|Wiesman delivers presidential remarks at NACCHO Annual Conference|
John Wiesman, DrPH student in Health Policy and Management, is the new president of the National Association of County and City Health Officials (NACCHO). He delivered his first presidential remarks at the 2012 annual NACCHP meeting in Los Angeles, CA in July. The conference theme was "Navigating the Currents: Positioning Local Health Departments for the Future" and he discussed how local health departments across the country can position themselves for the future.
Here is a copy of his presentation.
I want to start my presidential remarks with a question, "How many of you believe your health department is stronger today than it was several years ago and that it is well positioned for the future?"
I believe mine is.
The department I lead has lost 50% of its staff over the last four years and 40 percent of its funding since 2004.
Right about now, I suspect some of you are beginning to think I am nuts telling you my health department is stronger today! Maybe I am; but, I can say as harrowing as the changes were, as devastating as the job losses were for staff and their families, and as challenging as the additional workloads are on the staff that remain, the changes forced us to make tough choices and to prepare for a new future.
Many things needed to be changed. Six years ago, my Board of Health meetings lasted from 30 seconds to 10 minutes. I kid you not--30 seconds. Today, we have a monthly, one-hour Board meeting that has been separated from the Board of County Commissioners meeting. That turnaround occurred when one of my board members went to the 2006 National Association of Local Boards of Health (NALBOH for short) annual meeting in San Antonio, held jointly with NACCHO. He came back from San Antonio and told his fellow board members that public health needed their undivided attention and needed its own, separate meeting.
Four years ago my department was investing $1 million a biennium of local funding to support categorical clinics because the clinics were not efficient enough to live off their own revenues. Today, we have expanded primary care access by partnering with an FQHC that provides integrated primary care, which next year will operate without subsidy from my department.
During our reductions, we held on to the belief that the programs we were providing, like WIC, maternity support services, and others, were critically important to the health of our community. And we also believed that with the financial pressures, there were others in the community that could provide the services and do so for less expense. We opted to save programs by moving them into the community.
When we got to the point that we cut services to the core, our community public health advisory council turned to the Board of Health and said, "Enough, this community cannot accept any further cuts to the department." That year, my board raised the property tax to the 1% maximum allowed by state law, dedicated the entire increase to public health, and added it to our ongoing, baseline local funding. Today as we plan our budget for the next biennium, we are holding our own.
Gut wrenching as these changes were, we kept our vision on the future--influencing the conditions that improve the health of our communities. Just last month, the Board approved draft health policies to be integrated into the county's comprehensive growth management plan update, which defines our future built environment. We went from a time when a former commissioner was quoted as saying, "You will never convince me that planners make people fat" to a time when people understand the concept of "health in all policies."
So yes, even with severe budget and staff reductions, I believe my department is stronger today and prepared for the future.
I share this story to simply say that times have changed, and we must too. We must lead forward--that is our job. We must understand and accept that we will not be going back to what we knew prior to the Great Recession. Times have changed. The public wants something else from their government, at least for the foreseeable future. And, from where I lead, that is as it should be. Programs, services, and systems that don't change eventually find themselves irrelevant.
So now the question becomes, "how should local health departments across the country position themselves for the future?"
Leading forward, I believe there are six important currents we must navigate together.
The first current we must navigate is: narrowing the divide between public health and medical care. This window of action on this one is short and I will spend a bit more time on this current.
Many public health leaders, myself included, have been adamant that we draw a clear line between the two disciplines to differentiate ourselves. But given that we in governmental public health struggle for the most basic financial resources while our country spends the most per capita on health care in the developed world and we have some of the worst population health outcomes, I would argue that the divide isn't working well for anyone.
Our immediate opportunity to change course and narrow the divide is to fully engage in the implementation of health care reform. It is essential that we devote some of our own time, and that of our staff, to be engaged with and influence the work of hospitals, health plans, and health care providers in our local communities as they work to heal one patient at a time and refocus on preventive care. We need them to support our efforts to change the upstream conditions that will keep people healthier in the first place.
Public health's core function of assessment and our voluntary national accreditation requirements for community health assessments and community health improvement plans make it a no-brainer for us to work with non-profit hospitals as they conduct their federally required community health needs assessments. NACCHO's Mobilizing for Action through Planning and Partnerships (or MAPP) is an excellent tool to help local health departments complete these assessments and plans.
