The Future of Franklin County Public Health


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  • Thank you for taking your time to talk about the future of Franklin County Public Health – The health department that serves your citizens and your community It’s important that we have this conversation While change is a constant in life, there are always significant events or times that shape that changeOne of those significant times is now for public health
  • As your health department, we have many common interests - we are both boots on the ground, we are both eyes and ears on the streets, in the neighborhoods, serving the same citizensAnd as this quote illustrates, we are indeed in the same company as we are both ultimately measured by the well being of those citizens Which brings us to today’s meeting
  • The recent State Biennium Budget, as well as other local and national forces are impacting public health. These forces are affecting the residents and well-being of the communities we all serve. As important stakeholders, we would like your input as we consider options to sustain your public health services in the future. There is a human and economic value to public health Driving forces – happening now – we need to make decisionsFinances – yes, we have to have a discussion about funding But it’s about what we can return on investment – our visionLead us to a plan beginning in 2015Agenda will include plenty of time for questions and comments 
  • Most people when asked, “what is public health?” will commonly answer, “I don’t know!” Public health is not widely visible – our best work is often done when you don’t hear anything about us.
  • While medical care can prolong survival and improve prognosis after some serious diseases, more important for the health of the population as a whole are the social and economic conditions that make people ill and in need of the health care in the first place. In the US, spending is heavily weighted on medical care, even though emphasis on prevention and public health can produce a greater return on investment for the health of a community.
  • Example of One StudyAnother report estimates that from 1960 to 2000 medical care has spent $31,600 for each year of life gainedN Engl J Med 2006; 355:920-927Estimate for public health is $12,200-$25,600 for each year of life gainedOne component of Affordable Care Act – moving in this direction
  • Cost-effective Economic opportunityHealthier communities
  •  When I started working at Franklin County Public Health 14 years ago, we didn’t even have a computer on every desk. Now the issues we deal with are more sophisticated as well as the technology we use to address those issues. This is not unlike what you are experiencing in your field of expertise too. “Sinks and Toilets” (and vaccines) in the 20th century – that was our focus and it had incredible impact! Life expectancy and our quality of life improved dramatically. In spite of our progress, we still need to keep these things in our sights. We still cope with new and emerging infectious diseases; we still have issues in Franklin County with adequate sewage treatment systems; and in spite of an effective, safe flu vaccine, many people don’t get protected. Those are just a few.  
  •  In 2012, the Association of Ohio Health Commissioners (AOHC) recognized the need to critically assess the feasibility of sustaining 125 local health departments and to proactively explore new ways to structure and fund local public health. A public health futures committee was formed and released this report in June 2012. I served on that committee. The report documented a remarkable variety of activities by local public health agencies all across Ohio with very limited resources. It also illuminated an unsustainable system in decline.  
  • What should public health be doing? Committee developed Ohio Minimum Package of Core Public Health services.Responsible for providing these services in your district Consistent with 2012 Institute of Medicine report, For the Public’s Health and the national public health accreditation standards.
  • Skills and resources that support the core services.Ohio local health departments most often lack funding sources designated for basic infrastructure needs. All Ohioans, regardless of where they live, should have access to the core public health services. All local health departments, should have access to the skills and resources of foundational capabilities to effectively support core services.
  • The Ohio legislature picked up the AOHC report and created a committee to review. 11 recommendations
  • 2,700 local health districts in US19 have been accredited so far – 159 in process with PHAB – many more preparing!Support consistent standards across the country that lets the health department and the community know just how well we are doingI chair the statewide Ohio Voluntary Accreditation Team. We have the expertise and experience – just need the sustainable resources.
  • How well positioned are we to achieve our future state?
  • This chart shows our 3 main funds. There are 5 other funds that are for specific purposes (Anti-dumping, rabies, regional PHI, C&DD, groundwater) Intergovernmental includes State Subsidy, emergency preparedness, MAC reimbursement and Flu contract with Commissioners Contract Receipts include-BCMH,CDBG Sewer Taps, IDDE Licenses and Permits- Funds received from Environmental Health programs such as food, plumbing, sewage etc. 
