Category Archives: Public health agencies
Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Azmina Lakhani, MD, MPH, about what helped lead her to the field and where she hopes to go from here.
NPH: What’s your educational background in public health?
Azmina Lakhani: I went to the Illinois Mathematics and Science Academy for high school, and then I did medical school, undergraduate and public health all at Northwestern University in Chicago. I received a BA in psychology and global health as an undergrad and then for the next five years I attended medical school and earned a Master’s in Public Health, as well.
NPH: This seems like something that you went into knowing full well that this is what you’re interested in. What was it that encouraged you to pursue a degree and a career in public health?
Lakhani: I had sort of been interested in health care in general in high school, and I wasn’t really sure whether I was going to do research or clinical work or public health work, but in college I really started becoming interested in public health. First through global health, I started learning about different health care systems abroad and doing some volunteer work in Ecuador and Mexico City. That’s really when I got interested in health care delivery systems and also how one can have a greater influence on health.
I appreciate the clinical side. I’m a family medicine resident in training currently, so I love working one-on-one with patients. I also see a lot of value in making an impact on a larger scale—whether that’s how someone gets their health care, what insurance systems we have in place, or the traditional public health things that you think of such as vaccines—that have a really large impact on people. But I think for a shorter answer to your question, I really got interested in college and then built on that in medical school while I was getting my MPH.
NPH: Within the field of public health, what’s your primary interest? What really speaks to you? The global approach?
Lakhani: I think public health is just so awesome because it has so many different facets, and to be honest, I don’t have one particular interest in terms of public health. During my year at the Chicago Department of Public Health (CDPH) I worked on a project called PlayStreets. It’s a very simple idea where we close down streets in the city—neighborhood streets—to allow children with little access to public spaces to have a place to play. The whole intent is to get people out there, meeting their community members, and, in the long term, trying to reduce childhood obesity. It’s kind of a lofty goal, but I am interested in making resources available to people so they can take control of their own health on a broader scale and PlayStreets was one example of that.
Job loss at local health departments continues unabated, according to the 2013 edition of the National Association of County and City Health Officials (NACCHO) Profile of Local health Departments. The total number of employees in local health departments has fallen to 162,000 last year from 190,000 in 2008.
However, the report also highlights program gains:
- Nearly half of health departments not yet accredited plan to apply, have submitted a formal application or have submitted a statement of intent to apply for public health accreditation from the Public Health Accreditation Board.
- The percentage of local health departments who have completed the three key accreditation prerequisites — community health assessment, community health improvement plans and an agency-wide strategic plan — has grown from 20 percent in 2010 to 30 percent in 2013.
- Facebook use has grown from 20 percent in 2010 to 44 percent last year.
- Twitter use has grown from 13 percent in 2010 to 18 percent last year.
- YouTube use has grown from 6 percent in 2010 to 12 percent last year.
- In 2013, 56 percent of local health departments were engaged in some type of quality improvement (QI) activity, up from 45 percent in 2010.
NewPublicHealth is on the ground at the NACo 2014 Healthy Counties Initiative Forum. The theme of the forum this year is “Improving Health in a Climate of Change.” Ahead of the meeting we spoke with James McDonough, county commissioner in Ramsey, Minn., and chair of the Healthy Counties initiative about the meeting and the health changes he is seeing at the county level.
NewPublicHealth: Can you tell us how the NACo Healthy Counties Initiative got its start?
James McDonough: Three years ago the president of NACo at that time, Lenny Eliason, from Athens County, Ohio, really was concerned about how the majority of health care dollars were being spent on treating preventable conditions and the whole issue of the wellbeing of our constituents and our employees. So he elevated the issue of wellness and health in counties as a presidential initiative. Typically those are short term and last for a year or two, but NACo has embraced this and has continued this on as a task force to really embed it in the work that we do—elevating how counties can have an impact on wellness in communities.
NPH: What are the current goals?
McDonough: To really elevate and get the county commissioners and county managers throughout the country to just pause and take a look at what they're doing and what they could be doing. We’ve been talking about how we can do a better job supporting counties that are already doing great work in this area and helping share those best practices, and then helping counties that haven’t really taken a look at what their role is. That can help us have a better impact on getting ahead of some of the major preventable diseases in our communities.
NPH: How important is county-level action when it comes to health?
McDonough: For the most part, counties really are responsible for the public health departments within their communities. Throughout the country we operate almost 1,000 county hospitals and close to 700 county nursing homes, so we have a lot of responsibility for public health and—just as important—we employ more than 30 million people throughout the country.
Action, responsibility and efforts vary county to county, but for example, in Ramsey County, Minnesota, where I’m the County Commissioner, we run the public health department working with our cities, the state and with the federal government. So for us it’s a really big opportunity to be the convener as well to lead the Healthy Cities Initiatives as well to a larger regional more focused and concentrated effort.
NPH: The focus of the forum includes some critical topics such as behavioral health and key health issues in jails. How much of a financial burden do these health issues place on counties?
