Overarching Goal: To Assure a Competent Workforce10 Essential Public Health Services

Essential Service 8

GoalsTo help Indianas local health departments work toward accreditationTo achieve standardization within the public health workforce

ObjectivesTo create a simple method of documentation for education and trainingTo create a workable, usable toolkit for local health departmentsTo encourage local health departments to adopt the toolkit

Indianas Public Health Programs

Indianas Public Health Programs

Have you ever thought aboutWho looks at what is going on in the kitchen of your favorite restaurant?Who do you go to when your neighbor has raw sewage or piles of trash in their yard?Who works to prevent disease among your family, friends and neighbors?Who tracks the births and deaths occurring in our community?

Why Do We Need To Change?

Public Health StatusPublic Health is not well known to the public or to policy makers.Public Health efforts are drastically underfunded, poorly organized and fragmented.Public Health needs are not being fully met.

Public Health Worker RatioNational average of public health workers is 138 per 100,000 (Center for Health Policy 2000).Indiana average of public health workers is 46 per 100,000 (Center for Health Policy 2000).Indiana ranks 49th in the U.S., with only Pennsylvania having fewer public health workers (37/100,000) (Center for Health Policy 2000).

Source: Columbia University School of Nursing,Center for Health Policy, 2000

Funding ComparisonMidwest states received the least funding for disease prevention in FY 2009 - $16.50 per personOther areas of the country:Northeastern states - $19.80 per personSouthern states - $19.75 per personWestern states - $19.22 per person

Source: March 2010 TFAH and RWJ Reportat http://healthyamericans.org/report/74/federal-spending-2010

Funding ComparisonIndianas Rankings:48th-Federal Funding from the CDC FY 2009 ($14.25 per capita)50th-Federal Funding from Health Resources and Services Administration FY 2009 (HRSA - $13.63 per capita)47th-State Funding for Public Health FY 2008-2009 ($12.64 per capita)

Source: 2010 Trust For Americas Health (TFAH)Report at http://healthyamericans.org/states/?stateid=IN

Public Health StatusPublic Health is not well known to the public and Public Health needs are not being fully met(Insert Local Data)

Public Health ImpactIndianas ranking:13th Adults who do not participate in moderate physical activity (52.4%) (2007 Behavioral Risk Factor Surveillance System)15th Number of adults reporting fair or poor health (16.7%) (2008 Behavioral Risk Factor Surveillance System)

Data obtained from 2007 and 2008 BRFSS on 11/16/09

Indiana StatisticsObesity: The 2008 BRFSS reports that Indiana has a 27% obesity rate (Body Mass Index >30).Smoking: According to the CDCs 2008 Behavioral Risk Factor Surveillance System (BRFSS), Indiana ranked 2nd with a 26.1% rate of adults currently using cigarettes.Most of the illness, suffering, and disabilities can be prevented by:tobacco control, good nutrition, physical activity and maintenance of normal weight.

Data obtained from 2008 BRFSS on 11/16/09

Public Health = PreventionTobacco controlGood nutritionPhysical activityEducationDisease preventionEnvironmental assessment

What Can We Do?

Answer:Increase the QUALITY, QUANTITY AND EFFECTIVENESS of Indianas Public Health Workforce.

Impact of Workforce DevelopmentCurrently, about 95% of health spending goes to medical care & research.Strong evidence shows that behavior & environment are responsible for more than 70% of avoidable mortality.A larger and better public health workforce can appreciably improve health.

How Can Indiana Improve?We need a means to validate the impact and performance of public health. We are virtually invisible now.State and local public health departments must be data driven to measure and validate performance.

NACCHOs Programs2007 launched program for national identity for local public health.

NACCHO is on a quest to unify governmental public health functions.

Public Health LogoSymbol: 3 sided shield and symbol are universally associated with health, protection, & growth.

Colors: blue, white, khaki are colors of US Public Health Service uniform.

Essential Public Health Service #8Do we have a competent public health staff?How do we ensure that staff education and training is current?Workforce development is the foundation of all 10 Essential Public Health Services.

Healthy People 2020 Overarching GoalsAttain high quality longer lives free of preventable disease, disability, injury, and premature death.Achieve health equity, eliminate disparities, and improve the health of all groups.Create social and physical environments that promote good health for all.Promote quality of life, healthy development and healthy behaviors across all life stages.

