Public Health Infrastructure

PURPOSE: The overall purpose of the discussion was to review the proposed objectives for Healthy People 2010 Chapter 14 - Public Health Infrastructure and make suggestions for improvement of Chapter 14.

The participants voiced strong support for Chapter 14 and agreed that it was a critical chapter for Healthy People 2010. In fact the group recommended that the Public Health Infrastructure chapter be moved and placed at the beginning of Healthy People 2010, perhaps right after the Goal Summary section. The infrastructure goals and objectives drive the ability to support the other 25 priority areas. To emphasize the importance of the public health infrastructure it was also recommended that Figure on page 23 of the Goals section be changed by adding another concentric circle to the outermost ring of the target. This would visually convey that infrastructure is necessary for all else in the public health system.

The group recommended more discussion in the introduction on the relationship of core functions and the essential public health services. There was considerable discussion concerning the funding of the infrastructure. It was noted that there was not any specific objective related to funding of the infrastructure and the group raised the possibility that perhaps there should be one. The issue of categorical funding of public health services and programs and the lack of flexibility for state and local level was raised. Many state participants supported the notion of more flexibility in funding and a specific suggestion was made that there should be a 1-2% infrastructure set aside from every grant and in addition that perhaps state/local levels should be required to put up matching funds. A specific recommendation was to consider having an objective related to funding the infrastructure.

Possible wording was suggested as "To consolidate categorical federal funding into a set of performance partnership block grants linking 2010 objectives with state and local health plans."

There was discussion on assuring environmental health services are included in definition of public health. Some participants suggested adding a specific reference to environmental health service in the goal. It was noted that environmental health services are not listed in the essential public health services.

Definitional problems were discussed. The question of the the link between a broad definition of public health and the role of public health was raised as was the differentiation between the health of the public vis a vis public health agencies. The role of partnerships in public health was discussed. The group suggested that a sentence could be added to the definition of public health services that highlights the convening role of public health agencies in addition to their role as assurers of public health services. Assuring the health of the public is a partnership today and the improvement of community health status is a responsibility of all community partners. It was also suggested to add a sentence in the introduction that an additional role for a lead agency is beyond assuring the essential public health services, but is also to convene non-governmental organizations and others in pursuing public health goals.

There was strong support for the objective on competencies (14.1) but the intent should be broad based. It was agreed that the intent of the objective should be a basic level of understanding of public health and not necessarily specific competencies for professional disciplines. It was noted that competencies are also related to performance standards and establishing baseline competencies is critical to meeting performance standards.

There was strong support for a new objective related to developing the capacity at the state and local level for distance learning.

The issue of financial support for the collection and analysis of data was discussed and many advocated for more prominence of this area in the chapter. There was a suggestion to add an objective related to funding data management, data collection, analysis and dissemination linked to training and education. Concern was expressed that with the incorporation of HP 2000 Chapter 22 into HP 2010 Chapter 14 that somehow the role of data was diminished.

The issue of standardization for data and data collection was discussed. There was support for developing national standards for technical requirements and developing standardized data collection to promote comparability. This is especially important given the imminent changes resulting from new ICD codes. In addition severl identified the ned for technical assistance - beyond just funding - to make those transitions.

 Objective 7 was noted to be unrealistic for state and local levels. Several participants suggested adding an objective on increasing the percentage of states that measure and report on the leading indicators. Many felt that focusing on leading indicators rather than all HP2010 objectives was a more prudent approach.

It was pointed out that despite the title of the section -"Integrated Electronic Information Systems - there is no objective specifically focused on integrating information systems.

There was a strong recommendation to move this section to the first part of the chapter. The group emphasized that this section drives the other objectives. The group specifically recommended that objectives 14.10, 14.11 and 14.14 should be the first three objectives of the Chapter. In addition, a paragraph should be added to the section introduction to emphasize that data is not just collected for data's sake but rather for data to be used.

In Objective 14.11 the suggestion was made to emphasize in the wording that a state plan needs to be based on a state level assessment (rather then just a community assessment).

For Objective 14.12 information will be forthcoming from ASTPHLD on improved wording to clarify what is meant by an essential set of laboratory services.

There was discussion on Objective 14.13 about what the phrase "comprehensive epidemiological services" means; CSTE will be submitting further definition and clarification of this phrase.

There was a specific suggestion to add an objective to increase the number of state health data centers. There was also discussion as to whether this objective applied just to health departments or to others providing public health service. Some participants also remarked that this objective more closely resembled a goal. In Objective 14 there was discussion about what happened to the core functions of assessment, policy development, and assurance and a tie to the ten essential public health services.

The group did not have sufficient time to specifically discuss Objectives 14.15, 14.16 and 14.17.