When it comes to movies, sometimes the most realistic scenarios are also the scariest. The dramatic, often global and always fatal spread of infectious disease is now a well-worn movie trope—but because it could happen it remains scary every time. The good news (in addition to them just being movies, so no need to grip the theater armrest so hard!) is these silver screen attempts at showing the story behind the spread and containment of infectious disease help to highlight the importance of public health. Without the many integrated public health systems that touch our lives daily and protect us in emergency situations, we’d be much more susceptible to all the many types of outbreaks that plague Hollywood characters.
Well, maybe not all of them...
As part of Outbreak Week, we’ve compiled a list of some of the scariest outbreaks to terrify movie watchers. What do you think they got right? (And spoilers below...)
The scariest part of this outbreak is realizing how quickly disease can spread—and through interactions you may not even realize. It also highlights the wide range of reactions people can have to a disease spreading through a population. Several days pass before doctors and administrators at the U.S. Centers for Disease Control and Prevention realize the extent or gravity of this new infection. First they need to identify virus, then they can start working toward a means of combating it, a process that will likely take several months. As the contagion spreads to millions of people worldwide, people panic and society breaks down.
World War Z
A mysterious infection turns entire human populations into rampaging, mindless zombies. After barely escaping the chaos, United Nations Investigator Gerry Lane is persuaded to go on a mission to investigate the disease. What follows is a perilous global trek where Lane must brave horrific dangers and long odds to find answers before civilization falls. What at least the book gets right is the vast number of organizations and government groups that must come together to respond to an outbreak.
28 Days Later
How scary would it be to wake up after being in a month-long coma only to find your city completely deserted, with cars left empty and seemingly nothing but silence? One look at the film’s barren London streets will show you. Then think about how you’d feel if you found out that this emptiness was caused by rage virus-infected animals released by group of animal rights activists in protest of animals being used for medical research. And the virus was still out there...
An unknown virus wiped out five billion people in 1996. By 2035, only 1 percent of the population was still surviving, forced to live underground. A convict reluctantly volunteers to be sent back in time to 1996 to gather information about the origin of the epidemic (which he's told was spread by a mysterious "Army of the Twelve Monkeys") and locate the virus before it mutates, so that scientists from his time can study—and hopefully cure—the disease.
As a toxin begins to turn the residents of Ogden Marsh, Iowa into violent psychopaths, Sheriff David Dutton tries to make sense of the situation while he his wife, and two other unaffected townspeople band together in a fight for survival. Eventually military support is brought in to attempt to contain the outbreak.
(Image source: WikiCommons, Sailko)
Watch the live event right here starting at noon EST.
Today at 12 p.m. EST the Robert Wood Johnson Foundation will hold its very first Culture of Health Hangout. The goal of the new Hangout Series is to explore exactly what we all need to do to create a culture of health—and to shine a spotlight on communities that are already on their way. Panelists will talk through some of the complex ways public health is transforming, while also sharing innovative ways that public health departments are stepping up to the challenge.
This first Hangout will discuss the role of public health departments in transforming community health. Topics to be covered include:
- How the role of public health departments has evolved in recent years, and how it could continue to transform in the future
- How the scope of public health department partners is changing over time, and why that kind of broad partnership across sectors is critical for public health
- The particular public health challenges in rural settings
The panelists will include: Jewel Mullen, Connecticut Department of Public Health Commissioner; Muntu Davis, Public Health Director and County Health Officer of Alameda County; Karen DeSalvo, City of New Orleans Health Commissioner; and Michael Meit, Co-Director of the NORC Walsh Center for Rural Health Analysis. Our moderator is Paul Kuehnert, RWJF senior program officer and Public Health team director.
A full house of American Public Health Association (APHA) annual meeting attendees got an update on health department accreditation this week from Public Health Accreditation Board (PHAB) president and CEO Kaye Bender, RN, PHD, FAAN; board chair Carol Moehrle; and vice chair Leslie Beitsch, MD, JD. Right now, Moehrle told the crowd, 19 health departments—local, state and tribal—have been granted the credential and more than 200 departments are in various stages of their applications.
Moehrle gave some “heads–ups” on what’s upcoming for accreditation in 2014, including revised application standards and measures—called version 1.5—as well as the establishment of several additional PHAB think tanks to help expand the issues health departments are asked about when they apply for accreditation. Information from the previous think tanks informed the development of the Guide to Public Health Department Accreditation Version 1.0 and the PHAB Standards and Measures Version 1.0. New topics for PHAB think tanks will include the U.S. Army.
Moehrle also announced that the new version will be released on the PHAB website in January 2014, and those new standards and measures become effective for health departments' seeking accreditation beginning on July 1, 2014. To apply under the 1.0 version, health departments must submit their application by 11:59 PM Eastern Time on June 2, 2014.
