Local Public Health Association of MinnesotaPlatform & PrioritiesJulie MyhreWednesday, November 12, 2008Carlton County Public Health

Local Public Health AssociationELIGIBLE MEMBERS City, county and tribal govts in MN Public health managers and supervisorsEach unit of govt may appoint four voting membersCONNECTION NATIONALLY NACCHO www.mncounties2.org/lpha/

StaffFULL TIME DIRECTOR OF LPHA: Julie Ring Email: ring@mncounties.org

Legislative LobbyistCoordinates meetings and communicationsClarifies Issues, Provides advocacyPartners with other statewide organizations (ALA, ACS, Ready4K, AHA, etc.)

Standing CommitteesExecutive CommitteePolicy and Practice CommitteeLegislative CommitteeMembership Committee

Health Status

National Health ExpendituresAccess to Care 88%Other 8%Health Behaviors 4%Influence10% Access to Care20% Environment20% Genetics50% Health Behaviors

2009 2010 Legislative PlatformISSUESWhats happening? What are we concerned about?POLICY AND LEGISLATIVE POSITIONSWhat do want changed? Legislative or Policy?KEY CONTACTSContent experts

Public Health InfrastructureFUNDINGSupport adequate fundingPUBLIC HEALTH INFORMATION SYSTEMSupport fundingWORK FORCESupport policies and initiatives that promote education, hiring and retention of PH Workers

Chronic Disease Prevention and Promotion of Healthy BehaviorsHealth Care Reform neededSupport SHIP, increased coverageMonitor youth obesity trendsSchools: Food Meets Nutritional StandardsStrengthen Phy Ed & Health EducationMaintain & Protect Freedom to BreatheAccess to healthy foodsStatewide alcohol and cigarette tax: fund prevention

Communicable Disease Prevention & ControlEstablish state emergency fundHelps LPH recover costs from outbreak Oppose requiring LPH to report undocumented persons to state/fed govt.Additional reimbursement to LPH for investigation, control and treatment of TB

Correctional HealthLimit county responsibility for medical costs while maintaining a standard of health care to inmatesDemonstration projects: Release planningDivert persons with mental illness into alternative settingsSupport system of electronic exchange

Ensuring Health EquityContinue Eliminating Health Disparities InitiativeEnhance health care accessDiverse Health Care Work forceFunding for interpretation/translation services

Environmental HealthWalkable and Bikeable community designLimit exposure to mercury, radon, leadProper medical waste disposalExplore models of evidenced based environmental health services (FB&L)Address emerging EH issues Bisphenyl A, Phalates, etc.Vacation Home RentalNeed for systematic response for repairing, updating and monitoring septic systems

Health Care System ImprovementKeep funding for SHIPHealth Care Home PH role in case mgt/care coordinationExpand Health Care Coverage MA, MNCare, GASupport policies/incentives for preventive health services Uniform benefit set/ streamline admin processesImproved access to dental services

Healthy Children and FamiliesRestore and maintain stable, ongoing fundingFHV, Teen Pg Prevention, MCH, WIC, Youth Risk Reduction, etc.Continue TANF funding for FHVFunding for Child Care AssistanceFamily Violence Prevention Family Planning

Long Term CareDefine Roles for Care Coordination/Case Management as well as I&R, safety net, Identification of gaps in services, assurance of services (oversight function)Fully fund county rolesExpand availability of quality LTC insuranceSupport funding and policies of prevention and early intervention healthy lifestyles

Mental HealthFocus on prevention, early ID and interventionEncourage MH coordination with physical and social servicesSupport full funding for nurse-provided FHV for at-risk families with newbornsMental Health promotion campaign

PH Emergency PreparednessProvide state funding for LPH Emergency Planning and response activities (currently no state funding)Need funding for infrastructure so have work force that can respond to emergency

Approval ProcessAlign LPHA platform with MACCSASome key issues may make AMC PlatformMembership: Feedback and ApprovalNovember 20, 2008Changes can be made if membership agreeable

Legislative Priorities 2008Health System ImprovementStatewide Health Improvement PlanHealth Care AccessCounty Based Purchasing

Local Public Health Data IntegrationLPH needs interconnected, statewide info systemProviders implement interoperable EHR by 2015

Public Health Emergency PreparednessNeed ongoing, stable funding (fed $$ have decreased)

Other Key Issues in 2008County Role/Responsibilities for LTCCorrectional HealthYouth Risk Behavior (YRB)Social Conditions that impact HealthEnvironmental Health ProtectionAir quality (indoor and outdoor), radon, leadInfectious Disease Prevention and Control

LPHA ResourcesFact Sheets on the Web to help us tell our story!!

