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True or False:True or False:Public Health Core FunctionsPublic Health Core Functions
Are Still Relevant Today?Are Still Relevant Today?
Mid-America RegionalMid-America Regional
Public Health Leadership Institute Public Health Leadership Institute
St. Charles, IllinoisSt. Charles, Illinois
October 25, 2006October 25, 2006
Barney Turnock MD, MPHBarney Turnock MD, MPH
UIC School of Public HealthUIC School of Public Health
InstructionsInstructions
Be Here on TimeBe Here on Time Address the Institute’s ThemeAddress the Institute’s Theme Remember, Leaders from Outside Illinois Remember, Leaders from Outside Illinois
Are in the RoomAre in the Room Make Core Functions UnderstandableMake Core Functions Understandable Be UpbeatBe Upbeat Be ProvocativeBe Provocative
““It’s all road-kill, and never a word about the It’s all road-kill, and never a word about the chickens who get to the other side!”chickens who get to the other side!”
Provocative?Provocative?
What’s provocative about:What’s provocative about: Core Functions?Core Functions? Essential Public Health Services?Essential Public Health Services? Public Health Infrastructure?Public Health Infrastructure?
Provocative like George Carlin’s “7 words Provocative like George Carlin’s “7 words you can’t say on TV”?you can’t say on TV”?
Why Are We Here?Why Are We Here?
Don’t have all the answersDon’t have all the answers Previous performance not necessarily an Previous performance not necessarily an
indication of futureindication of future Lessons of past successes often Lessons of past successes often
misappliedmisapplied Churchill and Max DeusChurchill and Max Deus Binghamton by way of Elmira?Binghamton by way of Elmira?
A little history…A little history…
Three core functions (1988 IOM Three core functions (1988 IOM Report)Report) Assessment (What should be done? i.e. Assessment (What should be done? i.e.
Needs)Needs) Policy Development (What will be Policy Development (What will be
done? i.e. priorities)done? i.e. priorities) Assurance (How well is it done? i.e. Assurance (How well is it done? i.e.
performance)performance) Core Functions Steering Committee Core Functions Steering Committee
(1994)(1994) Public Health in AmericaPublic Health in America statement statement
Essential Public Health ServicesEssential Public Health Services
1.1. Monitor health statusMonitor health status
2.2. Diagnose and investigate Diagnose and investigate health problemshealth problems
3.3. Inform, educate and Inform, educate and empower peopleempower people
4.4. Mobilize communities to Mobilize communities to address health problemsaddress health problems
5.5. Develop policies and Develop policies and plansplans
6.6. Enforce laws and Enforce laws and regulationsregulations
7.7. Link people to needed Link people to needed health serviceshealth services
8.8. Assure a competent Assure a competent workforce - public health workforce - public health and personal careand personal care
9.9. Evaluate health servicesEvaluate health services
10.10.Conduct research for Conduct research for new innovationsnew innovations
Public Health Systems PerspectivePublic Health Systems PerspectivePublic Health Systems PerspectivePublic Health Systems Perspective
CapacityCapacity Process(Core Functions/Essential Public Health Services)
Process(Core Functions/Essential Public Health Services)
OutputsOutputs
OutcomesOutcomes
System InputsSystem Inputs
WorkforceWorkforce
InformationInformation
Organization & Organization & RelationshipsRelationships
FacilitiesFacilities
FundingFunding
WorkforceWorkforce
InformationInformation
Organization & Organization & RelationshipsRelationships
FacilitiesFacilities
FundingFunding
Improved organizational performance +
Improved program performance
Improved organizational performance +
Improved program performance
AssessAssess AddressAddress AssureAssure
Programs and Services consistent with mandates and community priorities
Programs and Services consistent with mandates and community priorities
Key Processes Key Processes
Improved Outcomes& Customer Satisfaction
Improved Outcomes& Customer SatisfactionIncreased Value
& Public Support
““Well, actually they ARE written in stone!”Well, actually they ARE written in stone!”