Moehrle said that PHAB is recommending that health departments review the proposed changes to the standards and measures before they automatically decide that they will apply under Version 1.0, because version 1.5 is designed to “enhance, strengthen, expand, and clarify the Standards and Measures document,” including the following:
- Number of examples needed and timeframes for required documentation
- Edits to version 1.0 for clarity and consistency, based on frequently asked questions from applying health departments
- New measures and revised content to advance public health practice based on suggestions from PHAB Think Tanks conducted on special topics, including health equity, communication science, public health informatics, public health ethics, public health workforce and emergency preparedness
It’s no secret that public health department budgets have been shrinking in the past few years. In the face of the recession, public health professionals must seek new and diverse partnerships in order to achieve greater impact despite the lack of funding. The topic of one session at the American Public Health Association (APHA) Annual Meeting held in Boston was just that—how to increase impact through strategic partnerships with unlikely partners.
“The need for austerity and efficiency opens up the conversation for collective impact,” said Joseph Schuchter of the University of California-Berkeley School of Public Health. Partnerships can include a wide array of non-public health entities, including non-profit organizations, businesses and schools. The APHA panel discussed different approaches to successful partnerships that advance public health programs.
The Center for Health Leadership and Practice provides group leadership training for cross-sector teams that are working together to advance public health. “We may all be talking about the same thing, we’re just using different vocabulary and styles,” says VP of External Relations and Director Carmen Rita Nevarez. The Center provides existing partnerships with the tools and training needed to move forward in the same direction, while understanding that individual efforts may differ. More than 90 percent of program participants agree that the approach is effective in supporting intersectoral leadership development and most teams report regularly engaging other sectors as a result.
Networked and Entrepreneurial Approaches
Networked and entrepreneurial approaches to partnerships offer public health professionals with resources and allow them to reduce the negative externalities of the economy. The impact investment market constitutes an $8 billion industry that is eager to fund novel solutions to social problems. In order to succeed in these partnerships, the field of public health must work with social entrepreneurs and investors to highlight the potential return on investment for prevention programs and produce irrefutable outcomes.
The Community Health Improvement Partners (CHIP) serves as a backbone organization for a larger, cross-sector childhood obesity initiative. Cheryl Moder of CHIP shared her insights into the role of such an organization and how to successfully grow a diverse partnership. A backbone organization must serve as mission leaders by recruiting and retaining partners and support aligned activities so that they connect to one another. In addition, backbone organizations must navigate the challenges of larger partnerships—such as developing and retaining trust, encouraging equal partner recognition and shared measurement and evaluation—in a way that suits the needs of partners from different sectors.
>>NewPublicHealth was on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Find the complete coverage here.
The American Public Health Association (APHA) launched its 141st annual meeting in Boston on Sunday by re-launching itself, its logo and its tagline which is now: For science. For action. For health.
”We’re deeply excited to share our new look and feel with our members and partners,” said Georges Benjamin, MD, executive director of APHA to the nearly 11,000 public health students, academics and practitioners attending the meeting. “With the challenges and opportunities presented by our rapidly changing health landscape, now is the time to better position APHA for success as the collective voice for the health of the public.”
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
Benjamin also shared the five core values that APHA’s next phase will emphasize:
- Science and evidence-based decision-making
- Health equity
- Prevention and wellness
- Real progress in improving health
Those themes were in abundance at Sunday’s opening session. ‘Social injustice is killing on a grand scale,” said Professor Sir Michael Marmot, chair of the World Health Organization’s Commission on Social Determinants of Health and Director of the International Institute for Society and Health at University College/London. At the request of the British Government, Marmot led a review of health inequalities in England, and published a report, ”Fair Society, Healthy Lives” in February 2010. He has also recently been asked by the World Health Organization to conduct a European review of health inequalities
Since 2008, local health departments have cut nearly 44,000 jobs, according to a recent survey conducted by the National Association of County and City Health Officials. Although workforce losses and gains were roughly equal in 2012, 41 percent of local health departments nationwide experienced some type of reduction in workforce capacity and 48 percent of all local health departments reduced or eliminated services in at least one program area. Currently, local health departments reporting cuts still exceed the percentage of local health departments reporting budget increases.
California’s Napa County has dealt with its budget cuts by revamping its health department in order to continue to stay on mission.
“I think we've come out the other end of all this as a much stronger health department,” said Karen Smith, MD, MPH, Health Officer and Deputy Director for Public Health at Napa County Health and Human Services. “We moved from what I think of as an ‘old style’ [public health agency] to a department that focuses on our role as a convener/partner, providing expertise and leadership, and helping to craft policy.”
NewPublicHealth recently spoke with Smith about the methods Napa Public Health used—and that other departments might follow—to adapt and improve in the face of budget cuts.
NewPublicHealth: How have budget changes impacted your department over the last five to ten years?
Karen Smith: Napa Public Health started out with a lean health division for the size of the county compared to some of our colleagues, and we remain lean. We have not really decreased services, however. We were able to get out ahead when we saw looming budget constraints.
Napa Public Health is part of the County’s Health and Human Service Agency, which includes social services, as well as mental health, drug and alcohol, child welfare services, comprehensive services for older adults and public health, and our administrative divisions. The previous director had a distinctive approach to budgeting: that the agency has a bottom-line budget and within that we have very detailed division budgets. So I have excruciatingly detailed budgets for every single program within public health, and that was crucial to our being able to respond to the budget shortfalls in creative ways that had limited impact on services.