  • Majority of expenditures are for personnel.Major expenditures in materials and supplies include our fleet of vehicles and the annex facility for mosquito control and emergency preparedness.
  • Franklin County Public Health follow-up to the Public Health Futures report reviewed by the legislature.Identifies strategies that directly impact the health of our communities as well as build foundational capabilities. Represent the most critical public health issues with the greatest potential to impact our communities:Robust infectious diseaseAccess to community health nursing servicesMosquito ControlEmergency preparednessHealthy neighborhoodsHealth promotion and preventionResource ManagementInformation management Continuous Quality improvement (CQI)
  • After a year of internal research and discussion, we are seeking your input. We strongly believe that public health delivers real value and that Franklin County Public Health is an exceptional value.
  • We believe it is important to continue the mission of Franklin County Public Health in the communities we serve.
  • The Future of Franklin County Public Health

    1. 1. The Future of Franklin County Public Health September 30, 2013
    2. 2. Our Public Health Story The success or failure of any government in the final analysis must be measured by the well being of its citizens. Nothing can be more important to a state than its public health; the state’s paramount concern should be the health of its people. Franklin D. Roosevelt
    3. 3. Purpose of Today’s Meeting • The Value of Public Health • Driving Forces – Challenges & Changes • Financial Picture • Our Vision for the Future • Next Steps – Asking for your input
    4. 4. What is a Health Department? • General Health District – Townships and Villages • City Health District – At least 5,000 population – can contract
    5. 5. Governed by a Board of Health • General Health District – 5 members appointed by District Advisory Council (DAC) – 5 year term • Must have a Physician • Must have a Licensed Entity represented
    6. 6. Franklin County Public Health • Serves 435,999 citizens in 17 townships, 14 cities and 9 villages • Is the 6th largest health district in Ohio • Has 65 employees
    7. 7. Our Public Health Story What is Public Health? Prevention • The child who didn’t get whooping cough • The restaurant that served safe food and didn’t make people ill • The creek for canoeing that wasn’t contaminated with sewage
    8. 8. Our Public Health Story The Value of Public Health Many national studies show: • While medical care can prolong survival and improve prognosis for disease, it doesn’t address the disease upstream (prevention) • U.S. health spending is mostly on medical care • Spending more on public health results in measurable improvements in health
    9. 9. Our Public Health Story For every 10% increase in local public health spending, you get: • 3.2% decrease in Heart Disease deaths per 100,000 population (800 Ohioans) • 1.4% decrease in Diabetes deaths (50 Ohioans) • 1.1% decrease in Cancer deaths (280 Ohioans) G. Mays, S. Smith. Health Affairs, 2011; 30 (8) 1585-1593
    10. 10. Our Public Health Story “Prevention delivers real value as a cost- effective way to keep Americans healthy and improve their quality of life. Everyone wins when we prevent disease rather than treating people after they get sick. Health care costs go down, our local neighborhoods are healthier and provide more economic opportunity, and people live longer, healthier, happier lives.” J. Levi, Trust for America’s Health
    11. 11. Our Public Health Story What is Public Health? • The only resource in our communities responsible for the health of everyone (not just those who choose us) • Controlling the factors that individuals can’t control, that control health
    12. 12. Our Public Health Story
    13. 13. Driving Forces • National Public Health Trends • 2 Critical Reports driving change in Ohio • Regionalization, Consolidation, Mergers • Public Health Accreditation
    14. 14. Driving Forces - Trends National Public Health Trends • “Sinks and Toilets” (and vaccines) in the 20th century improved life expectancy and quality of life • More sophisticated issues requiring more specialized workforce • Use of technology • Economic and social stressors
