The Division of Public Health Should Remain in the ... · The Full Report Today’s Slides Handout...
Transcript of The Division of Public Health Should Remain in the ... · The Full Report Today’s Slides Handout...
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Program Evaluation Division North Carolina General Assembly 1
The Division of Public Health Should
Remain in the Department of Health and
Human Services
A presentation to the Joint Legislative
Program Evaluation Oversight Committee
January 14, 2013
Catherine Moga Bryant, Principal Evaluator
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Program Evaluation Division North Carolina General Assembly 2
Handouts
The Full Report Today’s Slides
Handout
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Program Evaluation Division North Carolina General Assembly 3
Evaluation Team
Catherine Moga Bryant, Evaluation Lead
Jim Horne, Senior Evaluator
Carol H. Ripple, Principal Evaluator
Pamela Taylor, Statistician
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Program Evaluation Division North Carolina General Assembly 4
Our Charge
Session Law 2012-126 directed the Program Evaluation Division to study the feasibility of the transfer of all functions, powers, duties, and obligations vested in the Division of Public Health in the Department of Health and Human Services to the University of North Carolina Health Care System and/or the University of North Carolina School of Public Health
Report p. 2
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Program Evaluation Division North Carolina General Assembly 5
Overview: Findings
• North Carolina’s public health system is an intricate network of partnerships
• The Division of Public Health should remain in the Department of Health and Human Services
• North Carolina’s public health system is seen as a model, but ranks in the bottom half of states for health outcomes
• Organizational models could improve public health delivery
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Program Evaluation Division North Carolina General Assembly 6
Overview: Recommendations
• The Division of Public Health should remain in the Department of Health and Human Services
• The General Assembly should
– Establish the North Carolina Public Health Council
– Direct the Division of Public Health to strengthen the public health system by exploring ways to increase regionalization, improve the use of data, and strengthen quality improvement activities
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Program Evaluation Division North Carolina General Assembly 7
Background
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Program Evaluation Division North Carolina General Assembly
Public Health
The science of protecting and improving the health of families and communities through promotion of healthy lifestyles,
research for disease and injury prevention, and detection and control
of infectious diseases
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Report p. 2
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Program Evaluation Division North Carolina General Assembly
Division of Public Health
• In the Department of Health and Human Services (DHHS)
• Charged with improving and protecting the health of North Carolinians
• Ensures that public health services are available across the State
• State law and administrative rules grant the Division of Public Health (DPH) the power and authority to compel people to act to ensure the health of the public
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Report pp. 3-4
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Program Evaluation Division North Carolina General Assembly
Decentralized Public Health System
• DPH administers and monitors state public health programs, makes and enforces statewide public health rules, and allocates funding to local public health agencies
• Local health departments promote and protect public health in their jurisdiction
• State Health Director delegates authority to local health departments
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Report pp. 5-6
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Program Evaluation Division North Carolina General Assembly 11
Findings
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Program Evaluation Division North Carolina General Assembly
Finding 1
North Carolina’s public health system is an intricate network of
partnerships among the Division of Public Health and local health
departments, state agencies and universities, and other entities
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Program Evaluation Division North Carolina General Assembly
Network of Partnerships
• Division of Public Health works closely
–within the division
–with other divisions in DHHS
–with other state and non-state entities
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Report pp. 7-14
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Program Evaluation Division North Carolina General Assembly
Response to E. Coli Outbreak
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Report p. 14
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Program Evaluation Division North Carolina General Assembly
Finding 2
The Division of Public Health should remain in the Department of Health and Human Services and should not be transferred to the University of North Carolina Health Care System
or School of Public Health
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Program Evaluation Division North Carolina General Assembly
DPH Should Remain in DHHS
• Police power function under the 10th amendment
• Official voice of the State
• Aligned relationship with the Governor’s office
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Report pp. 16-17
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Program Evaluation Division North Carolina General Assembly
DPH Should Remain in DHHS
• Missions of UNC Health Care and UNC School of Public Health do not match the work of DPH
• Moving DPH could provide an unfair competitive advantage
• UNC Health Care and UNC School of Public Health do not support transferring DPH
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Report pp. 16-17
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Program Evaluation Division North Carolina General Assembly
DPH Should Remain in DHHS
• Local health departments and other stakeholders do not support transferring DPH
• Recent changes to the public health system may be affected by transferring DPH
– Environmental health moved to DPH
– Counties can create consolidated human services agency
– Incentives for multi-county departments