Benefits of Workforce Development and the Education and Training ToolkitBetter educated and trained workforceBetter services delivered to the publicIncreased recognition of public health Job satisfactionHealthier communitiesDocumentation aiding in public health validation and accreditation

What Can LHDs Do?Encourage and schedule regular staff education and trainingAccess on-line trainingsAttend state trainings Train to performance standardsAllocate resources for trainingSchedule adequate time for trainingDemonstrate value of training

In Summary, We Want to:Create a competent public health workforce that is professionally trained, assessed, and maintained.Enhance communication with the general public and policy makers.Validate funding and programs to improve Indianas public health.

Ultimately, We Want to Improve the Health of Hoosiers!

Together We Can Make a Difference!This project is funded by the NNPHI and RWJF MLC-3 Grant award number A07-9-197019.

City CouncilPublic Health Workers need your help!

Financial support to ensure public is protectedillness is preventedpublic health is promoted

County CommissionersPublic Health Workers need your help! Support is needed from public and policy makers to ensure public health needs are addressed.

We need your help!Support staff training to ensure the whole picture is addressed.Prepare for Accreditation.

Local Health Board

Slide Presentation RecommendationsLHD Staff: Slides 16, 812, 1429, 33County Council/County Commissioners: Slide 17, 919, 2325, 27-28, 30 and/or 31, 33Local Board of Health: Slides 17, 812, 1428, 32-33

*Many may not yet be familiar with the 10 Essential Public Health Services wheel. The 10 Essential Services are based upon national standards as the gold standard for public health. These essential services provide benchmarks for achievement goals, supporting continuous improvement. Indianas Public Health Workforce Development Education and Training Toolkit focuses on one of these ten services, Assure a Competent Workforce.

*One goal of the toolkit is to help local health departments in Indiana prepare for accreditation. By taking a proactive approach now and recognizing the need for documentation of public health workforce education and training, steps will be saved later when collection of documents is needed. A second goal is to help standardize the skill sets of the public health workforce from county to county.

*The objectives of the toolkit are: 1) to aid in a simple method of documentation. The toolkit provides templates, examples, and guidance to achieve this. 2) to make the toolkit usable. Because the toolkit was developed largely by local health department personnel, the hope is that it will be a very practical, usable asset. 3) to encourage local heath departments to adopt the toolkit. In the creation of a marketing plan and PowerPoint as part of the toolkit, it is hoped that local health department staff will see a need to use the toolkit.

*Public health in Indiana provides many valuable programs. These areas of service are reflected in the previously mentioned 10 Essential Public Health Services.

*Programs include restaurant inspections, vector control, immunizations, septic inspections, and many others.

*For County Council and/or Commissioners: Here is just some food for thought as we consider what your local health department does for you. What would our community be like without the day-to-day services provided by public health?

*We are already doing things well and to the best of our ability. Why are any changes necessary?

*Many people do not know what the local health department (public health) does, including our policy makers. Public health in Indiana is extremely underfunded. In order to continue to provide quality services, funding is needed. Education about and awareness of the role of public health are needed in order to provide the 10 Essential Public Health Services and meet the needs of our communities.*Indiana ranks well below the national average in number of public health workers per 100,000 population. These figures are from a report in 2000 by the Columbia University School of Nursing, Center for Health Policy.

*According to a March 2010 report from Trust for Americas Health commissioned by the Robert Wood Johnson Foundation, Midwestern states received the least amount of funding for disease prevention in fiscal year 2009, at only $16.50 per person. Other areas of the country received an average of $3.09 more per person.

*Indiana ranks 48th in the amount of funding received from the CDC, 50th in HRSA (Health Resources and Services Administration) funding, and 47th in state funding for public health. If money for public health is not available, it is hard to create and sustain programs. Yet sustainability is needed to show funders that dollars received give a good return on investment.

*For County Councils and/or Commissioners: Local information should be inserted in this slide, pertinent to your county. Examples of data to report are things you would include on your annual report to your Local Board of Health and the public. Additional information which could be reported: 1) county health ranking, 2) information from a community health assessment identifying needs and gaps in service, and 3) Public Health System Quality Improvement Program (PHSQIP) information.

*The lack of funding, workforce education and training, and workforce numbers are reflected in our states health outcomes. Moderate physical activity is equal to 30 minutes of moderate activity five days per week. More than half of adult Hoosiers dont get this much exercise. Its not surprising then that a number of Indianas adults report being in fair or poor health.