True or False:True or False:Public Health Core FunctionsPublic Health Core Functions
Are Still Relevant Today?Are Still Relevant Today?
Core Functions Still Relevant? Core Functions Still Relevant? It’s TRUE, Because…It’s TRUE, Because…
All the easy problems have All the easy problems have already been solvedalready been solved
We need a framework to assess, We need a framework to assess, address, and assure effective address, and assure effective responses to today’s wicked responses to today’s wicked problemsproblems
110.0
29.2
6.9
47.3
68.276.9
0
20
40
60
80
100
120
1900 1950 2000
Year
Life Expectancy at Birth (in years)
Infant Mortality Rate (per 1000 live births)
1446
1339
1223
1039
939
842
964 955 945878 864 854 833
869
700
800
900
1000
1100
1200
1300
1400
1500
1950 1960 1970 1980 1990 2000 2003
Year
Dea
ths
per
100,
000
Pop
ulat
ionCrude Mortality Rate
Age-Adjusted Mortality Rate
Actual Causes of Death, 2000Actual Causes of Death, 2000((SourceSource: Mokdad et al, : Mokdad et al, JAMAJAMA 2004) 2004)
TobaccoTobacco 435,000435,000
Poor diet & physical activityPoor diet & physical activity 400,000400,000
AlcoholAlcohol 85,00085,000
Microbial agentsMicrobial agents 75,00075,000
Toxic agentsToxic agents 55,00055,000
Motor vehicleMotor vehicle 43,00043,000
FirearmsFirearms 29,00029,000
Sexual behaviorSexual behavior 20,00020,000
Illicit drug useIllicit drug use 17,00017,000
Anthrax Attack 2001: Mail Flow Network…Anthrax Attack 2001: Mail Flow Network…
State Department SA-32 (VA)AMI Building (FL)
Brentwood Mail Facility (DC)
Truck to Atlanta, GA
Hamilton Processing Facility (NJ)
Morgan Central Postal Facility
(NY)
Carteret Hub & Spoke Facility (HSF) (NJ)
Boca Main Substation (FL)
Blue Lake PO (FL)
West Palm PO Main Branch (FL)
Lake Worth PO (FL)
Green Acres PO (FL)
Radio City PO (NY)
Rockefeller Ctr PO (NY)
Ansonia PO (NY)
56 USPS Facilities including:
Lenox Hill PO (NY)
Times Sq. PO (NY)
ENT Hospital (NY)
Pataki’s Office (NY)
NBC (NY)
ABC (NY)CBS (NY)
New York Post (NY)
Distribution plants including: (Bulk Mail Ctr, Dominic V Daniels,
Hackensack, Central NJ, Performance, Monmouth, Newark
Main, Patterson, West Jersey)
Dirksen Bldg
P-St. Mail Sorting (DC)
Hart Bldg
Ford Bldg
All DC City Mail for Zips 20000-20099
W. Trenton PO (NJ)
Princeton PO (NJ)
?