Public Health: A Good Investment at any Time

Dont Work in a Vacuum!Maintenance of Effort (MOE) IssueCurrent Tension between County & State GovernmentLast Session: PH got added $$$other departments didnt fair as wellLPHA works well with MDH other state agencies dont work as partners

How can you play a role?Identify PH Practice Issues & Potential Solutions You are the CONTENT EXPERTS!!Thank Elected Officials SHIP Educate and Inform Elected OfficialsInvite them on a home visitHelp LPHA Identify Priority IssuesWhats still an issue? Is anything missing??

Julie Myhre, DirectorCarlton-Cook-Lake-St. Louis Community Health Board

juliem@communityhealthboard.org

404 West Superior Street Suite 220Duluth, MN 55802218-733-2862

**Membership7 regionsUp to four members per county*Policy and Practice: Just started a message board*Published: September 29, 2008The United States spends more than any other nation in the world on health, over 2 trillion dollars per year, yet we do not rank in the top 10 on any world measure of health. Why is this? Primarily because as a nation we are not focusing on health and sustaining health. Only 3 percent of our annual health expenditures are spent on preventing disease; rather 97% is spent largely on care and most of that on consequences of preventable chronic diseases and most of it in the last years of life. Additionally we have over 40 million people without health insurance, and large numbers experiencing preventable disease; as examples, more than 500,000 are living with HIV and approximately 24 million with diabetes. As the nation's health agency, it is important for the Centers for Disease Control and Prevention (CDC) to lead the way and to join forces with leaders across the country to create solutions to become a healthiest nation.

Approximately 95% of the trillion dollarswe spend as a nation on health goesto direct medical care services, whilejust 5% is allocated to population-wideapproaches to health improvement.However, some 40% of deaths are causedby behavior patterns that could bemodified by preventive interventions.McGinnis et al, 2002.U.S. healthcare expenditures increased from $245 million (or $1,066per person) in 1980 to $2 trillion (or $6,697 per person) in 2005.When the Legislature investedin youth tobacco preventionprograms in 2000, localpublic health departmentsquickly mobilized andimplemented programs thatproduced dramatic results.Working with schools,community partners andMDH, we reduced overallyouth tobacco use ratesby 25% in five years. Wereduced cigarette smokingin middle school students by43% during this time frame.HEALTH STATUS*SOURCE: Partnership for Solutions, Making the Case for OngoingCare, 2004, Medical Expenditure Panel Survey, 2001.83% of health care costs goes to people to chronic diseases17% of health care costs go to people without chronic diseasesMost effective approach to improving health and reducingburden of chronic diseases is to address four risk factors:The Plan is based on the national Steps to a Healthier USmodel that has been tested in four Minnesota communities:Minneapolis, Rochester, Saint Paul, and Willmar.The Plan relies upon state level oversight and guidance of*Used as a communication piece when talking with legislatorsWill be deciding upon key leg issues for 2009 soon!!!*LTC County Role LTCC, Coordinating services, monitoring quality and assurance role these roles MUST BE FUNDEDCorrectional Health: Increased complexity of inmate needs, costs are dramatically increasing bared by counties, mental health issues, substance useYRB: used tobacco settlement money to fund youth development activites but funds were eliminated in 2003. Social Conditions: prolonged poverty, racial and cultural barriers, unemploymentEnvironment: Infectious Disease Prev and Control: rate of diseases is increasing but funding is not. Need better funding for immunizations child and adult*Example Mental HealthNeed to maintain spending at the same level as 2004-2005 For some counties the costs were higher those years than in 2007 (was enacted in 2007) Ex. had more acute ER and hosp rates closing of Reg Treatment Centers but then built a community health center and costs decreased yet counties still need to maintain that spending levelCounties might want to spend dollars on other priorities27 counties had not met their MOE req for 2007 (had to develop corrective action plan)