““It Takes A Region: the West It Takes A Region: the West Central Public Health and Central Public Health and

Environment Collaborative,Environment Collaborative,

““An innovative approach to An innovative approach to public health practice”public health practice”

Peg Mewes, Director, Montrose CountyPeg Mewes, Director, Montrose County

Health and Human ServicesHealth and Human Services

Richard Thompson, Environmental HealthRichard Thompson, Environmental Health

Official, West Central RegionOfficial, West Central Region

Delta * Gunnison* Hinsdale * Delta * Gunnison* Hinsdale * Montrose * Ouray * San MiguelMontrose * Ouray * San Miguel

About the region…About the region…

9,569 sq miles of mostly mountainous terrain, much of 9,569 sq miles of mostly mountainous terrain, much of which is public lands, on Colorado’s western slopewhich is public lands, on Colorado’s western slope

A rural, frontier region, population 93,440A rural, frontier region, population 93,440 Region wages 67.3% of state av. with % of poverty higher Region wages 67.3% of state av. with % of poverty higher

than statethan state Region has highest number of uninsured in the stateRegion has highest number of uninsured in the state Largest producer of coal (45.8% of coal mined in Co.) and Largest producer of coal (45.8% of coal mined in Co.) and

increasing in oil and gas productionincreasing in oil and gas production Tourism extremely important to region. Two major ski resorts Tourism extremely important to region. Two major ski resorts

and year round recreational and outdoor activities aboundand year round recreational and outdoor activities abound Montrose County, most populous, regional trade center and Montrose County, most populous, regional trade center and

agricultural hubagricultural hub Delta County has the only health department in the regionDelta County has the only health department in the region

West Central Region population by West Central Region population by year and county, 1990-2005year and county, 1990-2005

Region grew Region grew 52.2%, a rate 52.2%, a rate of increase of increase higher than higher than the state in the state in that time that time period period (42.9%)(42.9%)

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

San Miguel

Ouray

Montrose

Hinsdale

Gunnison

Delta

The beauty of it all…The beauty of it all…

Fall 2005, the growing problem…Fall 2005, the growing problem…

A challenged public health and environment A challenged public health and environment infrastructureinfrastructure

Growing population with largest number of Growing population with largest number of uninsured in the stateuninsured in the state

Aging public health workforce (50% over age 50) Aging public health workforce (50% over age 50) and lack of qualified human resources to replaceand lack of qualified human resources to replace

Strained and inadequate financial resourcesStrained and inadequate financial resources Healthy People 2010 priorities addressed based Healthy People 2010 priorities addressed based

on funding and not good community assessment on funding and not good community assessment and strategic planningand strategic planning

Inadequate Environmental Health resourcesInadequate Environmental Health resources

The Colorado Trust…The Colorado Trust…

Mission:Mission:The Colorado Trust is dedicated to advancing the The Colorado Trust is dedicated to advancing the

health and well-being of the people of Coloradohealth and well-being of the people of Colorado

““Colorado’s public health system is widely Colorado’s public health system is widely decentralized…This scattered system, combined decentralized…This scattered system, combined with the continuing decline of federal, state, local with the continuing decline of federal, state, local public health budgets, has increased the need for public health budgets, has increased the need for the on-going coordination and provision of the on-going coordination and provision of essential public health services. Weaknesses in essential public health services. Weaknesses in the public health infrastructure, compromise the the public health infrastructure, compromise the ability to protect Coloradoans from emerging ability to protect Coloradoans from emerging health threats…health threats…

The Colorado Trust 2005 annual report p. 15The Colorado Trust 2005 annual report p. 15

The Opportunity…The Opportunity…Fall 2005, The Colorado Trust’s Fall 2005, The Colorado Trust’s Partnerships for Health InitiativePartnerships for Health Initiative

““The Colorado Trust’s eight year (2005-The Colorado Trust’s eight year (2005-2013) $8.6 million Partnerships for Health 2013) $8.6 million Partnerships for Health Initiative is designed to help improve the Initiative is designed to help improve the coordination of health services at the coordination of health services at the community level.”community level.”

