Orienting Local Boards of Health to Population Health Strategies: A Training Resource

8/10/2016 2:00 PM - 4:00 PM

Orienting Local Boards of Health to Population Health Strategies: A Training Resource

Phyllis Meadows, PhD, MSN, RN, Associate Dean for Practice, Office of Public Health Practice, University of Michigan School of Public Health
Phoebe Goldberg, MPH, CHES, Program Manager, Michigan Public Health Training Center, Office of Public Health Practice, University of Michigan School of Public Health

That boards of health bring together leaders from across disciplines is one of their greatest strengths. For this reason, however, it is necessary to ensure that new members receive training in foundational public health concepts. Doing so will enable the board to most effectively draw upon the expertise of its members to impact population health strategies and outcomes. This session will introduce a training resource designed to equip new board of health members with a basic understanding of public health and provide them with practical suggestions for supporting the work of local public health agencies and their leadership. Governance in Action for Public Health was designed by the Michigan Public Health Training Center at the University of Michigan School of Public Health in partnership with the Michigan Public Health Institute. The 7-module online series draws upon the Six Functions of Public Health Governance and includes short recorded segments, examples from the field, optional discussion topics, and suggested resources. This session will provide an introduction to the course as a tool for board of health orientation, demonstrate several of the modules, and provide an opportunity to discuss the training needs of new and experienced board of health members.

1.1. Evidence in Action: How to choose effective strategies

8/11/2016 10:30 AM - 11:15 AM

1.1.  Evidence in Action: How to choose effective strategies
Alison Bergum - County Health Rankings & Roadmaps, Madison, WI

Congratulations!  You’ve completed your community health assessment, identified areas to focus your efforts toward improving health in your community, and you’re ready to get started. But how do you identify the policies and programs that are going to make a difference? With evidence ratings, literature summaries, and implementation resources for over 350 policies and programs, What Works for Health (WWFH) is a great starting place to find ideas to address your community’s priorities. In WWFH,trained research analysts systematically assess, summarize, and rate evidence of effectiveness for policies and programs that can affect the many factors that influence health, including health behaviors, social and economic factors,clinical care, and the physical environment. In-depth information for each policy and program will help you understand the specific outcomes it has been shown to change, who to bring to the table to move forward, and the effect implementation might have on health disparities in your community.

In this session, we’ll explore WWFH, the criteria used to assign evidence of effectiveness ratings, and how to think about these ratings to select an approach for your community. We’ll also discuss evidence in decision making more broadly, tackling thorny questions such as what to do if there is no evidence to be found, what to consider when innovating, and how to know if a policy or program is a good fi for your community. You’ll have a chance to explore along with us bring your laptop, tablet, or smart phone.

1.3. Mumps Mayhem in the Midwest: A Partnership between Public Health and a University to Address an Outbreak

8/11/2016 10:30 AM - 11:15 AM

1.3.  Mumps Mayhem in the Midwest:  A Partnership between Public Health and a University to Address an Outbreak
Julie Pryde - Champaign-Urbana Public Health District, Champaign, IL

According to the Centers for Disease Control and Prevention, in recent years there has been a significant resurgence in the number of outbreaks related to vaccine-preventable diseases. Local Health Departments, all across the nation, are already dealing with a variety of emerging and reemerging health concerns/issues such as Ebola, Avian Flu, multidrug-resistant Tuberculosis, drug resistant Sexually Transmitted Diseases (STDs), and others.

In spring of 2015, the Champaign Urbana Public Health District (CUPHD) - a mid-sized health department in Illinois and home to one of the big ten universities, faced a similar situation, in the form of a large outbreak of Mumps (140 cases as of September 28th 2015).  This was further exacerbated by the impending financial crisis of the State of Illinois. A budget impasse for the current fiscal year meant shrinking, if not termination, of many health related services and programs. Furthermore, a sizeable percentage of incoming students to the University of Illinois at Urbana Champaign for the summer and fall semester meant a larger risk of compounding the outbreak. 