Those hospital community health assessments should then inform and influence the hospitals' required community benefit giving. As hospitals' uncompensated care decreases as more individuals have health insurance, it is essential that we, local public health, be at the table to help hospitals redirect their community benefit dollars from uncompensated care to community systems that will improve health outcomes and reduce the conditions that cause health inequities.
Continuing with the core function of assessment, local public health must engage in the development of health information exchanges to ensure that we can electronically exchange data with the medical care system. This is vital to our ability to monitor and report on health care access, utilization, and quality issues as well as obtain reportable disease and surveillance data.
When it comes to the formation of accountable care organizations, we must ensure that prevention has a prominent role and that community support systems are in place for those who have the greatest health inequities. The medical care system cannot deliver on quality and good outcomes if public health, behavioral health, and community based organizations are excluded from the delivery system.
Finally, it is critical that we engage the leaders of health plans as they decide new payment systems. To achieve the triple aim of better patient experience, improved health outcomes, and decreased costs, payment systems must be rethought to pay for the triple aim outcomes. We need to be at the table advocating for payment systems that pay for improved patient health literacy and decision making, for integrated oral health, behavioral health, and primary care, for patient navigators that help our most vulnerable navigate the complex health care system, and for asthma management plans and healthy home surveys to change the conditions in which providers send their patients back home and out into the community.
The second current we must navigate is to rid ourselves from the mantra that, "once you have seen one health department, you have seen one health department." To position health departments for the future we must identify a core (or as the recent Institute of Medicine report calls it, minimum) package of public health services that include foundational capacities and an array of basic programs that no health department can be without. By not having a consistent set of capacities and basic programs, we are confusing the public and making it hard for them and our elected policy makers to support us. And who can blame them? If there is no common core, then there really isn't a system. We need this core set of services to help form our brand. The national public health logo that we, NACCHO, created, is a necessary component to creating a brand. But it is not sufficient. The missing piece is having a common, minimum package of public health services across all departments. Then, and only then, will we truly have a national public health brand that creates a feeling, and a promise, to the public we serve and the policy makers on whom we rely for funding.
The third current we must navigate is ensuring we sustain our past successes and confront our emerging challenges. This requires us to maintain our capacities and capabilities to prevent communicable diseases and injuries; promote maternal, infant, and child health, and protect our food, water, air, and soil. While doing this, we must also make a part of our regular work the activities, programs, and partnerships that will change policy, systems, and environments as they relate to promoting healthy eating and active living as well as reducing adverse childhood experiences. And we simply must advocate for policies and actions that mitigate climate change and help us prevent and reduce the human health impacts of climate change. The recent outbreaks of extreme heat, winds, wildfires, and flooding that have ravaged much of our nation these past weeks could soon be the new norm. Climate change is here and we need to act now.
The fourth current we must navigate is the knowledge and skill development needed in our future workforce. We must invest in training and developing our staff so they can effectively carry out the work of the future. This means our workforce must have the skills needed to:
The fifth current we must navigate is changing technology. We urgently need to modernize our information technology systems to be ready to electronically exchange information with our medical provider partners as they continue to switch to electronic medical records. We also must continue to research and explore the best ways to use social media, the Internet, apps, and other technologies for population-based prevention work. And we must identify, train, and hire public health informatics staff to successfully bridge the practices of medicine and public health with information systems, surveillance and epidemiology, health planning and decision-making, and quality improvement.
The sixth and final current we must navigate is the retirement of our baby boomers and the development of our management and leadership workforce. To do that, we urgently need to address succession planning in our organizations. If you have not done so yet, I urge all of you to go home and profile your workforce by age and years to retirement. Then consider who you have to replace those workers. And as you identify persons to replace those workers, ask who you will replace those replacements with. Quickly you will find that we need to be developing our future first line supervisors all the way up to the people who will replace us. We need to create a leadership pipeline of competent managers and leaders ready for the extremely challenging environments in which they will need to lead.
While we have our work cut out for us, I know that we have the talent in this room, in our profession, and within NACCHO and our other national partners to navigate these currents and create the health departments of the future. Our nation's health depends upon it.
|Last updated August 01, 2012|