Gunnison County takes the leadGunnison County takes the lead Grant written Nov. 2005 for $10,000 six (6) Grant written Nov. 2005 for $10,000 six (6)

month planning grant. Awarded by The month planning grant. Awarded by The Colorado Trust in Dec. 2005Colorado Trust in Dec. 2005

The goal: to initiate discussions regionally The goal: to initiate discussions regionally to address how to make the best use of to address how to make the best use of existing and future resources and how to existing and future resources and how to work together to assess our community and work together to assess our community and share resources to address all Healthy share resources to address all Healthy People 2010 focus areas and public health People 2010 focus areas and public health performance standardsperformance standards

Healthy People 2010 focus area #23 Public Healthy People 2010 focus area #23 Public Health Infrastructure was chosenHealth Infrastructure was chosen

Jan. 24, 2006 Gunnison County BOCC Jan. 24, 2006 Gunnison County BOCC hosts regional BOCC representatives hosts regional BOCC representatives and county administrators. and county administrators.

Public Health and Environment staff Public Health and Environment staff from the six counties and CDPHE from the six counties and CDPHE local liaison staff also attend. local liaison staff also attend.

Facilitation provided by The Trust. Facilitation provided by The Trust. Results: Unanimous decision to move Results: Unanimous decision to move forward with strategic planning.forward with strategic planning.

““

““Strength is derived from unity. The range of Strength is derived from unity. The range of our collective vision is far greater when our collective vision is far greater when

individual insights become one.”individual insights become one.” Andrew CarnegieAndrew Carnegie

Successive meetings of the EH and PH staff in the Successive meetings of the EH and PH staff in the six counties define:six counties define:

1.1. The mission, vision and values of the The mission, vision and values of the PartnershipPartnership

2.2. The role of the Partnership coordinator and The role of the Partnership coordinator and organizational structureorganizational structure

3.3. The Intergovernmental AgreementThe Intergovernmental Agreement4.4. ““Employees” of the PartnershipEmployees” of the Partnership5.5. The strategic plan, collaborative ideas into goal The strategic plan, collaborative ideas into goal

areasareas

West Central Public Health PartnershipWest Central Public Health PartnershipMissionMission

The mission of the West Central The mission of the West Central Public Health Partnership is to build Public Health Partnership is to build and strengthen public health and and strengthen public health and environment infrastructure by environment infrastructure by identifying and implementing identifying and implementing collaborative projects that benefit the collaborative projects that benefit the counties of Delta, Gunnison, counties of Delta, Gunnison, Hinsdale, Montrose, San Miguel and Hinsdale, Montrose, San Miguel and OurayOuray

West Central Public Health PartnershipWest Central Public Health PartnershipVisionVision

We envision a public health We envision a public health partnership that protects the people partnership that protects the people and environment in our six county and environment in our six county region, promotes health and prevents region, promotes health and prevents disease, resulting in optimal health disease, resulting in optimal health for all our citizens as our region for all our citizens as our region grows and becomes more diverse.grows and becomes more diverse.

Criteria for projectsCriteria for projects

Must have some degree of benefit to Must have some degree of benefit to all six countiesall six counties

Must be measurableMust be measurable Must be demonstrated best practices Must be demonstrated best practices

and/or evidenced basedand/or evidenced based Must not ultimately add to the current Must not ultimately add to the current

work load of the individual countieswork load of the individual counties Must be realistic and attainableMust be realistic and attainable

How do we meet the goal areas of How do we meet the goal areas of the strategic planthe strategic plan

In July 2006, Gunnison County received In July 2006, Gunnison County received the Implementation grant from The the Implementation grant from The Colorado Trust for the region to Colorado Trust for the region to complete the strategic plan.complete the strategic plan.