This presentation will discuss the challenges and opportunities of the Local Health Department, in collaborating with the University Health Center and the State Health Agency to devise a plan to mitigate and control the spread of mumps. This included convincing the Centers for Disease Control and Prevention (CDC) to recommend a third dose of the Measles, Mumps and Rubella (MMR) vaccine as a best management practice to get a firm handle over the outbreak. We will also share our experience in working with conservative University officials to plan and implement a co-staffed mass vaccination clinic which would be responsible for administering more than 10,000 vaccines over five days. We will discuss the logistics of implementing a strict exclusion policy for all exposed students and an aggressive marketing campaign. All of these strategies finally lead to a sustained dip in the number of new cases. The financial impact of dealing with this outbreak is estimated at more than $1 million and counting, which during a looming State Budget crisis imposes a huge burden on the Health Department. Finally, we will also discuss the potential of a failed MMR vaccine and some recommendations for the Federal Agencies, including but not limited to, revisiting the composition and constitution of the Mumps component of the MMR vaccine.

2.1. Mind the Gaps: Engaging Communities Through the County Health Rankings & Roadmaps Health Gaps Report

8/11/2016 11:30 AM - 12:15 PM

2.1.  Mind the Gaps:  Engaging Communities Through the County Health Rankings & Roadmaps Health Gaps Report
Marjory Givens - County Health Rankings & Roadmaps, Madison, WI

Not everyone in the U.S. has the means and opportunity to be their healthiest. Within each state across the country, there are meaningful differences in health outcomes according to where people live, learn, work, and play. The County Health Rankings & Roadmaps Health Gaps Reports explore the size and nature of gaps in the factors we know influence health and illustrate the avoidable differences among counties in the opportunities for residents to be healthy.  To build on the initial dialogue sparked by the Health Gaps Reports, CHR&R is developing resources and tools to engage multiple stakeholders.

This presentation will focus on tools to support dialogue among community residents, policymakers and other community leaders as well as strategies to engage media that spur conversation, aid framing and messaging, and help build a campaign to close gaps.

2.3. A Board Governance Conundrum: Legalized Marijuana

8/11/2016 11:30 AM - 12:15 PM

2.3.  A Board Governance Conundrum:  Legalized Marijuana
Thomas Fawell - Board of Health, Tri County Health Department, Greenwood Village, CO

As states deal with the question of marijuana, both medical and recreational, local Boards of Health are faced with puzzling problems regarding the health consequences of its use, as well as challenges entailed in addressing a myriad of related issues.  The governance role of policy decisions and oversight will be examined, as well as possible strategies for the future.

3.1. Using Science and the Variance Process to Protect the Public's Health

8/11/2016 1:45 PM - 2:30 PM

3.1.  Using Science and the Variance Process to Protect the Public's Health
Gary Edwards - Salt Lake County Health Department, Salt Lake City, UT

Many boards of health have a legislative responsibility, namely adopting local public health regulations. Adopting a regulation should be a deliberative process, taking into account scientific data balanced with input from the affected public. Despite a thorough process, very few regulations can account for all contingencies, especially considering constant scientific updates, technological advances, and the ingenuity of people. Such was the case in Salt Lake County, Utah, where the Board of Health had adopted a comprehensive swimming pool regulation only to be approached by a “temporary pool” event organizers, something that was never considered when adopting the regulation. This makes very clear the need for a well-defined variance process so the Board of Health can respond appropriately to the public while maintaining a focus on the public’s health. This session will review the process used by the Salt Lake County Board of Health to address recent requests for variance, the challenges encountered, and successes realized.

3.3. Lessons Learned From Indiana's HIV Outbreak

8/11/2016 1:45 PM - 2:30 PM

3.3.  Lessons Learned From Indiana's HIV Outbreak
Carrie Lawrence - Rural Center for AIDS/STD Prevention IU School of Public Health-Bloomington, IN

Injection drug use continues to pose public health, economic and social problems throughout the US. The recent HIV outbreak in a southern Indiana county exposed a myriad of both political and systems issues which continuously challenge effective interventions to address health disparities. While recent state policy interventions were developed to directly address public health consequences associated with injection drugs, Hepatitis and HIV, they created new roles of local health departments to institute harm reductions strategies including syringe exchange programs without additional resources for implementation. Localities weakened by policy history of property tax capitation continue to  fall short in building local capacity that strengthens local infrastructure for policy intervention adoption.  Issues of social stigma among and across sectors related to HIV and injection drug use, as well as rural-urban divisions permeate and challenge collaboration.  In spite of these challenges, local health departments have increasingly recognized such shortfalls and have developed innovative ways to engage in new partnerships and cross sector collaborations through engagement of diverse local and outside organizations.  These new collective efforts have leveraged existing and uncovered new resources for the development and implementation of programs and public goods. Ultimately, such efforts will construct and/or redesign local public  health institutions that will effectively address complex health and ongoing social determinants associated with injection drug use, HIV and Hepatitis C.

