The Changing Public Health System: A New Outlook for Public Health Workers

Sharon Davis, MPH, Ph.D., CHES Associate Professor Department of Public Health Sciences The University of Texas at El Paso Director - Community Outreach and Engagement Core The Hispanic Health Disparities Research Center

Objectives Discuss the implications of current budget constraints on health education and training Discuss how the Health Care Reform Act is changing health education, training, and evaluation activities Identify strategies that help public health workers meet the challenges of the rapidly changing health care system.

Certification that Addresses the Growing Demands of the Health Education Specialists

Future of Public Health Workforce 5 Shortage of public health workers by 2020 Recommends designing a system: where people can transfer their experience and skills easily between content areas

Health Education Specialists Trained at 250 colleges and universities nationwide Health education employment is anticipated to grow 18% by 2018 (SOPHE, 2010)

Health Educator Competencies Studies Role Delineation Study 1980-1985 Volunteer Donations & grants Competency Update Project 1998-2005 Primarily volunteer Donations, grants & NCHEC Health Educator Job Analysis 2008-2009 Contracted vendor Funded by publication profits NCHEC, AAHE SOPHE, 2010

Seven Areas of Responsibility of an Entry-Level Health Education Specialist: RESPONSIBILITY I: ASSESS INDIVIDUAL AND COMMUNITY NEEDS FOR HEALTH EDUCATION RESPONSIBILITY II: PLAN HEALTH EDUCATION STRATEGIES, INTERVENTIONS, AND PROGRAMS RESPONSIBILITY III: IMPLEMENT HEALTH EDUCATION STRATEGIES, INTERVENTIONS, AND PROGRAMS

RESPONSIBILITY IV: CONDUCT EVALUATION AND RESEARCH RELATED TO HEALTH EDUCATION RESPONSIBILITY V: ADMINISTER HEALTH EDUCATION STRATEGIES, INTERVENTIONS, AND PROGRAMS RESPONSIBILITY VI: SERVE AS A HEALTH EDUCATION RESOURCE PERSON RESPONSIBILITY VII: COMMUNICATE AND ADVOCATE FOR HEALTH AND HEALTH EDUCATION

HEJA Outcomes Verified CUP findings regarding Hierarchical Model Advanced builds on entry Differentiation of entry vs. advanced based on 5-year experience 7 Areas of Responsibility NCHEC, AAHE SOPHE, 2010

Three Components: Meet Academic Eligibility Standards Pass Written Examination Continuing Education Requirements -75 in 5 years Voluntary National in Scope Based on Generic Health Education Responsibilities and Competencies Verified through a Job Analysis Meets NCCA standards Over 9,000 Active CHES NCHEC 2010 CHES Certification

Benefits of Certification Establishes national standard Attests to individuals knowledge and skills Assists employers in identifying qualified practitioners Sense of pride and accomplishment Promotes continued professional development

Master Certified Health Education Specialist (MCHES) (began October 2011) Confirms Professional Development / Career Ladder Exam Eligibility: 5 Years Experience AND Masters Degree or 5 year CHES NCHEC 2010 Major and/or Degree In Health Education Academic Transcript Reflecting 25 Semester Hrs Addressing the Seven Areas of Responsibility of Health Educators OR Continuing Education 75 Hours in 5 Years 30 CECH Must be Linked to Advanced-Level Sub-competencies

The Role of CHES/ MCHES in the Professional Growth of Health Educators More than just one crossroad; intersecting pathways

Future Challenges & Lessons Learned Quality Standard Set and enforce minimum pass score Update competencies regularly Apply standards consistently NCHEC 2010

Show Me The Money!!! Wait, we dont have any! Everyone affected Public health departments, health care providers, community-based organizations Bottom line is we're all doing more with less More important than ever to manage resources well people as well as money

