Healthy People 2000 Consortium Meeting
November
7, 1997
Summary of Breakout Group Discussion Concerning Public
Health Infrastructure
I. General Structure and Framework of Healthy People 2010
One gap identified by the group was that there was no place for
discussion or input on policy. Instead the framework still
supports program priorities rather than input into health policy
at the community, State, and Federal level. There was discussion
that perhaps there should be a policy objective for each
objective. Currently we have a top down approach on the national
objectives and it would be better to have a local level up
approach. The group thought that policy input could be included
in this focus area and should since it is one of the ten
essential services of public health (ESPH).
From conversations and meetings with other colleagues, several
work group members felt some categorical interests remained in
maintaining this framework, but the real question is how do we
make it a more interactive tool for others besides health
educators. The framework seems so general it will be hard to get
public comment.
One member shared how a colleague sent out specific questions
(via e-mail) on the framework to get input from their
organization, e.g., how do you feel about the goal of eliminating
health disparities? Others around the table liked this idea to
generate more comments within their own departments and
organizations and to get more grassroots responses.
The group was reminded that these are not agency or Federal
objectives, but rather objectives for the Nation and it is very
important for the objectives to be meaningful to States and local
levels and to get the input from States and locals. One member
suggested that most States do their own documents, and that is an
opportunity to get more of a State focus
There was very strong support for moving Public Health
Infrastructure out from a focus area in the fan and make it more
prominent as an underlying foundation for all focus areas.
Several suggested it could be placed above enabling goals as a
semicircle while another suggestion was to put Public Health
Infrastructure as a broad bar at the bottom of the whole fan.
Concern was also expressed about the three sub areas indicated
for Public Health Infrastructure and how they were selected. The
sub areas should be consistent with the areas in the development
of the infrastructure objectives.
II. Special Populations
There was much discussion on the issue of special populations and
eliminating health disparities
- NCHS is having a meeting on December 17th to decide about
criteria for classifying the population into separate
groups/populations. Although we need to track special
populations we have a problem that if you break out all
of the race groups the database becomes unmanageable.
- The definition of "special populations" is not
clear and people of color seem to fall under it. People
of color already have disparities, so eliminating health
disparities would be more fair to bring people of color
back up (or down) to the total population. We will need
to know the baseline of the disparity to bring them up to
equity with the general population. How targets are set
is problematic and should they be set at the top group's
performance or at some other level.
- WHO and PAHO are working with over 40 countries with the
goal to achieve equity, not to eliminate health
disparities. Differences are not always caused by race,
but also by economic status and other determinants.
Special populations themselves are not homogeneous across
the Nation or the world.
- Do we have the capacity to break out special groups? If
not, then the HP 2010 document becomes only rhetoric.
- We cannot control for income or education and it may make
more sense to work toward equity rather than eliminating
disparities. We talk about poverty all of the time, but
we have not included it in this framework— education
is there but not poverty — we could make some sort
of impact as a public health community— like
weighing in on issues such as minimum wage. Sometimes
special populations are also geographical, e.g., rural
— with large disparities.
- Are there any objectives that this group, PHI, could come
up with that deal with education, income to get at these
issues?
- A challenge for HHS to capture a framework that includes
all influences/determinants on health, but many of those
issues are more global than HHS and are dependent on its
relationships with other cabinet members. Health is
broader than HHS and includes violence, education,
justice, etc.
With regard to the question of duplicative objectives, one
comment was, "Don't you lose as much as you gain." The
common thinking is "weigh it, don't read it."
The issue of different versions or components of HP 2010 was
discussed. Rather than continue to waste trees and only have a
huge document, consideration should be given to separate
documents for the different focus areas. It was pointed out that
the Web site will help out on this and allow searching of only
those areas the reader is interested.
III. What Has Been Done to Date on PHI Objectives
The Public Health Practice Program Office, Centers for
Disease Control and Prevention, is coordinating development of
national objectives for the proposed Healthy People 2010 focus
area on public health infrastructure on behalf of the Public
Health Functions Steering Committee. To date, two national
workgroup meetings with representatives from Federal, national,
State, and local levels have been held. Draft objectives are
being formulated and circulated to a wide range of partners. The
framework for the chapter development is the ten essential public
health services and the four major components of infrastructure -
systems, competencies, relationships and resources.
Draft objectives that had been developed were distributed and
discussed. Below is a synopsis of the discussion on each
objective and recommendations. Further comments can be sent to
Pomeroy Sinnock, Ph.D., by e-mail at pxs1@cdc.gov, or by
telephone at (770) 488-2469. Future drafts of the PHI objectives
will be posted on the Public Health Functions Home Page to gather
a wide range of comments at http://www.health.gov/phfunctions.
Overall Comments and Discussion
- Jargon is too "public health-ese"
- Objectives need to be measurable, and many of these are
not
- Many fail the first criteria— important and
understandable to a broad audience
Community and Organizational Competencies
- By 2010, increase to 75% the proportion of local health
departments that have implemented a community health
improvement plan based on a comprehensive needs
assessment and broad public participation, and includes
HP2010 goals, financing, evaluation processes, and
progress reporting to the public.
