PUBH

Intro to public health

Prevention and Public Health Fund

The Affordable Care Act established a new source of funding for public health known as the

increase available resources

Prevention and Public Health Funds have been used to replace rather than

policing and from expectations that government would serve individuals unable to provide for themselves

Historically, states had authority over health through

Public health workforce

The individuals involved in carrying out the core functions and essential services of public health

definition of public health worker.

Estimating the size of the public health workforce is challenging because of uncertainties about the

2000s

There's been a decline in the governmental public health workforce since

2008 economic recession

Further reductions in the public health workforce was influenced by the

291,000

How many governmental public health workers were identified in the 2014 enumerations

50%

What percentage of the 2014 workforce works in local, settings?

30%

What percentage of the 2014 workforce works in state settings?

20%

What percentage of the 2014 workforce works in federal settings?

Whites

The workforce is majorly made up of

22%

What percentage of the PH workforce intends to leave for retirement?

25%

What percentage of the PH workforce intends to leave for other reasons?

41%

What percentage of the PH workforce intends to leave ?

Public health physicians (116k)
Physician assistant (76k)
Agency leadership (71k)
Nurse (64k)
Nutritionist (59k)

The five highest paid public health workers are

14%

What percentage of the PH workforce has formal education?

30%

What percentage of the PH workforce have advanced degree?

5%

What percentage of the PH workforce has a doctoral degree?

25%

What percentage of the PH workforce has a masters degree?

37%

What percentage of the PH workforce has a bachelors degree?

15%

What percentage of the PH workforce has an associate degree?

18%

What percentage of the PH workforce has no college degree?

front line entry level staff,
program management and supervisory level staff
senior management/executive level positions

What are the three levels in public health workforce?

Budget and financial management (55%)
systems and strategic thinking (49%)
Vision for healthy community (45%)
Change management (43%)
cross-sectoral partnerships (38%)
cultural competency (31%)
Data for decision-making (28%)
Effective communication (18%)

Cross Cutting Skills Training Needs as Reported in PHWINS 2017 Survey are

promoting shared priorities with an integrated approach

According to the CDC, PH workforce and public health can benefit by

Data for decision
crosscutting competencies
quality standards for training
training decision tools and access
funding integration

The five shared priorities by the CDC

the Beaumont Foundation, ASTHO, + > 30 national public health members associations, federal agencies & other partners

The PH WINS survey was developed in 2013 by

the National Consortium for Public Health Workforce Development

The PH WINS survey is known as

2014, 2017, 2021

The PH WINS survey was fielded in

The PH WINS survey

The only nationally representative source of data about the governmental public health workforce is

To help health agencies understand workforce strengths, gaps, and opportunities to improve skills, training and employee engagement
To inform and guide future workforce research and development (Retention and recruitment efforts)
To support the workforce in modernizing their traditional public health roles to meet the evolving needs of the public
To identify demographic trends and their implications for the workforce

All of the following are The PH WINS survey goals

Insufficient pay (46%)
Lack of advancement (40%)
Workplace environment (31%)
Job satisfaction (26%)
Lack of support (26%)
Creativity and innovation
Communication between staff and leadership

What are the motivations to leave the workforce and their percentages?

Access needs
Communicate value
Equip future leaders

The PH community must improve its ability to

Health equity (85%)
The quality of social systems (75%)
K-12 system (63%)
Quality of housing (59%)
Economy (56%)
Built environment (55%)
The quality of transportation (53%)

PH agencies should get involved in

to promote and provide for general welfare and to regulate commerce

The historic role of the federal government in PH system is

providing incentives and or withholding funding on state and local programs

The role of the federal government changed after 1935 by

Medicare and Medicaid programs

After 1965, the federal government emerged as major purchaser of health care through

the mid-1800s.

The first state health department was founded in Massachusetts in

1911

First county health department created in Washington State in

The Department of Health and Human Services, including CDC and seven other Public Health Service Agencies

What is the principal agency for protecting the health of all Americans?

more than ¼

What portion of the total federal budget is spent on health?

10%

What percentage of the total federal budget is spent on public health?

10% since 2010

The funding for the CDC has declined over?

The office of the of the Surgeon General

Who oversees the operations of the 6,000 member Commissioned Corps of the U.S. Public Health Service?

The office of the of the Surgeon General, under the Office of the Assistant Secretary for Health

Who is the nations doctor and where are they housed?

To articulate the best available scientific information to the public regarding ways to improve personal health and the health of the nation
To advise the Assistant Secretary on public health crises as needed

All of these are the duties of the Surgeon General

1946 in Atlanta, GA

The CDC was formed as a vision of Dr. Joseph Mountain (past surgeon general) in

in controlling communicable disease outbreaks

The CDC was founded to support state and local health units

near Emory University

The CDC was originally built in 1947

main epidemiological and assessment agency for the nation.

The CDC is the

publishes Morbidity and Mortality Weekly Report

The CDC

Center for Health Statistics that collects data on U.S. population concerning all aspects of health

The CDC is the

Xavier Becerra

Who is the current secretary of health?

Vivek Murthy, MD

Who is the current surgeon general?

Rochelle Walensky

Who is the current CDC director?

4.0 trillion

What is the total federal outlay for 2017?

591 billion

What is the net federal medical outlays for 2017?