Epidemiology Remains Important We still need to know who is most at risk more difficult when people are in the shadows as is common in tough economies Often the most at risk are the most difficult to reach (e.g. undocumented, uninsured, language barriers, not help-seeking) Co-morbidities such as HIV, diabetes, addiction More important than ever to go where the people are

On The Border - and Beyond Three of the 10 poorest counties in the U.S are on the Texas/Mexico border 1 Health care access & availability challenges Hispanic heterogeneity We live in a region where cultures converge, coalesce, evolve 2 Tailoring health promotion programs means being responsive to community-level data, not just relying on national indicators

Salience of Social Determinants in the Context of TB Poverty, hunger, and minority status 3 Increased attention to structural determinants of health 4 Reinforce social stratification & inequities Structural determinants of TB 3 lead to TB exposure, disease progression, late diagnosis, inadequate treatment

STOP TB 2011-2015: WHO 6 key components Pursue high quality Directly Observed Therapy Short Course (DOTS) Address TB & HIV, multi-drug resistant TB, and the needs of poor/vulnerable populations Contribute to health system strengthening based on primary health care

STOP TB 2011-2015: WHO 6 key components Engage all care providers Empower people with TB and communities through partnership Enable and promote research

Health Care Reform: A work in Progress Many unknowns May increase access for some May also decrease access and coverage for others Increased role for public health professionals Health education specialists Promotores/Community Health Workers

Perspectives from the President of APHA 5 Shortage of public health professionals Increasing needs Increased recognition of roles across the spectrum of health promotion education Public health practitioners health education specialists Promotores/Community Health Workers

What can we do? Use a wide range of community-based activities 6 Diversify the public health research and practice communities through purposeful mentoring of students and new professionals 7 Build health equity through intentional prioritizing of groups most affected by TB

Practice the Four Cs Capitalize On partnerships and resources Collaborate With new & existing partners Communicate With stakeholders & policy makers Communitize health education

Communitizing Health Education 8 Builds partnerships Increases perceived competence among health educators Facilitates increased knowledge & positive behavioral intentions increases engagement & investment in social justice approaches to building health equity 9

Reflections from the Border

Profile El Paso, Texas and its sister city of Ciudad Juarez, Mexico represent the largest urban border community in the world. The combined 2.2 million inhabitants live in a larger region known as the Paso del Norte or Pass of the North. It is a unique place where high rates of unemployment and poverty translate into poor health.

California Arizona New Mexico Texas Baja California Sonora Chihuahua Coahuila Nuevo Len Tamaulipas Nogales San Diego Tijuana Las Cruces El Paso Ciudad Jurez Reynosa McAllen !

Hispanic Health Disparities Research Center Funded by the National Institutes of Health, National Center on Hispanic Health and Health Disparities Collaboration between: The University of Texas at El Paso & The University of Texas Health Science Center at Houston School of Public Health

HHDRC Aim Works to foster sustainable mechanisms for scholarship development in Hispanic health disparities research. The HHDRC mentors health investigators through learning institutes, funding for pilot research studies, and dissemination of new knowledge.

Cores Administrative - Maintains administrative oversight Research - Oversees selection and funding of research projects Education and Training - Recruits and assists students and transitional faculty and conducts training seminars and activities (currently supporting 8 student research projects) Community Engagement/Outreach

Strengthen and expand partnerships that synergistically inform HHDRC efforts and facilitate translation of research to practice.

Community Engagement/Outreach Support and synergize HHDRC efforts to disseminate and translate results to healthcare providers, foundations, community groups, and other stakeholders. Build and sustain community partnerships that engage community leaders in discussions with HHDRC researchers to identify new research questions. Implement innovative dissemination interventions that promote practice and policy change.

Theoretical Framework Community Members Partners Leaders Researchers Policy Makers

Multilevel Approach to Community Connections and Outreach Community Members Community Partners Community Engagement & Outreach Core University Partners

Project Profile Building Equity: Increasing Community Preparedness Be Red Cross Ready Purpose train health education students to provide high quality, theory-driven community preparedness education in a community on the US/Mexico border Evaluation Approach - two-fold Participants in the BRCR program evaluated Student educators evaluated.