*Here are some examples of Indianas health status rankings. We know that obesity and tobacco use are huge challenges for our state.

*In public health, we are all about prevention. Good public health practice and adequate provision of the 10 Essential Public Health Services can make a positive impact on the health of our communities. One of the pillars of good public health is prevention.

*The good news is that there ARE things we can do as part of the public health workforce.

*We can increase the QUALITY of our workforce by further education and training, maintaining up-to-date standards and using evidence-based practice. Documentation of this education and training is a key component in preparing for accreditation of public health. We can increase the QUANTITY of our workforce by better advocacy for public healthletting those who hold the purse strings know what public health does for the community and what the absence of public health services would mean. Once again, documentation of what we do and the education we have and training we receive can support the need for an increase in workforce numbers. We can increase the EFFECTIVENESS of the public health workforce by using quality improvement efforts and future public health accreditation as drivers for change.

*Currently 95% of health spending goes to medical care and research. Some estimate this percentage may be even higher. Yet we know that through modifying behavior and environment, we can make an impact on the health of our communities. This is where public health comes in. Showing what an effective, adequate, well-educated and trained public health workforce can accomplish is essential to advocating for the value of public health.

*We need a means to effectively document and evaluate our performance as public health providers. By having sufficient data and documentation, we can assure that we are practicing evidence-based public health.

*In 2007, the National Association of County and City Health Officials provided a vehicle whereby public health could be identified, recognized, and unified. NACCHO is assisting in the national effort to accredit local public health agencies.

*This is the nationally recognized symbol of public health, with a unified goal of prevention, promotion, and protection. The 10 Essential Public Health Services all fit within one of these areas. For example, we prevent disease in our communities by monitoring the population and environment (Essential Service #1). We promote healthier lifestyles by informing, educating, and empowering people to make healthy choices (Essential Service #3). We protect the public by diagnosing and investigating disease outbreaks (Essential Service #2) and by developing policies and enforcing laws that keep the public safe (Essential Services #5 and #6). These are just a few examples of how we prevent, promote, and protect.

*We need to ask ourselves if we have a competent workforce. Is our staff adequately educated and trained to perform the everyday functions of public health? Do we document their education and training and the skills they have? Once again, our public health workforce is the foundation needed to prevent, promote, and protect.

*In order to meet the goals of Healthy People 2020, we must have a competent public health workforce.

*There are many benefits to workforce development and the education and training toolkit. We can achieve a more competent workforce which better serves the public. We can get increased recognition of the jobs we do every day. Job satisfaction comes from knowing we are accomplishing something important and that what we do is worthwhile. All of this will lead to better health outcomes. By documenting what we do, we are validating public health and preparing for national voluntary accreditation.

*What can LHDs do? We need to encourage individual staff education and training and provide regularly scheduled training. This regular training can address identified gaps in public health knowledge and service. We can encourage online training. There are many excellent resources available, all at your fingertips. Courses can be completed from your own work station and many can be finished over a period of time and are in modular format. Staff should be encouraged to attend all state trainings provided. Use the state health department as a resource and take advantage of trainings. Make sure staff are trained to performance standards. Allocate resources for training. Advocating for public health to elected officials may bring in additional funding for staff education and training. Schedule adequate timeallow staff to complete training during their normal workday. Make sure time is set aside for this important endeavor and cross-train employees so that they can cover for each other while each attends offsite trainings. Demonstrate the value of training by encouraging participation, allowing time, and documenting training in employee records.

*In summary, we WANT a competent public health workforce that is professionally trained, assessed, and maintained. We want the public and policymakers to be informed about the role of public health in our communities. We want validation of public health in the form of support and funding.

*We always need to keep in mind why we do what we do every day: we want to improve the health of Hoosiers and keep them healthy!

*Together we can make a difference!

*For County Council: The local health department understands the huge responsibility of providing public health services, preventing disease, promoting healthier lifestyles, and protecting the community. We cant do it without your continued support and financial backing.

*For County Commissioners: The local health department needs the backing and support of the public and our County Commissioners. We want to have a strong workforce able to meet our communitys needs.*For Local Board of Health: The Board of Health can help by promoting and supporting staff education and training. Local health department staff need your support in this endeavor and as we prepare for national voluntary public health accreditation. You can help by learning more and advocating for the public health workforce!**