Susan Allan, MD, JD, MPH

Working Effectively with State, Local and Tribal Public Health Agencies

Session Overview

8:45 to 9:00 AM  Overview of Session and PH agencies

9:00 to 9:30 AM   PANEL 1: National Practice Orgs: Each panelist will offer three practical suggestions

9:30 to 9:45 AM      PANEL 2: PHTC: Each panelist will offer two suggestions

9:45 to 10:05 AM       Questions, General Discussion

10:05 to 10:30 AM Break out sessions – STATE SESSION- Roosevelt Room (O’Keefe)– LOCAL SESSION- Madison Room (Troutman)– TRIBAL SESSION- Plaza II&III (D’Ambrosio)

10:30 to 10:45 AM Report out (Tilson)

State and Local Public Health Agencies

State Public Health Agencies

• >100,000 state health agency employees– 27,778 work in local health departments– 17,333 work in regional or district offices

• 27% of employees eligible for retirement in FY14

• Federal funds are the largest source of state health agency revenue

Number of FTEs by State Population

Average # of FTEs Average # of FTEs per 100,000 population

State Size # of states Mean # of states Mean

Small 16 876 16 82

Medium 17 2,045 17 47

Large 16 3,567 16 27

Environmental Health(n=51)

Environmental epidemiology

Food safety educationToxicology

Radiation control

Indoor air quality

Vector control

Radon control

Private water supply safety

Public water supply safety

Groundwater protection0

10

20

30

40

50

60

70

80

90

100

90% 88%

73% 71% 69%63% 61%

53% 53%

45%

Percent

Health Activity

Other Public Health Activities (n=51)

Trauma system coordination

State health planning / development

Veterinarian public health activities

Institutional Review Board (IRB)

Nonclinical services in corrections facilities

Occupational safety and health services

Forensics laboratory

Needle exchange

State mental institutions/ hospitals

Medical examiner0

10

20

30

40

50

60

70

80

90

100

78% 76%71%

67%61%

39%

31%27%

24% 22%

Perc

ent

Activity

Public Health Competencies Used –State PH Agencies (n=49)

0

20

40

60

80

100

61%39% 33% 18%

8%

Perc

ent

Training by State PH Agencies -Topics(n=49)

Preparedness

Disease prevention/controlTobacco

Maternal and child health

Cultural Competency/Health Disparities

Environmental health

Vital records, statistics or surveillance

Administrative proceduresOther

None of the above0

10

20

30

40

50

60

70

80

90

100

90% 88%86%

82% 82% 78% 76%

61%

31%

6%

Perc

ent

Topic

Local Public Health Departments

• 2,565 total LHDs in the US

• 63% serve populations <50,000– These small jurisdictions account for only 11%

of the US population

• Approx 5 % of LHDs serve 49% of the US population

Local PH Workforce (2010)

• Median number of FTEs - 17 – ~87% of LHDs had <100 FTEs– 15% of LHDs had <5 FTEs

• 31 %of LHD staff was a race other than white – 12 percent of LHD staff was Hispanic.

• 28% of all LHDs have used the Core Competencies for Public Health Workers

Types of Services provided by LHDs varies greatly

# of states in which more than half of LHDs had budget cuts

late 2008 - 7

mid 2009 - 20

late 2010 - 28

mid 2011 - 30

early 2012 - 15

Tribal Public Health Organizations

American Indian/Alaska Native populations

• 2010 Census • Over 2.9 million American Indian/Alaska Native Only

• Over 5.2 million AI/AN alone or in combination with other races/ethnicities

• >60% of AI/AN people live in urban areas

• Over 560 federally recognized tribes

• Each is sovereign

• Great degree of variability in size of tribe, resources, governance, and public health programming

Source of public health services to tribal communities varies greatly

• Tribal Health Departments• Indian Health Service (IHS) Facilities, • Area Indian Health Boards (12)• Urban Indian Health Centers

• Some tribes also receive services by agreement from local or state health depts

Tribal Health Organizations - Employees

• 54% have less than 50 employees

• 10 %have more than 200 employees

• The average number employees is 64

Tribal Health Department Services

• THDs provide more health screenings and behavioral health services than LHDs

• LHDs provide more environmental health and regulatory functions (e.g., food service inspections)

• THDs are often more integrated with the health care delivery system than LHDs

INDIAN HEALTH SERVICE

• The Indian Health Service (IHS) is the

principal federal health care provider and

health advocate for Indian people

• Significant variations in tribal governance,

population size, land base, and access to

public health services exists among IHS

Areas

IHS Areas

Albuquerque

Portland Billings

CaliforniaPhoenix

Oklahoma

Nashville

NavajoTucson

Alaska

Aberdeen Bemidji

Summary

• Significant overlap in roles among state, local and tribal

• Extreme variability in structure, governance, resources and service

• “If you’ve seen one *** health department,

you’ve seen one *** health department”

Sources for Additional Information

NACCHO “The National Profile of Local Health Departments”

ASTHO “Profile of State Public Health”

NIHB “2010 Tribal Public Health Profile "and “A Profile of Tribal Health Departments”

Break Out Sessions

STATE -- Roosevelt Room

Resource Person – Lacy M. Fehrenbach, MPH, CPH

Facilitator – Elaine O’Keefe, MS

LOCAL -- Madison Room Resource Person – David Dyjack, DrPH

Facilitator – Adewale Troutman, MD, MPH, CPH

TRIBAL -- Plaza II&III

Resource Person – Donald K. Warne, MD, MPH

Facilitator – Luann D’Ambrosio, MEd