177 Federal Agencies including:
Bellmawr Distribution plant (NJ)
48 local Post Offices including:
Boulevard PO (NY)
Other Post
Offices
State Department SA-3 (DC)
Longworth Bldg
Landover (Justice)
Pentagon PO Branch
Southwest PO Station
Friendship PO Station
Dulles PO Branch
Anacostia mail room
Walter Reed Complex
DC VAMC
BATF
Supreme Court
Local Businesses including:
Kuser Road Business
US Embassy in Yekaterinburg,
Russia
US Embassy in Lima,
Peru
US Embassy in Vilnius, Lithuania
NYC001-47 Home
Stamp Fulfillment Kansas City, MO
Lantana PO (FL)
= Environmental samples positive
= Confirmed anthrax case associated with site
= Suspect anthrax case associated with site
November 7, 2001
Hotel MHong Kong
Guangdong Province,
China
A
A
B
J
H
CD
E
I
K †
FG †
Hospital 2Hong Kong
A
H
J
B
4 other Hong Kong Hospitals
Hospital 3 Hong Kong
Hospital 1 HK
Hospital 4 Hong Kong
2 family members
C D E
34 HCWs
HCW
B Germany
Bangkok
Singapore
United States
IL§
M§
Vietnam
IrelandK †
37 HCWs
HCW
0 HCWs
28 HCWs
156 close contacts of HCWs and
patients
Canada
G †
F
4 family members
10 HCWs
37 close contacts
99 HCWs (includes 17 medical students)
4 HCWs*
3 HCWs
HCW
HCW
2 family members
Unknown number
close contacts
2 close contactsSARS Transmission Spring 2003
Rodent Shipment Ghana
TEXAS50 Gambian giant rats (GR)
53 rope squirrels (RS) 2 brushtail porcupines (BP)
47 tree squirrels (TS)100 striped mice (SM)
~510 dormice (DM)
NJRS, BPTS, SM
TX-3RS, SM
DM
IA†
GR, DM
TX-4DM
TX-5DM
TX-6TS, SM
DM
TX-2GR
TX-8DM
TX-7DM
TX-9DM
JapanDM
TX-10DM
MNDM
WIDM
IL-2DM
IL-1§
GR, DM
MINo human
cases
SCNo human
cases
MO Human cases:
2 confirmed
KS Human cases:
1 confirmed
IN Human cases:
7 confirmed9 probable/
suspect
IL‡
Human cases:8 confirmed4 probable/
suspect
WI Human cases:17 confirmed22 probable/
suspect
1 PD traced
200 prairie dogs (PDs) at facility
1 PD traced
11 PDs traced
24 PDs traced
14 PDs traced
42 PDs traced
Monkeypox Outbreak 2003
Core Functions Still Relevant?Core Functions Still Relevant?It’s TRUE, Because…It’s TRUE, Because…
When you’re a hammer, When you’re a hammer, the whole world looks like the whole world looks like a nail…a nail…
When you’re a hammer…When you’re a hammer…
SpecializationSpecialization Categorical ApproachesCategorical Approaches Silos Instead of SystemsSilos Instead of Systems Poor Charlie’s Democratic PrinciplesPoor Charlie’s Democratic Principles
Organizations engaged in regulation, inspection and/or licensing activities
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Cosmetology businesses
Tobacco retailers
Housing (inspections)
Health-related facilities
Mobile homes
Campgrounds & RVs
Hotels/motels
School/daycare
Food service establishments
Percentage of Jurisdictions
LHD only Other local gov't onlystate gov't agency only multiple gov't agenciesnon-gov't agency only
Organizations engaged in regulation, inspection and/or licensing activities
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Milk processing
Public drinking water
Food processing
Solid waste disposal sites
Solid waste haulers
Smoke-free ordinances
Lead inspection
Private drinking water
Septic tank installation
Swimming pools (public)
Percentage of Jurisdictions
LHD only Other local gov't onlystate gov't agency only multiple gov't agenciesnon-gov't agency only
Organizations providing environmental health services
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Radiation control
Hazmat response
Land use planning
Noise pollution
Hazardous waste disposal
Pollution prevention
Surface water protection
Indoor air quality
Groundwater protection
Vector control
Food safety education
Percentage of Jurisdictions
LHD only other local gov't agency onlystate agency only multiple gov't agenciesnon-gov't organization only
Core Functions Still Relevant?Core Functions Still Relevant?It’s TRUE, Because…It’s TRUE, Because…
We need a plan…We need a plan…
LHD Participation in Community LHD Participation in Community Health Assessment (CHA)Health Assessment (CHA)
CHA completion or plansCHA completion or plans PercentagePercentage
