed program cannot support EBL expenditures

GRB proposed investments

POP 505, Oregon Healthy Kids school-based health center (SBHC) component

  • Offers expansion of the SBHC system in up to five new counties
  • Allows up to seven counties that already have SBHCs to expand into the next range of funding
  • Provides access for an estimated 3,000-7,000 additional students in grades K-12, improves capacity to provide mental health services and enhances sustainability of SBHCs
  • Revenue source: an increase in provider tax paid by hospitals and insurers included in HB 2116

GRB proposed investments

  • POP 507, Tobacco Prevention and Education Program
  • Tobacco is the leading cause of death and disability in Oregon, killing approximately 7,000 Oregonians each year
  • Oregon’s Tobacco Prevention and Education Program is funded at only 20 percent of the level recommended by the Centers for Disease Control and Prevention
  • POP further invests in Oregon’s program, enhancing its ability to keep kids from starting to smoke, protect people from secondhand smoke, and help smokers quit smoking
  • Revenue source: tobacco tax included in HB 2122

Major sources of Federal Funds at modified EBL

  • USDA Food and Nutrition Program (WIC)
  • CDC Public Health Emergency Preparedness
  • HHS Bioterrorism Hospital Preparedness
  • EPA Drinking Water Primacy and State Revolving Loan Fund
  • HHS Family Planning (Title X, Expansion Waiver Title XIX)
  • CDC Immunization
  • HHS Maternal Child Health (Title V)
  • CDC Ryan White
  • CDC Chronic Disease
  • CDC Tobacco Prevention

Major sources of Other Funds at modified EBL

  • Vital Records
  • Aids Drug Assistance Program Drug Rebates
  • Tobacco Tax (Ballot Measure 44)
  • Medical Marijuana Registration
  • Emergency Medical Technician Licensing
  • Radioactive Materials and X-ray Machine Licensing
  • Food, Lodging and Pool Consultation Fees
  • Infant Formula Rebates

Outstanding Federal Funds issues

  • Public Health Emergency Preparedness required match
    • Begins August 2009
    • Required state match 5 percent during first year, increasing to 10 percent in subsequent years
    • Applies to both the Public Health Preparedness and Response for Bioterrorism and the Hospital Preparedness grants

Drinking Water State Revolving Loan Fund

    • Funds safe drinking water construction projects
    • Current annual allocation is approximately $12 million; Federal Stimulus Bill will provide an additional estimated $28 million
    • Current list of approved projects is approximately $280 million

DHS Public Health Division (PHD)

  • Themes
  • Public health is an excellent investment, particularly in difficult economic times
  • Oregon’s current public health system faces serious challenges including lack of investment in chronic disease and injury prevention, lack of local health department capacity, and over-reliance on federal funding