    15. 15. Driving Forces - Reports Public Health Futures: Consideration for a New Framework for Local Public Health in Ohio • Local public health capacity, services and quality • Jurisdictional structure • Financing • Implementation Association of Ohio Health Commissioners (AOHC), June 2012
    16. 16. Public Health Futures - June 2012 Core Public Health Services • Environmental Health • Communicable Disease Control • Epidemiology • Birth and Death Records • Health Promotion and Prevention • Emergency Preparedness • Linking People to Health Services • Community Engagement
    17. 17. Public Health Futures - June 2012 Foundational Capabilities • Quality Assurance • Information Management & Analysis • Policy Development • Resource Development • Legal Support • Laboratory Capacity • Support & Expertise for community engagement strategies
    18. 18. Driving Forces - Reports Legislative Committee on Public Health Futures (Am.Sub.H.B. 487) • Recommendations for legislative and policy changes to include in the 2014-2015 state biennium budget October 2012
    19. 19. Driving Forces Regionalization, Consolidation, Mergers • Both Reports: – do NOT recommend population requirement for consolidation – do NOT recommend forced consolidation – DO recommend feasibility studies to address local conditions, sustainable funding and core services – DO recommend to continue current trend toward voluntary consolidation and shared services • Franklin County & Columbus?
    20. 20. Driving Forces Public Health Accreditation • Voluntary recognition by a credible body – the Public Health Accreditation Board (PHAB) – for meeting a set of national public health standards • New – introduced in 2011 • MANDATORY for local health departments in Ohio to continue receiving funds (2018-2020)
    21. 21. Our Future State We envision that: • We are rooted in strong community engagement. • We have strong public health promotion, education and community health nursing to achieve “winnable battles”. • We have healthy homes and neighborhoods through environmental health.
    22. 22. Our Future State We envision that: • We are supported by adequate resources and capabilities that align with community need and public health science. • That we all reap the benefits of measurable improvements in health, well-being and prosperity for every community we serve.
    23. 23. Our Financial Picture 2013 Total Budget - $ 7,194,932 Townships, Villages, Cities - $ 2,446,258 Contract Cities »$5.93 per capita Townships & Villages »Property valuation (inside millage)
    24. 24. Our Financial Picture 2013 Budget – Revenues by Category Administration, Environmental & Nursing Funds Only Contract Cities, Townships and Villages 41% Intergovernmental 11% Contract Receipts 19% Charges for Services 2% Licenses & Permits 27%
    25. 25. Our Financial Picture 2013 Budget – Expenditures by Category Personal Services 52%Fringe Benefits 23% Materials & Services 25% Capital Outlays & Equipment Less than 1%
    26. 26. Our Financial Picture Local Health Department Expenditures per Capita – 2010 • For the U.S. overall, the median per capita expenditure for local health departments was $41 • Ohio had a median per capita expenditure of $33 • Franklin County Public Health had a per capita expenditure of $16.50
    27. 27. Our Financial Picture Strengthening Public Health in Franklin County: A Proposal to Fund Core Public Health Services • Additional Annual Investment needed - $3.00 per capita ($1,308,000) • Franklin County Public Health would increase to a per capita expenditure of $19.50, still $13.50 below the Ohio median of $33 October 2012
    28. 28. Summary Public Health delivers real value as a cost-effective way to keep people and communities healthy and productive. Franklin County Public Health is an exceptional value – we are already a model for shared services.
    29. 29. Summary We want to continue the mission of public health in the communities we all serve and . . . We need your help to acquire the resources to accomplish our mission
    30. 30. Next Steps We need to hear from you… • Questions / Comments about today • Electronic Survey in October • Planning Session in early 2014
    31. 31. Next Steps Electronic Survey • One per jurisdiction • Your choice who or how you complete survey • Questionnaire will be sent by e-mail from Saperstein Associates, subject line: FCPH Survey • Will not require you to open an attachment • Will take no longer than 10 minutes to complete
    32. 32. Thank You!