Completed CHA in past three yearsCompleted CHA in past three years 51%51%
Plans to complete CHA in next three Plans to complete CHA in next three yearsyears
65%65%
Either completed CHA in past three Either completed CHA in past three years or plans to complete in next three years or plans to complete in next three yearsyears
79%79%
Both completed CHA in past three years Both completed CHA in past three years and plans to complete in next three and plans to complete in next three yearsyears
38%38%
LHD Participation in Community LHD Participation in Community Health Improvement Planning Health Improvement Planning
(CHIP)(CHIP)PercentagePercentage
Participated in CHIPParticipated in CHIP 54%54%
CHIP based on results of CHA*CHIP based on results of CHA* 86%86%
CHIP linked to state’s health CHIP linked to state’s health
improvement plan*improvement plan*
68%68%
Participation in past three years*Of those LHDs that have participated in CHIP
Participation in CHA by StateParticipation in CHA by State
ID
AZ
UT
MT
WY
NM
CO
AL
FL
SC
TN
KY
INOH
NC
SD
KS
NE
MN
WI
IA
IL
MO
AR
MS
OK
ND
OR
CA NV
WA
TX
WV
PA
M E
VA
NY
United S tates of Am erica
LA
GA
MIRI
VT N
H
M D
C T
HI
D E
N J
AK
M A
< 25%
25-49%
50 - 75%
>75%n=2280Completed CHA in last 3 years
Participation in CHA: Comparison Participation in CHA: Comparison with 1999 Infrastructure Studywith 1999 Infrastructure Study
Population sizePopulation size 19991999 20052005
All LHDsAll LHDs 55%55% 51%51%
<25,000<25,000 44%44% 42%42%
25,000 – 49,99925,000 – 49,999 63%63% 53%53%
50,000 – 99,99950,000 – 99,999 65%65% 57%57%
100,000 – 499,999100,000 – 499,999 66%66% 61%61%
500,000 +500,000 + 72%72% 67%67%
Participation in CHIP: Comparison Participation in CHIP: Comparison with 1999 Infrastructure Studywith 1999 Infrastructure Study
Population sizePopulation size 19991999 20052005
All LHDsAll LHDs 53%53% 54%54%
<25,000<25,000 4141 4545
25,000 – 49,99925,000 – 49,999 5959 5555
50,000 – 99,99950,000 – 99,999 6868 5959
100,000 – 499,999100,000 – 499,999 6969 6161
500,000 +500,000 + 7676 6868
LHD Role in Community Health PlanningLHD Role in Community Health Planning
17%
33%28%
14%
8%
Developed primarily by LHDCoalition - LHD leadCoalition - LHD as equal partnerCoalition - some LHD involvementNo LHD involvement
Core Functions Still Relevant?Core Functions Still Relevant?It’s TRUE, Because…It’s TRUE, Because…
It provides a job description for It provides a job description for public healthpublic health
Countering the frequently raised Countering the frequently raised argument: “That ain’t my job! argument: “That ain’t my job! Nobody told me I was supposed to Nobody told me I was supposed to do that.”do that.”
Ain’t my job?Ain’t my job?
Coming Soon to a Coming Soon to a Local Health Local Health Department in your Department in your neighborhood?neighborhood?
The MAPP ModelThe MAPP Model
Road-MAPPRoad-MAPP
Public Health Systems PerspectivePublic Health Systems PerspectivePublic Health Systems PerspectivePublic Health Systems Perspective
CapacityCapacity Process(Core Functions/Essential Public Health Services)
Process(Core Functions/Essential Public Health Services)
OutputsOutputs
OutcomesOutcomes
System InputsSystem Inputs
WorkforceWorkforce
InformationInformation
Organization & Organization & RelationshipsRelationships
FacilitiesFacilities
FundingFunding
WorkforceWorkforce
InformationInformation
Organization & Organization & RelationshipsRelationships
FacilitiesFacilities
FundingFunding
Improved organizational performance +
Improved program performance
Improved organizational performance +
Improved program performance
AssessAssess AddressAddress AssureAssure
Programs and Services consistent with mandates and community priorities
Programs and Services consistent with mandates and community priorities
Key Processes Key Processes
Improved Outcomes& Customer Satisfaction
Improved Outcomes& Customer SatisfactionIncreased Value
& Public Support
True or False:True or False:Public Health Core FunctionsPublic Health Core Functions
Are Still Relevant Today?Are Still Relevant Today?