Discussion:
"Comprehensive needs assessment" — health
only? Must include assets as well
Important to have State and local together in this
objective
Suggest splitting into two objectives to separate some of
the complex issues
- By 2010 increase to X% of SHDs and LHDs that have
conducted a comprehensive health assessment with
broad organization and citizen participation.
- Increase to X% of SHDs and LHDs that have
developed and implemented a community health
improvement plan that mobilize health departments
and community resources for identified health
priorities.
- By 2010, increase to 75% the proportion of local public
health agencies that voluntarily meet national
performance standards for essential public health
services.
Discussion:
Many issues need to be ironed out before this should be
an objective.
Gap—review of public health standards.
- By 2010, increase to 100% the proportion of State
governments with broad-based State health coalition that
has developed a State health improvement plan, based on a
comprehensive needs assessment and broad public
participation, and includes HP2010 goals, financing,
evaluation processes, and progress reporting to the
public.
Discussion:
Rewritten into the proposed new objectives under #1
— important to link State and local.
- By 2010, increase to 100% the proportion of State public
health agencies that voluntarily meet national
performance standards for essential public health
services.
Discussion:
Same as #2.
- By 2010, establish a national surveillance system of
local public health agencies to monitor their capacity to
meet performance standards for essential public health
services.
Discussion:
Reworded to read: By 2010, establish a national
surveillance system of local public health agencies to
monitor their capacity to deliver or assure essential
public health services.
- By 2010, increase to 100% the proportion of State and
local agencies responsible for public health that will
have appropriate legal authority to enable performance of
the essential health services.
Discussion:
The group liked this objective, would also need to
include assessment and review.
- By 2010, increase to 100% the proportion of State and
local public health agencies that have access to a core
set of accurate and reliable public health and personal
health care laboratory services.
Discussion:
Reworded the objective to read: By 2010, increase to 100%
the proportion of State and local public health agencies
that have access to a core set of accurate and reliable
public health, including environmental health, laboratory
services.
Workforce Competencies
Issue: The definition of a public health worker or the
public health workforce is problematic. The Public Health
Workforce: An Agenda for the 21st Century report includes in
the public health workforce — all those responsible for
providing the services identified in the Public
Health in America statement, regardless of the organization in
which they work. For example, in many communities the private
sector workers deliver pubic health services and these workers
are definitely part of the public health workforce.
Discussion:
Agree with the definition used in the report above, don't want to
create 2 definitions — would be confusing to the public
Integral for us to think through: 1) What we think of the
workforce as, and 2) Who we are going to measure?
- By 2010, increase to 95% the proportion of State and
local public health officials that meet competency
standards in leadership and management practice,
respectively.
Discussion:
We don't currently have competency standards
Objective needs to set competency standards — only
after that will we be able to set measures — only
feasible through ASTHO and affiliates and NACCHO
Don't want to just have attendance at classes, institutes
Leadership and management practice don't seem measurable
This is an anecdote not a measure — drop
- By 2010 increase to X% the proportion of public health
workers that meet competency standards related to the
essential public health services and appropriate to their
job.
Discussion:
Currently impossible to measure
Measurable for licensing and degrees (but that does not
include a large proportion of public health workers)
Instead of "competency standards related to the
essential public health services and appropriate to their
job" perhaps two things can be broken out — 1)
a basic understanding of public health and 2) specific
competencies for their jobs
"Competency standards" too strong of word
choice
Could we make it specific to those areas that are
certified now or have standards
- By 2010, increase to 100% the proportion of schools of
public health that formally orient their curricula to the
essential public health service competencies outlined in
The Public Health Workforce: An Agenda for the 21st
Century report.
Discussion:
Shouldn't reference the report because those competencies
are in draft form only and are to be vetted and refined
(Council on Linkages Between Academia and Public Health
Practice is leading that effort).
Is this meaningful to the public?
Suggest rewording the objective to: By 2010, increase to
100% the proportion of accredited schools of public
health that formally orient their curricula to the
essential public health service competencies.
- By 2010, increase to at least 50% the proportion of local
health departments providing planned, structured training
programs to their workforce/employees addressing the
health needs of culturally and linguistically diverse
populations.
Discussion:
This one could drive action and is measurable (see
rewording below).
There are a lot of important issues in this objective but
they need to be separated. We have suggested making three
objectives that are measured annually and regularly:
- General understanding of public health —
basic overview or training, possibly using the
Public Health in America statement
- General access to continuing education
(annually), e.g., State and local health
departments have akcess to or attended training
in past year.