$187,500 over two and a half years $187,500 over two and a half years with additional $187,500 grant to with additional $187,500 grant to follow for additional 2 ½ yearsfollow for additional 2 ½ years

Goal areas of the strategic planGoal areas of the strategic plan Formalization of the regional Formalization of the regional

partnershippartnership Development criteria and initiate Development criteria and initiate

regional health assessmentregional health assessment Prevention and decreasing the Prevention and decreasing the

incidence of food borne illnessincidence of food borne illness Maximize public health resources for Maximize public health resources for

pandemic planningpandemic planning

Goal #1: Formalization of the Goal #1: Formalization of the PartnershipPartnership

Accomplishments: Accomplishments:

An IGA (Intergovernmental An IGA (Intergovernmental Agreement) was signed by the BOCC Agreement) was signed by the BOCC in each of the six countiesin each of the six counties

Partnership coordinator job Partnership coordinator job description was written and description was written and coordinator for the Partnership hiredcoordinator for the Partnership hired

Operating guidelines for the Operating guidelines for the PartnershipPartnership

Goal #2: Regional Health Goal #2: Regional Health AssessmentAssessment

Accomplishments: Accomplishments:

Indicators to be assessed and tracked Indicators to be assessed and tracked for the regional health assessment for the regional health assessment were identifiedwere identified

Staff obtainedStaff obtained First regional health assessment was First regional health assessment was

completed December 2007completed December 2007

Goal #3 Improve safe food Goal #3 Improve safe food preparation practices in retail preparation practices in retail

establishmentsestablishmentsAccomplishments:Accomplishments:

Expanded Partnership to include CSU Expanded Partnership to include CSU Extension Service and developed Extension Service and developed available, consistent food safety available, consistent food safety classes in each county throughout classes in each county throughout the region. Classes available in the region. Classes available in English and SpanishEnglish and Spanish

Hired regional EH official and Hired regional EH official and purchased regional equipment for EHpurchased regional equipment for EH

Goal #4 Maximize Pandemic Goal #4 Maximize Pandemic Planning resourcesPlanning resourcesAccomplishments:Accomplishments:

Regional pandemic planner hired to Regional pandemic planner hired to assist counties in completing phase 1 assist counties in completing phase 1 and scope of work as outlined in the and scope of work as outlined in the pandemic planning contract to each pandemic planning contract to each countycounty

ChallengesChallenges

Geographic and weather related travel to Geographic and weather related travel to meetingsmeetings

Time away from the office, especially for the Time away from the office, especially for the agencies with one staffagencies with one staff

Not all counties benefit equally from all Not all counties benefit equally from all projectsprojects

Communication is slowerCommunication is slower All six counties are not equally invested in All six counties are not equally invested in

the Partnershipthe Partnership Greater need in some countiesGreater need in some counties Implementation of SB 194Implementation of SB 194

Accomplishments

All six counties met their emergency preparedness deliverables within the timelines as required.

Successfully completed community needs assessment with comparable data for the six counties against the region and the state.

Accomplishments

Determined indicators that need additional research, and Colorado School of Public Health is taking the lead.

Have been able to produce cost effectiveness data related to services being provided throughout the region.

Per Capita Spending by County

$46.94$30.16

$59.64

$426.00

$69.04$57.10

$0.00

$50.00

$100.00

$150.00

$200.00

$250.00

$300.00

$350.00

$400.00

$450.00

Montrose Delta Gunnison Hinsdale San Miguel Ouray

Series1

Montrose County Percentage of Funding by Program

Communicable Disease

26%

Chronic Disease16%

Community Health Services

48%

Disaster Peparedness

3%

Tobbacco0%

Environmental Health7%

Other 0%

Regional EH, Accomplishments Regional EH, Accomplishments

Regional Environmental Health Regional Environmental Health official hired part time and official hired part time and progressed to full time with progressed to full time with additional part time staffadditional part time staff

Food safety classes in each countyFood safety classes in each county Regional radon testing and educationRegional radon testing and education School chemical safety awareness School chemical safety awareness

and monitoringand monitoring

Public Health RevitalizationPublic Health Revitalization SB 08-194 SB 08-194

What are the Personal Health and Environmental What are the Personal Health and Environmental Health requirements for a local Public Health Health requirements for a local Public Health Agency?Agency?