Core Functions Still Relevant?Core Functions Still Relevant?It’s FALSE, Because…It’s FALSE, Because…
That’s not what they taught That’s not what they taught me in public health school!me in public health school!
““Hmmm…traces of oil, gas, lead, EDBHmmm…traces of oil, gas, lead, EDB… … it’s water, all right.”it’s water, all right.”
““Go about your business. Act normal.”Go about your business. Act normal.”
““To prevent a heart attack, take one aspirin every day.To prevent a heart attack, take one aspirin every day.Take it out for jog, then take it to the gym, then take it Take it out for jog, then take it to the gym, then take it
for a bike ride…”for a bike ride…”
Core Functions Still Relevant?Core Functions Still Relevant?It’s FALSE, Because…It’s FALSE, Because…
You get what you pay for?You get what you pay for?
Get what you pay for?Get what you pay for?
Actual Causes of Death, 2000Actual Causes of Death, 2000((SourceSource: Mokdad et al, : Mokdad et al, JAMAJAMA 2004) 2004)
TobaccoTobacco 435,000435,000
Poor diet & physical activityPoor diet & physical activity 400,000400,000
AlcoholAlcohol 85,00085,000
Microbial agentsMicrobial agents 75,00075,000
Toxic agentsToxic agents 55,00055,000
Motor vehicleMotor vehicle 43,00043,000
FirearmsFirearms 29,00029,000
Sexual behaviorSexual behavior 20,00020,000
Illicit drug useIllicit drug use 17,00017,000
““Tell the public we don’t want to hurt anyone.Tell the public we don’t want to hurt anyone. All we want is their money.”All we want is their money.”
Pop Quiz QuestionPop Quiz Question
• Over the past 50 years, total expenditures Over the past 50 years, total expenditures and per capita spending for public health and per capita spending for public health activities in the United States has been:activities in the United States has been:
a.a. Increasing steadilyIncreasing steadily
b.b. Decreasing steadilyDecreasing steadily
c.c. UnchangedUnchanged
d.d. Don’t knowDon’t know
Adjusted total public health spending (in Adjusted total public health spending (in millions) from federal and state/local sourcesmillions) from federal and state/local sources
US, 1960-2000US, 1960-2000
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
$20,000
1960 1965 1970 1975 1980 1985 1990 1995 2000
Adjusted total public health spending
Adjusted state/local public health spending
Federal public health spending
Per capita public health expenditures from federal Per capita public health expenditures from federal and state/local sources, US, 1960-2000and state/local sources, US, 1960-2000
$5$8
$15
$20$24
$27
$39
$51
$62
$3 $4$7
$14
$19
$28
$36
$44
$3$5
$11$13
$2
$15$11
$10 $8
$18
$0
$10
$20
$30
$40
$50
$60
$70
1960 1965 1970 1975 1980 1985 1990 1995 2000
Real per capita adjusted total public health spending
Real per capita adjusted state/local public health spending
Real per capita fedeal public health spending
Core Functions Still Relevant?Core Functions Still Relevant?It’s FALSE, Because…It’s FALSE, Because…
We assume it to be true and our We assume it to be true and our assumptions are often incorrect!assumptions are often incorrect!
Look what happens when we get Look what happens when we get what ask for!what ask for!
““I guess he must have made it… It’s been more I guess he must have made it… It’s been more than a week since he went over the wall.”than a week since he went over the wall.”
Conventional Wisdom?Conventional Wisdom?
