Considerations for Shared Governance Structureswww.health.state.mn.us/sslc Minnesota Department of Health

Public Health in Minnesota

“Humankind has not woven the web of life. WE are but one thread within it. Whatever we do to the web, we do to ourselves. All things are bound together. All things connect.”

Chief Seattle

Today’s Agenda

•Minnesota Public Health Structure• Statutory Responsibilities• Challenges and Opportunities

Definitions of Public Health

“Public health is what we, as a society, do to collectively assure the conditions in which people can be healthy.”

Institute of Medicine

Definitions of Public Health

“Public health is the science and art of disease prevention, prolonging life, and promoting health and well-being through organized community effort.”

CEA Winslow (1877-1957)

Public Health Impact

25 of the 30 years of life gained in the 20th century resulted from public health accomplishments!

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Life expectancy at birth, United States, 1900-1998

FemaleMale

Age

Ten Greatest Public Health AchievementsUnited States, 1900-1999• Vaccinations•Motor vehicle safety• Safer workplaces• Control of infectious diseases• Fluoridation of drinking water• Safer and healthier

foods•Healthier mothers and babies• Family planning•Decline in deaths from heart disease and stroke• Recognition of tobacco use as health hazard

Levels of Government

US Capitol Building Minnesota StateCapitol Building

Label

Public Health and the Supreme Court

“The preservation of the public health is one of the duties devolving upon the state as a sovereign power, and cannot be successfully controverted or delegated. In fact, among all the objects to be secured by government laws, none is more important than the preservation of the public health.”Schulte v. Fitch, NW 717, 1925

Protecting the public’s health is so basic, and the consequences of not protecting the public’s health are so serious, that both the state and federal constitution contain provisions to ensure this protection.

Minnesota Department of Health

Protecting, maintaining, and improving the health of all Minnesotans.

Federally Recognized Tribes in Minnesota

■ AnishinaabeBois ForteFond du LacGrand PortageLeech LakeMille LacsRed LakeWhite Earth

■ DakotaLower SiouxPrairie IslandShakopee MdewakantonUpper Sioux

Origins of County Public Health Nursing

State Boards of Health (c. 1950)

1. Creation of the boards was encouraged

2. Purpose: • Assess health• Create policies to prevent

communicable diseases• Assure sanitary conditions

Boards of HealthBefore 1976

Community Health Act (1976)

Community Health Services System (CHS System)• Community involvement• Local control• Integrated statewide system• Adequate population base / economies of scale• Funding, with multi-county incentive

Purpose of CHS System

“’Community health services’ [denotes] activities designed to protect and promote the health of the general population within a community health service area by emphasizing the prevention of disease, injury, disability, and preventable death through the promotion of effective coordination and use of community resources, and by extending health services into the community.”

Minn. Stat. § 145A.02, subd. 6(Local Public Health Act)

Community Health Boards in Minnesota

c. 2015

Considerations for Shared Governance Structureswww.health.state.mn.us/sslc Minnesota Department of Health

Minnesota’s State-Local Partnership

State Community Health Services Advisory Committee (SCHSAC)

STATECOMMUNITYHEALTHSERVICESADVISORYCOMMITTEE

• Hallmark of Local Public Health Act• Advise Commissioner of

Health• Representatives from

each community health board• Work performed by

workgroups

Local Public Health Act of 1987

•Minnesota Legislature further clarified roles and responsibilities of the state and local public health system• Replaced the Community Health Services Act with the Local Public Health Act, also known as Minnesota Statute § 145A• Focuses accountability for funding on set of statewide outcomes

Local Public Health Act of 2014

• Again modified to clarify public health responsibilities and accountability• Eliminate unnecessary and obsolete language• Align statute with current public health practices• Require community health boards to engage in performance management

Elected Official’s Public Health Responsibilities

• Policy development• Resource stewardship• Legal authorization• Partner engagement• Continuous improvement•Oversight

Considerations for Shared Governance Structureswww.health.state.mn.us/sslc Minnesota Department of Health

Local Public Health Assessment and

Planning

Minnesota Local Public Health Assessment and Planning Process

Implement Plans ■ Monitor Progress ■ Revise Plans as Needed

Quality Improvement

Planning Process

Community Health Improvement

Planning Process

Organizational Strategic Planning

Process

Organizational Self-Assessment

Community Health Assessment

Ten Most Important Community Health

IssuesDELI

VER

AB

LE

Three Standards Most in Need of ImprovementD

ELI

VER

AB

LE

QI Plan DELIVERABLE

DELIVERABLE

Strategic Plan

CHIPDELIVERABLE

Implement

Plan

Prioritize

Assess

Areas of Public Health Responsibility

in Minnesota• Assure an adequate local public health infrastructure• Promote healthy communities and healthy behaviors• Prevent the spread of communicable disease• Protect against environmental health hazards• Prepare for and respond to emergencies• Assure health services

Essential Public Health Services

In Minnesota, these services refer to activities that are conducted to accomplish the areas of public health responsibility.

Examples: Assure an Adequate Local Public Health Infrastructure

• These planning meetings• Agency strategic planning process• Recruiting and retaining staff with appropriate expertise

Examples: Promote Healthy Communities and Healthy Behaviors

• Statewide Health Improvement Program (SHIP)•Healthy Families America• Chronic disease management• Asthma programs

Examples: Prevent the Spread of Communicable Disease

•H7N9 (avian influenza)• Pertussis reemergence•Norovirus• Enterovirus D68

Examples: Protect Against Environmental Health Hazards

• Regional mold plan• Food, beverage, and lodging delegation• Radon identification and mitigation• Public health nuisance

Examples: Prepare for and Respond

to Emergencies

• Community planning for flu centers and ILI local surveillance•Mass dispensing clinics• Vaccination promotion campaign

Examples: Assure Health Services

•MN CHOICES• Family planning• Early Childhood Dental Network• Fluoride varnish•Mental health initiatives for children and adults

Public Health Challenges & Opportunities

Challenge is a dragon with a gift in its mouth. Tame the dragon, and the gift is yours.

Noela Evans