1. STRATEGIC HEALTH PLANNING May 16, 2003 Working Smarter For Better Health…… STEP ONE: DEVELOPING A DRAFT LIST OF HEALTH PRIORITIES

2. GROUND RULES One person speaks at a time Be brief and to-the-point – no need to get on your soapbox, to debate, or to give long explanations Stay on time & finish on time Stay focused on “target“ & outcome needed for this day Keep the big picture in mind Be courteous & respectful of all participants Have spin-off discussions & “debates” during lunch breaks & get back on track when its time to return to agenda Be nice to facilitator!!!

3. Strategic Health Planning Timeline May 16 th, 2003Develop “DRAFT” Health Priorities June – AugustPublic Feedback/Comment period Presentation – Epi Analysis Media Promotions Focus Groups Board member-sponsored forums August (End)Finalize Strategic Plan to Address Health Priorities SeptemberGo To United Board of Health and 4C’s Governing Board Meetings to Adopt Strategic Health Plan October 1, 2003Implement Strategic Health Plan Targeting Health Priorities in Galveston County

4. MISSION AND VISION MISSION Assuring Conditions in Which People Can be Healthy VISION Healthy People in Healthy Communities

5. PUBLIC HEALTH FUNCTIONS 1.Monitor health status 2.Diagnose and investigate 3.Inform, educate, and empower 4.Mobilize community partnerships 5.Develop policies and plans 6.Enforce laws and rules 7.Link individuals to resources 8.Ensure a competent workforce for the provision of essential public health services. 9.Research insights and solutions. 10.Evaluate the effectiveness, accessibility, and quality of health services

6. HOW PRIORITIES WILL BE USED To make decisions about areas to focus our efforts (time, money and brainpower) given limited resources To make decisions about whether or not to apply for various grants To make decisions about the types of collaborations, members and workgroups to dedicated resources To develop district-wide, program specific measurable goals targeting each priority To guide the development of departmental and program operating planning process for long-term health and budget forecasting

7. WHAT SUCCESS LOOKS LIKE Priorities are consistent with the Health District’s vision, mission, and legal scope of responsibilities

8. WHAT SUCCESS LOOKS LIKE Priorities will guide the District’s selection of HP2010 focus areas and objectives for long-term planning and evaluation

9. WHAT SUCCESS LOOKS LIKE For each priority, measurable goals will be developed, monitored, evaluated and periodically reviewed at all levels in the Health District

10. WHAT SUCCESS LOOKS LIKE Priorities are fully integrated at all levels in the Health District – District-wide, 4Cs clinic, Departments, Programs, and employees (evaluations, awards, merits, recognition activities)

11. WHAT SUCCESS LOOKS LIKE Public health education and prevention goals can be established for each priority as a means to prevent adverse health outcomes and costly medical treatments

12. WHAT SUCCESS LOOKS LIKE Priorities address a health condition and/or a health system issue that requires long-term (3-5 yr.) planning and coordination in order to make a measurable improvement

13. WHAT SUCCESS LOOKS LIKE Priorities are meaningful and are accepted as addressing the “common good” of the Galveston County general public as well as health stakeholders

14. KEY HEALTH ISSUES Growing limitations in healthcare financing Health concerns regarding air and water quality Sedentary lifestyles, lack of fitness, and obesity Health security and public health preparedness for disaster-type events

15. HEALTH DISPARITIES Age Gender Race/Ethnicity Geographic Risk Socio-Economic Status

16. PROGRESS IN LAST DECADE Infant Mortality - rates of early prenatal care in Galveston county are better than state and national averages Communicable Diseases – rates of syphilis and TB have been reduced, as well as health consequences and cost Vaccine Preventable Diseases - some improvements in childhood immunization rates (however, we do face challenges on how to better assess all children in the county) Access to Care – Some improvements in assessing barriers and best practices in the county’s Indigent Healthcare System via Community Assessment Program (CAP)

17. IMPACT OF POPULATION CHANGES Galveston County Population has increased by over 15% in the last decade (mostly in northern parts of county) An increasing proportion of Hispanics An increasing proportion of seniors (aging of the “baby boom” generation) An increasing need for District services

18. Galveston county has an overall higher death rate than Texas and the U.S.

19. Top Ten Causes of Death Galveston County #1 Heart Diseases #2 Cancers #3 Strokes #4 Unintentional Injuries #5 Chronic Respiratory Diseases

20. Top Ten Causes of Death Galveston County #6 Diabetes #7 Alzheimer’s Disease #8 Influenza & Pneumonia #9 Septicemia #10 Kidney Diseases

21. Galveston County Premature Mortality Top Three causes of Early Death in Galveston County #1 Unintentional Injuries #2 Cancers #3 Heart Diseases

22. “Actual” Causes of Death, U.S., 1990 CauseRate (per 100,000)Percent of all deaths Tobacco160.819 Diet / activity patterns120.614 Alcohol40.25 Microbial agents36.24 Toxic agents24.13 Firearms14.12 Sexual behavior12.11 Motor vehicles10.11 Illicit use of drugs8.0< 1 Total426.250 Source: McGinnis & Foege, JAMA, 11/1993

23. National Health Indicators Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Responsible Sexual Behavior Mental Health Injury and Violence Environmental Quality Immunization Access to Care www.healthypeople.gov

24. STATE HEALTH PRIORITIES A Focus On Health Outcomes… Protect Texans against vaccine-preventable diseases by improving immunization rates Focus on fitness by promoting healthy eating and regular physical activity; and Eliminate disparities in health among population groups in Texas A Focus On The Public Health System Improve our ability to respond to disasters or disease outbreaks whether they are intentionally caused or naturally-occurring; and Improve the efficiency and effectiveness of TDH business practices

25. DRAFT PRIORITY #1 Prevention through public awareness activities targeted towards issues such as obesity, fitness, nutrition, tobacco cessation, childhood immunizations, oral health, disease reporting, etc….

26. DRAFT PRIORITY #2 Identify and eliminate barriers which contribute to health disparities such as cultural/language, inequitable access to health care, transportation, lack of a coordinated indigent health care system, ability to pay.

27. DRAFT PRIORITY #3 Improve public health system and business practices in order to recruit and retain competent public health employees, to increase access to technologies which will improve efficiency, to improve training programs, to improve internal and external communications, to be prepared for public health disasters/emergencies, and to comply with legal responsibilities.

28. DRAFT PRIORITY #4 Improve health care financing in order to avoid loss of revenue from Medicaid, to finance medications and indigent health care, and to increase medical reimbursements in the clinic.

29. DRAFT PRIORITY #5 Improve management of chronic conditions such as high blood pressure, heart disease, diabetes, asthma, depression, etc.

30. DRAFT PRIORITY #6 Address environmental issues involving air, water and food to include aspects of wastewater management, enforcement, bacterial contamination, animal control violations, toxic substances monitoring, and conservation of natural resources.

31. DRAFT PRIORITY #7 Address senior health issues such as isolation, social needs, healthcare, legal, transportation and housing.

32. DRAFT PRIORITY #8 Immunize children and adults to prevent infectious diseases.