Public Health Workforce is shrinkingPublic Health Workforce is shrinking Average age is high (~47)Average age is high (~47) Public Health workers soon will be retiring in large Public Health workers soon will be retiring in large
numbers numbers Recruitment and retention are major issues, especially in Recruitment and retention are major issues, especially in
rural communitiesrural communities Key disciplines (such as public health nurses and Key disciplines (such as public health nurses and
epidemiologists) are increasingly scarceepidemiologists) are increasingly scarce Few public health workers have received formal training Few public health workers have received formal training
in public healthin public health Public Health Workforce is not prepared for current and Public Health Workforce is not prepared for current and
future threatsfuture threats
Pop Quiz QuestionPop Quiz Question• Over the past dozen years, the size (# and ratio) of the Over the past dozen years, the size (# and ratio) of the
public health workforce in the United States has been:public health workforce in the United States has been:
a.a. Increasing steadilyIncreasing steadily
b.b. Decreasing steadilyDecreasing steadily
c.c. Increasing in the 1990s through 2000 and then Increasing in the 1990s through 2000 and then decreasingdecreasing
d.d. Decreasing in the 1990s through 2000 and then Decreasing in the 1990s through 2000 and then increasingincreasing
e.e. UnchangedUnchanged
f.f. Don’t KnowDon’t Know
Pop Quiz QuestionPop Quiz Question• Over the past dozen years, the size (# and ratio) of the Over the past dozen years, the size (# and ratio) of the
public health workforce in Illinois, Indiana, Wisconsin, public health workforce in Illinois, Indiana, Wisconsin, Michigan, etc. has been:Michigan, etc. has been:
a.a. Increasing steadilyIncreasing steadily
b.b. Decreasing steadilyDecreasing steadily
c.c. Increasing in the 1990s through 2000 and then decreasingIncreasing in the 1990s through 2000 and then decreasing
d.d. Decreasing in the 1990s through 2000 and then Decreasing in the 1990s through 2000 and then increasingincreasing
e.e. UnchangedUnchanged
f.f. Don’t KnowDon’t Know
FTE Workers FTE Workers (per 100,000 pop.)(per 100,000 pop.) of State and Local of State and Local Governmental Health Agencies, U.S.Governmental Health Agencies, U.S.
(Public Employment Census Data, Selected Years)(Public Employment Census Data, Selected Years)
73
137
81
143
89
151
88
150
83
144
0
50
100
150
200
1993 1998 2001 2003 2005
Local State+Local
FTE Workers FTE Workers (per 100,000 pop.)(per 100,000 pop.) of State and Local of State and Local Governmental Health Agencies, TexasGovernmental Health Agencies, Texas
(Public Employment Census Data, Selected Years)(Public Employment Census Data, Selected Years)
81
140
93
146132
189
108
166
94
150
0
50
100
150
200
1993 1998 2001 2003 2005
Local State+Local
Full Time Equivalent (FTE) Workers of Full Time Equivalent (FTE) Workers of Governmental Health Agencies, 1995-2005Governmental Health Agencies, 1995-2005
Source:Source: Data from U.S. Bureau of the Census, Federal, State, and Local Governments, Public Data from U.S. Bureau of the Census, Federal, State, and Local Governments, Public Employment and Payroll Data. Available at Employment and Payroll Data. Available at www.census.gov/govs/www/apes.htmlwww.census.gov/govs/www/apes.html..