- Addressing the health needs of culturally and
linguistically diverse populations
Some other suggestions for objectives for Workforce:
- (Concept) Provide education to outside/others on public
health — meaning CBOs, health care providers,
foundations, medical schools, other disciplines, the
public
- (Concept) Collect basic information about the public
health workforce — currently there are gaps —
e.g., average age, gender, ethnicity
- Include the objective regarding the Standard Occupation
Classification system from an earlier draft —
Increase to 100% the State and local health departments
adopting and using the Standard Occupation Classification
(SOC) taxonomy
Information Systems
- By 2010, increase to 100% the proportion of Federal,
State and community public health agencies that manage an
electronic information system — integrated with
laboratories, health care providers, and other public and
private organizations — for comprehensive
surveillance of health, the health system, and the
performance of the essential public health services, and
for rapid communication with health professionals and the
public.
Discussion:
Developmental — need to agree on a standard
integrated information data system
Many people still don't have electronic systems
The word electronic is not necessary and is confusing
— not the right terminology
Maybe the objective should be more basic— State and
local health departments have the capacity of an
integrated information data system (needs to be defined)
— to do what?
Suggest breaking into 3 objectives dealing with: 1)
machinery, 2) linking, and 3) analysis/dissemination of
data
Reword the objective to read: By 2010, increase to 100%
the proportion of Federal, State and local public health
agencies that manage an integrated information system for
tracking surveillance of health, the health system, and
for rapid communication with health professionals and the
public.
- By 2010, increase to 100% the proportion of Federal,
State, and community public health workers who have
regular access to the Internet as appropriate to their
work assignment.
Discussion:
Internet may be a dated term— perhaps "online
information system"
This one is measurable and important
Reword to read: By 2010, increase to 100% the proportion
of Federal, State, and community public health workers
who have regular access to online information systems.
- By 2010, increase to 100% the proportion of public health
workers with access to the Internet who are trained in
application of informatics to effectively conduct
surveillance, assessment, interventions, research, or
other functions as appropriate to their particular job
and competency in essential public health services.
Discussion:
Good idea here, but wording to complicated
This is really a workforce training issue more than an
information systems issue.
- By 2010, increase to X% the proportion of Federal, State,
and local public health agencies that release within 1
year of collection, surveillance and survey data needed
by health professionals, government agencies, and
community-based organizations to measure progress towards
achievement of HP 2010 objectives.
Discussion:
A developmental objective
Need to include timeliness and periodicity (e.g., surveys
done every 5,7,10 years — data becomes old)
Define "release"—do we mean electronic,
usable by the public.
Reword to read: By 2010, increase to X% the proportion of
Federal, State, and local public health agencies that
release within 1 year of collection, surveillance and
survey data, including HP2010 objectives.
- By 2010, increase to 100% the proportion of Federal,
State and community public health agencies that adopt
national standards for data collection, transmission,
analysis, reporting, and privacy protection.
Discussion:
Good development objective
Worried the % may be too high
Watch word choice — community vs. local public
health agency — pick one.
Research
- By 2010, establish and implement a comprehensive,
national agenda for population-based prevention research
responsive to State and community public health
priorities and needs.
Discussion:
Agree with concept but. agenda needs to evolve and change
as issues change
Need to look into the future
This links to issues with funding and information
dissemination/linking
Is this an agenda or strategy? Or a clearinghouse?
Reword to read: By 2010, establish and implement a
dynamic, national agenda for population-based prevention
research responsive to State and community public health
priorities and needs.
- By 2010, increase to 100% the proportion of Federal
agencies that develop a career track for new
population-focused researchers through the dedication of
a proportion of research funds targeted towards young
investigators just entering the public health research
area.
Discussion:
Promote inclusion of community health perspective into
the education
Also need to work with people currently in the system
Delete the word "young"
Finance
- By 2005, increase to 100% of the proportion of State
health agencies and to 80% the proportion of local health
agencies that have a tracking system for public health
expenditures related to essential public health services.
Discussion:
Good objective — but is it too bold (i.e., lower
percentage, or push back the annual objective
Goal needs to be for 2010, not 2005
Participants
Pomeroy Sinnock and Charles Gollmar, Facilitators, Centers for
Disease Control and Prevention
Nicole Cumberland, Recorder, Office of Disease Prevention and
Health Promotion
Scott Becker, Association of State and Territorial Public Health
Laboratory Directors
Patricia Berry, Vermont Department of Health
Carol Brown, National Association of County and City Health
Officials
Debra Burns, Minnesota Department of Health
Liza Centra, National Association of County and City Health
Officials
Lou Fuller, Minnesota Department of Health
Richard Klein, National Center for Health Statistics
Jeffrey L. Lake, Virginia Department of Health
Louise Lex, Iowa Department of Health
Cristina Markites, Pan American Health Organization
Robert Moon, Association of State and Territorial Directors of
Health Promotion and Public Health Education
Dixie W. Ray, Indiana University
Colleen Ryan, National Center for Health Statistics
Tom Sims, West Virginia Bureau of Health
Hugh Sloan, U.S. Public Health Service Region VII
Martina Vogel-Taylor, National Institutes of Health
Breakout Session List