Colorado BOH has not announced what these are. Colorado BOH has not announced what these are. Expectation is that it may provide for a ranking or Expectation is that it may provide for a ranking or

assessment for phasing in Personal Health and assessment for phasing in Personal Health and Environmental Health Services.Environmental Health Services.

The required and Optional Services profiles from The required and Optional Services profiles from 1984 may provide a clue.1984 may provide a clue.

EH Accomplishments continuedEH Accomplishments continued

Equipment purchased for use within regionEquipment purchased for use within region laptop, GPS devices, indoor air laptop, GPS devices, indoor air quality equipment, etc.quality equipment, etc. Partnership developed with septic haulers Partnership developed with septic haulers

regionally. The first Wastewater/Biosolids regionally. The first Wastewater/Biosolids conf. heldconf. held

Regional consumer protection contracts Regional consumer protection contracts and agreementsand agreements

Additional EH capacity and support for all Additional EH capacity and support for all counties in the region when neededcounties in the region when needed

New Partnerships…New Partnerships…

Consideration to contract for services Consideration to contract for services between the counties to meet the SB-194 between the counties to meet the SB-194 public health and environmental health public health and environmental health service requirements. service requirements.

Will “Director” qualifications require Will “Director” qualifications require increased requests for waivers or can increased requests for waivers or can regional partnerships expand to provide regional partnerships expand to provide shared directorship or districts formed?shared directorship or districts formed?

CORE BELIEFSCORE BELIEFS A competent, qualified, functioning health A competent, qualified, functioning health

department consist of Public Health Nursing and department consist of Public Health Nursing and Environmental Health collaborating together with Environmental Health collaborating together with support from specialized state support functions support from specialized state support functions such as Epidemiology.such as Epidemiology.

Public Health delivered in this way saves $$$. Public Health delivered in this way saves $$$. Delivery of services is best done when conducted Delivery of services is best done when conducted

at a local level.at a local level. Cost savings at the local level for counties to Cost savings at the local level for counties to

cooperate and still retain many of the benefits of cooperate and still retain many of the benefits of local services. Enables smaller counties to have local services. Enables smaller counties to have services and expertise not otherwise available.services and expertise not otherwise available.

The Future…The Future… Regional Educational/Marketing campaign to educate Regional Educational/Marketing campaign to educate

region’s population on results of assessment and indicators region’s population on results of assessment and indicators needing improvement.needing improvement.

Regional Public Health Educator to address chronic disease Regional Public Health Educator to address chronic disease prevention, injury prevention, marketing, and collaborative prevention, injury prevention, marketing, and collaborative grant projects.grant projects.

Build relationship with Colorado School of Public Health as Build relationship with Colorado School of Public Health as means of keeping regional assessment indicators current means of keeping regional assessment indicators current and updating assessment annually to show trends and and updating assessment annually to show trends and emerging issues.emerging issues.

Environmental Health planning, regional contracts.Environmental Health planning, regional contracts. Build on baseline assessment of Public Health and Build on baseline assessment of Public Health and

Environmental Health infrastructure, programs and funding Environmental Health infrastructure, programs and funding in preparation for SB194 implementation.in preparation for SB194 implementation.

More structure for the Partnership for long-term stability of More structure for the Partnership for long-term stability of public health and environmental health regional services.public health and environmental health regional services.

““Never doubt that a small group of Never doubt that a small group of thoughtful, committed citizens can thoughtful, committed citizens can change the world; indeed, it’s the change the world; indeed, it’s the

only thing that ever has.”only thing that ever has.”Margaret Mead, Am. AnthropologistMargaret Mead, Am. Anthropologist