YearYear
Fed (F)Fed (F)
FTEFTE
State (S)State (S)
FTEFTE
Local (L)Local (L)
FTEFTE
S+LS+L
FTEFTE
F+S+LF+S+L
FTEFTE
19951995 125,048125,048 160,031160,031 208,588208,588 368,619368,619 493,667493,667
19981998 119,846119,846 166,930166,930 219,655219,655 386,585386,585 506,431506,431
20012001 122,999122,999 172,414172,414 251,399251,399 423,813423,813 546,812546,812
20022002 124,979124,979 176,345176,345 252,326252,326 428,671428,671 553,650553,650
20032003 124,828124,828 176,868176,868 253,888253,888 430,756430,756 555,584555,584
20042004 127,933127,933 174,301174,301 249,857249,857 424,128424,128 552,061552,061
20052005 125,163125,163 178,465178,465 246,300246,300 424,765424,765 549,918549,918
Approaches to Public Health Approaches to Public Health Workforce Development: Workforce Development: Pipeline vs. Willy SuttonPipeline vs. Willy Sutton
Conventional Wisdom approach to workforce Conventional Wisdom approach to workforce developmentdevelopment: more schools, increase number of : more schools, increase number of graduates, higher proportion of gradates into graduates, higher proportion of gradates into primary public health workforce through primary public health workforce through scholarships and loan repayment programs scholarships and loan repayment programs (Pipeline approach)(Pipeline approach)
Willie Sutton approach to workforce development: Willie Sutton approach to workforce development: focus on the work organizations (that’s where the focus on the work organizations (that’s where the workers are now and where they will be tomorrow).workers are now and where they will be tomorrow).
Public Health Work-Doing Public Health Work-Doing SystemSystem
What Should We Do with the Next What Should We Do with the Next $230 Million?$230 Million?
Pipeline Approach: scholarships and loan Pipeline Approach: scholarships and loan repayment programsrepayment programs
Willie Sutton: assess, enhance, recognize Willie Sutton: assess, enhance, recognize and reward ( i.e., manage) and reward ( i.e., manage)
It’s their way of thanking us for all we’ve done for them --- it’s called “tobacco”
Core Functions Still Relevant?Core Functions Still Relevant?It’s FALSE, Because…It’s FALSE, Because…
Why else would we whine Why else would we whine so much?so much?
““That’s just great! I discover the cure for the That’s just great! I discover the cure for the common cold, and all you can do is criticize.”common cold, and all you can do is criticize.”
When’s the Last Time You Heard When’s the Last Time You Heard Someone at a Public Health Someone at a Public Health
Conference Say… Conference Say… The public health infrastructure is not The public health infrastructure is not
crumblingcrumbling Public health workers are better prepared Public health workers are better prepared
than everthan ever Accreditation and Credentialing are good Accreditation and Credentialing are good
things for public health practicethings for public health practice Those Essential Public Health Services Those Essential Public Health Services
really get my juices flowingreally get my juices flowing
Reported change in selected LHD functions over the past three years Reported change in selected LHD functions over the past three years as a result of efforts to improve emergency preparedness (N= 393)as a result of efforts to improve emergency preparedness (N= 393)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Preparedness planning
Communication systems
Workforce training
Information systems
Public health surveillance
Epidemiology
Legal basis for PH actions
Relationships with other agencies
Immunization
Surge capacity
Access to laboratory services
Screening for diseases & conditions
Other environmental health activities
Treatment for communicable diseases
Population-based primary prevention
Other health sercices
Regulation, inspection & licensing
Maternal & child health
StrongerNo ChangeWeaker
Core Functions Still Relevant?Core Functions Still Relevant?
Maybe TRUE?Maybe TRUE? Adapts to a dynamic Adapts to a dynamic
agendaagenda Fosters systems, not Fosters systems, not
silossilos Provides the plan we Provides the plan we
lacklack Serves as public Serves as public
health’s job descriptionhealth’s job description
Maybe FALSE?Maybe FALSE? Not what they taught Not what they taught
meme Hasn’t impacted Hasn’t impacted
fundingfunding Assumptions often Assumptions often
unfoundedunfounded We continue to whineWe continue to whine
Some Days It Takes Hours to Get DressedSome Days It Takes Hours to Get Dressed
Thanks, Now Its Your Turn.. Thanks, Now Its Your Turn..
Any Questions?Any Questions?
What Do You Think?What Do You Think?
““I think you need to be more explicit here in Step 2”I think you need to be more explicit here in Step 2”
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