A New Public Health for the 21st Century Kaye Bender, RN, PhD, FAAN President and CEO, PHAB 1

Session Objectives Describe the national trend toward performance and quality improvement in public health. Discuss the key public health elements included in the health reform discussions. Recognize the potential future scenarios for public health practice.

What Was Wrong with the Old Public Health? Public health in disarray—governmental only (Institute of Medicine Report,1988) Public health in disarray—broader public health (Institute of Medicine Report, 2003) Accountability and performance (Blueprint for a Healthier America, 2008) Accountability, performance, and QI (Lessons Learned from the MLC Projects, 2007)

Poll Question Do you agree with the comments about the problems of the old public health? A. Yes B. No Click on the down arrow if you can’t see the response choices.

What’s Changed Over the Past Decade? Increasing emphasis on performance and quality improvement More programs focused on health promotion Decreased funding and overall economic pressures Emergency preparedness

What’s next for public health?

Congressional Interest in Public Health Reform Not health care reform Not about funding streams Prevention and wellness (focus of Senate and House bills) Interested in prevention and wellness (Policy makers comments)

APHA’s Health Reform Suggestions Invest in population-based services Address chronic underfunding Have more fiscal accountability Require methods to study impact of federal policies & programs on public health

APHA’s Health Reform Suggestions Develop, expand, and monitor programs aimed at reducing health disparities Have the healthiest nation in one generation Provide health care coverage for all

Report of PHLS/NACCHO Session on Health Reform What part of health reform should public health not be interested in? Some public health programs are best coordinated statewide. Population-focused public health programs increase the likelihood of success in clinical programs.

Report of PHLS/NACCHO Session on Health Reform Public health programs can reach populations not covered in health care reform. The public health infrastructure has to also prepare itself for a new day in public health if health care reform occurs as planned.

PHAB Board of Directors Vision for the Future High performing health departments contributing to a healthier nation! 60% of the population will be covered by accredited health departments by 2015.

PHAB’s Partners NACCHO APHA ASTHO NALBOH NIHB PHF NNPHI CDC RWJ Foundation

Developmental Work Standards development & vetting Assessment process Beta test Research & evaluation A great deal of work is currently underway Great care is being given to ensure that the development of the program is thoughtful and inclusive Evaluation and CQI will always be an important part of how PHAB operates Program development work being done largely by workgroups, all of which are comprised primarily of public health practitioners in state and local health departments [Workgroup members are posted on phaboard.org for those who would like to see individual names and affiliations] Work includes: Developing standards and measures and assessment process Undertaking a beta test of standards, measures and the process Determining how to recognize state-based accreditation programs for LHDs that are sufficiently similar so as to confer national accreditation benefits on LHDs that have been accredited through “equivalent” state programs Getting the word out about accreditation and its value – not only to health departments, but also to their governing bodies, as their support will be critical Planning up front for careful, ongoing evaluation of the accreditation effort, and also establishing a research agenda Developing a robust set of incentives for participating LHDs Fees & incentives Information systems development

Why Accreditation for Public Health? Baldrige for health systems and businesses Joint Commission for Health Systems PHAB is planning a system that blends the two

The Value of Accreditation: Agency Benefits & Public Benefits Improved public health outcomes A tool for quality and performance improvement Accountability Credibility Recognition of excellence Clarification of expectations Increased visibility Improved community health status We are in conversation with researchers

Which Public Health Departments Are Affected? Territorial health departments Local health departments State health departments Tribal health departments Organizational structure does not matter!

Three required components Community health assessment Community health improvement plan Agency strategic plan Three required components

Potential Vision for the New Public Health Department No longer the safety net Stronger links to the health care system for assuring the health of the public Focus on high performance, accountability, and a culture of improvement Increase visibility Improved recruitment and retention

Poll Question This national picture that we’ve just discussed has a lot to do with the daily work of health departments. A. Strongly agree B. Agree C. Disagree D. Strongly disagree Click on the down arrow if you can’t see the response choices.