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Report pp. 17-18
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Program Evaluation Division North Carolina General Assembly
Finding 3
North Carolina’s public health system is seen as a model, but the State ranks in the bottom half of
states for health outcomes because of high risk factors
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Program Evaluation Division North Carolina General Assembly
N.C.’s Model Public Health System
• North Carolina has a strong decentralized public health system
• Model practices
–Accreditation
–Partnering
–Surveillance data
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Report pp. 18-19
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Program Evaluation Division North Carolina General Assembly
N.C. Ranks 32nd in Overall Health
• United Health Foundation analyzes data for 23 measures
• Determinants – actions that will affect the future health of the population
• Outcomes – what has already occurred
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Report pp. 20-24
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Program Evaluation Division North Carolina General Assembly
N.C. Ranks 31st in Determinants Measure Ranking
Behaviors
Binge drinking 8
Obesity 30
High school graduation 36
Smoking 36
Community and Environment
Infectious disease 15
Occupational fatalities 22
Violent crime 27
Air pollution 35
Children in poverty 47
Public and Health Policies
Immunization coverage 6
Lack of health insurance 38
Public health funding 42
Clinical Care
Early prenatal care 18
Preventable hospitalizations 24
Primary care physicians 26
All Determinants 31
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Program Evaluation Division North Carolina General Assembly
N.C. Ranks 38th in Outcomes
Measure Ranking
Geographic disparity 20
Poor physical health days 26
Poor mental health days 30
Cardiovascular deaths 31
Cancer deaths 35
Diabetes 36
Premature deaths 36
Infant mortality 46
All Outcomes 38
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Report p. 24
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Program Evaluation Division North Carolina General Assembly
N.C.’s Health Rankings
• Improvement in health outcomes requires the efforts of many partners and state agencies
• DPH can encourage stakeholders, but can not compel other organizations to act
• Federal government has created a cabinet-level council to bring focus, coordination, and leadership to public health issues
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Report pp. 24-25
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Program Evaluation Division North Carolina General Assembly
Finding 4
There are organizational models that could improve public health
delivery in North Carolina
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Program Evaluation Division North Carolina General Assembly
Organizational Models
• Increase regionalization
– Strongest predictor of performance is size of jurisdiction of a public health department
• Use data to focus resources
– Georgia used data and mapping to target interventions to improve infant mortality rates
• Continue quality improvement training
– Lowers costs, improves health outcomes, and find more efficient processes with a focus on patient satisfaction
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Report pp. 25-28
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Program Evaluation Division North Carolina General Assembly 27
Recommendations
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Program Evaluation Division North Carolina General Assembly
Recommendations Overview
The Division of Public Health should remain in the Department of Health and Human Services and not be transferred to either UNC Health Care or UNC School of Public Health
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Program Evaluation Division North Carolina General Assembly
Recommendation 1
Establish the North Carolina Public Health Council
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Program Evaluation Division North Carolina General Assembly
Establish N.C. Public Health Council
• Develop a government-wide action plan for improving the overall health in North Carolina
• Membership includes department heads of state agencies with a role in the State’s health and wellness
• Create a dashboard showing progress meeting health objectives
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Report pp. 29-30
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Program Evaluation Division North Carolina General Assembly
Recommendation 2
Explore ways to increase regionalization, increase the use of
data, and strengthen quality improvement activities
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Program Evaluation Division North Carolina General Assembly
Strategies to Improve Public Health
• DPH should determine how to increase regionalization, increase the use of data, and continue quality improvement activities
• Create an action plan with UNC School of Public Health, local health departments, and other stakeholders
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Report p. 31
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Program Evaluation Division North Carolina General Assembly 33
Summary
• North Carolina’s public health system is an intricate network of partnerships
• The Division of Public Health should remain in the Department of Health and Human Services
• North Carolina’s public health system is seen as a model, but ranks in the bottom half of states for health outcomes
• Organizational models could improve public health delivery
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Program Evaluation Division North Carolina General Assembly
Summary
• The Division of Public Health should remain in the Department of Health and Human Services
• The General Assembly should
– Establish the North Carolina Public Health Council
– Direct the Division of Public Health to strengthen the public health system by exploring ways to increase regionalization, improve the use of data, and strengthen quality improvement activities
34
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Program Evaluation Division North Carolina General Assembly
Legislative Options
• Accept the report
• Refer it to any appropriate committees
• Instruct staff to draft legislation based on any of the report’s recommendations
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Program Evaluation Division North Carolina General Assembly 36
Report available online at
www.ncleg.net/PED/Reports/reports.html
Catherine Moga Bryant
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