Project Rationale Should a manmade or natural disaster strike, 7% of Americans would be prepared but only 1% of El Pasoans (American Red Cross) El Paso, Texas is strikingly underprepared for emergent situations such as fires, flooding, and other unexpected disasters Proper preparation can minimize the impact of such events and save lives

Provided education at community health worker/promotora programs, public school mother/daughter programs, senior centers, churches, and shelters for victims of domestic violence

Results Community Perceived susceptibility increased, Self efficacy regarding preparation increased Self efficacy regarding taking action increased Barriers decreased Benefits increased

Students Health Education Specialist Student perceived competence as health educators increased

Other Collaborations 1.New collaborations and partnerships 2.Evaluation support 3.Interdisciplinary teams 4.Transitioning programs

Innovative Research 10 Binational Photovoice Project conducted by Dr. Eva Moya and colleagues Participatory Action Research Strategy Provides cameras to disenfranchised populations

Stop the stigma, discrimination and negligence 10

My Duty and Responsibility 10

Torture vs. Gift of Life 10

Freedom 10

Acknowledgements Holly Mata, Ph.D., CHES Research Associate The Hispanic Health Disparities Research Center

Thank you! TB Education and Training Network Public Health Education, Training, and Evaluation : Brandy Peterson Dr. Eva Moya Hispanic Health Disparities Research Center (NIH-P20) The University of Texas at El Paso

References 1.U.S. Census Bureau. (2005). Income and poverty estimates from the American community survey. Retrieved December 8, 2008, from http://www.census.gov/Press-Release/www2005/jwaite_script2004iph.htmhttp://www.census.gov/Press-Release/www2005/jwaite_script2004iph.htm 2.Dempsey, H. (2009). Advocacy on the U.S. - Mexico border: Better health through better research. Health Education Monograph Series: Health Education in Changing Times, 26(1) 3.Hargreaves, J., Boccia, D., Evans, C., Adato, M., Petticrew, M., & Porter, D. (2011). The Social Determinants of Tuberculosis: From Evidence to Action. American Journal of Public Health, 101(4), 654-662. 4.World Health Organization (2011). The global plan to stop TB 2011-2015: Transforming the fight towards elimation of tuberculosis. Available at http://www.stoptb.org/assets/documents/global/plan/TB_GlobalPlanToStopTB2011- 2015.pdfhttp://www.stoptb.org/assets/documents/global/plan/TB_GlobalPlanToStopTB2011- 2015.pdf 5.Murray, L. (2011). Future of public health workforce lies in better education, training. The Nations Health, September, 3. 6.Rifat, M., Rusen I.,Mahmud, M., Nayer, I.,Islam, A., Ahmed, F. (2008). From mosques to classrooms: Mobilizing the community to enhance case detection of tuberculosis. American Journal of Public Health, 98(9), 1550-1552. 7.Stoff, D., Forsyth, A., Marquez, E., & McClure, S. (2009). Introduction: The case for diversity in research on mental health and HIV/AIDS. American Journal of Public Health, 99(S1), S8-S15. 8.Thompson, S., Dempsey, H., Hanson, B., Huereque, E., & Smith, B. (2009). Facilitating education, advocacy, and empowerment: Community health fairs can increase perceived competence among health education students. Health Education Monograph Series: Health Education in Changing Times, 26(1) 9.Mata, H., & Balcazar, H. (2010) Increasing engagement and investment in social justice approaches to building health equity: the salience of environmental and biopsychosocial factors. Presented (podium) at the 2010 American Public Health Association Annual Meeting, Denver. 10. De Heer, Moya, E.M., & Lacson, R. (2008). Voices and images: Tuberculosis photovoice in a binational setting. Cases In Public Health Communication & Markenting, 2, 56-86.

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The Changing Public Health System: A New Outlook for Public Health Workers