1. Essential Service #6 :

2. Refresher: Why learn about Essential Services? Improve quality and performance. Achieve better outcomes – improved health, less preventable death and disease. Be more efficient with time and money. Receive national accreditation.

3. Refresher: Why pursue accreditation? Documents accountability Encourages continuous Quality Improvement Sets benchmarks on services Leads to best practice sharing Helps to identify gaps in performance

4. Essential Service #6: In plain English Enforce public health laws and regulations. (Or When we enforce health regulations, are we up-to-date, technically competent, fair and effective?)

5. What does ES #6 include? Review, evaluation, and revision of legal authority, laws and regulations Education about laws and regulations Advocacy for regulations needed to protect and promote health Support of compliance efforts and enforcement

6. ES# 6: In the Assurance Core Function

7. Examples of ES #6 Communicable disease statute and regulations Food protection laws, inspection processes Hospital/long term care statute & regulations Housing codes, e.g., Lead Poisoning Prevention; Radon; septic systems Indiana Code Title 16-Health More examples?

8. How do we assess our performance? Four Model Standards: Planning and Implementation State and Local Partnerships Performance Management/Quality Improvement Public Health Capacity and Resources

9. ES#6 - Planning and Implementation We should ask ourselves, do we: Review existing and proposed laws? What is current scientific knowledge? Are there new Best Practices? Solicit input on laws from stakeholders? Legislators Legal advisors General public Persons/entities in the regulated environment.

10. Planning and Implementation, cont Do we: Review/update state laws to assure appropriate emergency powers? [e.g., isolation & quarantine] Support compliance among persons/entities in regulated environment? [e.g., food handlers] Provide written guidelines related to new regulations? [e.g., swimming pool inspections; camp ground inspections; HPV education materials]

11. State and Local Partnerships Do we: Offer technical assistance to local communities on newly enacted laws and regulations? Assist local health departments to develop local laws/ordinances?

12. Performance Management/Quality Improvement Do we: Review whether PH laws are on target & meeting the needs to keep the public healthy & safe? Make sure enforcement activities effective? Assure ongoing Quality Improvement by managing the overall performance of enforcement activities?

13. Public Health Capacity and Resources Do we: Commit adequate financial resources for the enforcement of laws? Rely on PH system partners to focus their assets on enforcement activities? Use workforce expertise to effectively review, develop, and enforce public health laws? [e.g., changes in immunization laws; new sanitary systems]

14. How did we do?

15. Results by Model Standard

16. Keys to improvement: Competencies Analytic/Assessment Skills Define a public health problem that needs a new law or regulation Collect data to justify the need for new laws Policy Development/Program Planning Skills Identify, interpret, implement PH laws, regulations, policies Decide on appropriate course of action

17. Keys to Improvement: Competencies Communication Skills Communicate new laws and regulations Solicit input from individuals, organizations Lead/participate in groups to address new laws Listen in an unbiased manner; respect points of view of others; promote expression of diverse opinions, perspectives

18. Keys to Improvement: Competencies Cultural Competency Skills Understand how laws and regulations may affect various cultures [e.g., immunizations; disease registries; food preparation] Understand forces contributing to cultural diversity, importance of a diverse PH workforce Interact effectively with persons from diverse backgrounds

19. Keys to Improvement: Competencies Basic Public Health Sciences Skills Understand how laws and regulations impact determinants of health and illness* [e.g., access to care; genetic screening; setting poverty level] *Biologic, Behavioral, Environmental, Socio/Economic, Access to Care Leadership and Systems Thinking Skills Use legal and political system to affect change

20. Keys to Improvement: Competencies Financial Planning and Management Skills Develop and present budgets to implement regulations Follow laws and manage programs within budget constraints Monitor program performance in implementing regulations

21. References CDC National Public Health Performance Standards Program Website: http://www.cdc.gov/od/ocphp/nphpsp/Essential PublicHealthServices.htm#es2 http://www.cdc.gov/od/ocphp/nphpsp/Essential PublicHealthServices.htm#es2 Council on Linkages Training Project Website: http://www.trainingfinder.org/competencies/list _ephs.htm#2 http://www.trainingfinder.org/competencies/list _ephs.htm#2 Indiana Public Health System Quality Improvement Report (2007).

22. Discussion: What does your program do to implement Essential Service #6?