Social security(23%)
Medicare (15%)
Nondefense (15%)
Defense (15%)
Medicaid and other insurance (11%)
others (14%)
Net interest (7%)

Total federal spending for 2017 are

Medicare (644,827)
Medicaid (418,681)
Discretionary programs (97,167)
Children's entitlement programs (33,564)
TANF (16,502)

The department of health and human services budget for FY 2019 is

Chronic disease (1.187)
HIV, hepatitis, STD, TB (1.132)
PH preparedness/response (857)
immunization (798)
injury prevention (648)
Emerging/zootonic infection (620)

Majority of the CDC's enacted budget for 2019 was on

29, 21 , umbrella organization

In 2016, _ state public health agencies were freestanding while _ were a unit of a larger combined state health and human services agency, referred to as an

27

How many states have a decentralized or largely decentralized LHD- Local government led and retain authority over most fiscal decisions?

14

How many states have a largely centralized governance structure- State retains authority over most fiscal decisions

5

How many states have a mixed governance system in which state employees lead some local health departments while locals lead others?

4

How many states have a shared governance system in which state or local government employees lead local health?

Coordinate activities of local health agencies and provide funding
Collect and analyze data
Laboratory services
Manage Medicaid
License and certify medical personnel, facilities, and services
Environment, mental health, social services, and aging may be handled by separate agencies

The following are functions of State Health Departments

Data collection, epidemiology and surveillance
Population based primary prevention services (tobacco, HIV, STDs)
Laboratory services
Maternal and Child Health Services

The following services are frequently provided by state agencies

$84

The median per capita expenditure of state health department in 2016 was

federal (48%)
state (36%)
fees (6%)
NGO (10%)

The source of capita expenditure of state health department in 2016 was

local health agencies in the US; more than 2500

Who are the boots on ground in the US and how many are there?

62% serve small jurisdictions < 50,000 people
33% serve jurisdictions between 50,000-499,000 people
6% serve jurisdictions with more than 500,000 people.

What is the distribution of local health agencies by population?

69% serve single counties
8% serve multi-counties
20% serve cities or towns
3% serve multiple cities and towns.

What is the distribution of local health agencies by location?

$48; a decrease of 24% since 2008

What was the median per capita expenditure of local health department in 2016?

local (30%)
state (21%)
federal funds passed through state (17%)
federal funds directed to local agency (17%)
Medicaid or Medicare (12%)
fees and fines (8%)

The major sources of funding for local health department are

147,000

Total full-time equivalent (FTE) employees for local health department in 2016 was

8 (< 25,000)
27 (

Median number of FTEs for local health department per serving populations was?

the effectiveness of Local Health Departments

Uneven distribution of staff and funding (cut since 2008) across urban and rural areas is a major challenge to

consolidation of agencies
cross jurisdictional sharing of services
basic minimum set of PH services to be provided

To strengthen the capacity of LHDs, public health leaders have considered the following

Communicable disease control
Chronic disease and injury prevention
Environmental public health
Maternal, child, and family health
Access to and linkage w/clinical care

The following are the foundational areas of LHD

Assessment
All hazards preparedness/response
Policy development/support
Communications
Community partnership development
Organizational competencies

The following are the foundational services/capabilities of LHD

leadership/governance
health equity
accountability/performance management
financial management
legal

Organizational competencies include the following

Communities
the health care delivery system
employers and business
the media
academia

The following are NGOs and Non- Health Related Governmental Agencies in Public Health

to identify ways to improve policy decisions in multiple sectors
promoting job stability
improving neighborhood safety
increase transportation options

Goals of health in all policies are

the power and duty of the state to ensure the conditions for people to be healthy and the limitations on the state's power to constrain autonomy, privacy, liberty, and proprietary interests of individuals and businesses

Gostin (2000) defines public health law as

Constitutionally based law - Right to bear arms; Freedom of Speech
Legislatively based law - EPA, FDA
Administratively based law (AKA rules and regulations)- Smoking bans
Judicially based law - Roe v Wade

Types of laws in the US and examples

state

Most public health laws are enacted and enforced at what level of government?

regulate interstate and international commerce and to provide for the general welfare

The U.S. Constitution gives the federal government the authority to

Healthcare system

all aspects of the overall organization, financing, and provision of personal healthcare services (medical care for individuals) for the prevention and treatment of disease, illness, and injury in the United States.

Healthcare delivery system

specific groups of healthcare providers (doctors, hospitals, clinics, etc.) within the U.S. healthcare system that are responsible for providing healthcare to the populations they serve.

Individual (patient)
Relationship (healthcare team)
Community (health system infrastructure)
Societal (healthcare policy)

The four level model of the US Healthcare system are

CDC
NIH
HRSA
AHRQ
FDA

What are the HHS agencies

Centres for Medicare and Medicaid services

Which service is responsible for Medicare, Medicaid, and CHIP?

IOM
AMA
PCORI

The nongovernmental scientific and professional organizations are

Employer-provided
Charity care
Public clinics for communicable diseases
Community health centers
Medicare and Medicaid (passed in the 1960s)
Children's Health Insurance Program (CHIP)

The US insurance programs include

20%

What percentage of the 65 US population is uninsured?

2010

The Affordable Care Act was passed in

Everyone over 65 is eligible plus younger people who are disabled

Medicare is part of the social security system and is meant for _

Part A: hospital insurance
Part B: voluntary, monthly premium; covers doctor bills and other outpatient costs
Part D: Prescription drug plan (started in 2006).

The parts of Medicare are

federal and state governments

Medicaid is a welfare program for the poor and its cost is shard by _