4.1. Position Papers As a Tool For Policy Change

8/11/2016 2:45 PM - 3:30 PM

4.1.  Position Papers As a Tool For Policy Change
Douglas Beardsley - Johnson County Public Health, Iowa City, IA
Michael McLaughlin - Kirkwood Community College, Cedar Rapids, IA

Policy Development is one of the major responsibilities of a Board of Health.  In Iowa, Local Boards of Health are empowered to address public health issues within their jurisdiction.  Issues which clearly originate in or affect the Boards jurisdiction are generally straight forward.  However, many policies which directly and substantially affect the health of populations within a Boards jurisdiction, are set by state or federal bodies.  Local Boards, therefore, must wrestle with how to address those issues while operating within their scope of responsibility. 

The Johnson County Board of Health has adopted a number of position statements on various issues of public health concern over the past several years, as a way to guide local action while at the same time advocating for policy development at higher levels of government.  Well-researched statements, making use of best practices and sound science, can be powerful tools to empower staff action, educate and support the efforts of other policy makers, and act as a template for other Boards of Health and public health advocates.  This presentation will review the Boards history and process for adoption of position statements and examples of how statements addressing issues such as raw milk, electronic cigarettes, HUD policies and fluoridation, to name a few, have helped shape local, State and National policies.

4.3. Improve Your Response by Building Closed POD Networks

8/11/2016 2:45 PM - 3:30 PM

4.3.  Improve Your Response by Building Closed POD Networks
John Anthony - St. Louis County Department of Public Health, St. Louis, MO
David Reddick - Bio-Defense Network, St. Louis, MO
Harlan Dolgin - Bio-Defense Network, St.  Louis, MO

Learn how St. Louis County became the most prepared county in the country to deal with a bioterrorism event.  The County now covers 75 percent of its population of one million with Closed Points of Dispensing, (Closed PODs). This session will offer insights into a winning program designed to recruit Closed POD hosts and how to maintain them after an entity has agreed to partner with you.    Working together starting in 2011, the county and Bio-Defense Network reached out to the largest employers in the area to enroll them as Closed POD hosts, explaining the benefits and making the process easy to understand and to comply with.  The partnership conducted kickoff meetings with employers, did follow-up with those who expressed interest, created a comprehensive workbook for Closed POD representatives and established a periodic evaluation process to assure the PODs could activate and operate in the event of a bio-terrorism attack to the area.  A national study conducted in 2015 by Saint Louis University reported that fewer than half of the nation’s health departments believe they will be able to fully staff the Open Points of Dispensing needed to adequately serve their community in the wake of a bio-terrorism attack.  That points to the importance of creating or expanding Closed POD networks.

5.1. Affordable Care Act: Examining Policies and Implementation with State and Local Health Departments

8/12/2016 9:30 AM - 10:15 AM

5.1.  Affordable Care Act: Examining Policies and Implementation with State and Local Health Departments
Michael Meit - NORC at the University of Chicago, Bethesda, MD
Amy Nevel – Office of the Assistant Secretary for Planning and Evaluation, US Department of Health & Human Services, Washington, DC

NORC is conducting the study of the Affordable Care Act: Examining Policies and Implementation with State and Local Public Health Departments for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the Department of Health and Human Services (HHS). The study examines how expanded insurance coverage and enhanced access to clinical preventive services changes how individuals seek care, shifts where preventive services are obtained, and affects the role of state and local health programs. The study seeks to identify how health departments are responding to ACA-related changes and the anticipated future changes to public health practice.   

Project activities include an environmental scan, case studies using both site visits and telephone interviews, and ongoing consultation with a Technical Advisory Group (TAG). Qualitative data were collected via interviews with staff from ten state health departments (SHDs) and select local health departments (LHDs) in case study states. Researchers held discussions with the state health officer, program staff, Medicaid staff, and LHD staff. Participating states varied in terms of geography, provision of clinical services, population served, and Medicaid expansion status.   Findings show that health departments are seeing reductions in client volume for some public health programs (e.g., immunizations, breast and cervical cancer screening) and respondents believe it is a result of ACA insurance expansion. While all case study states are expanding their capacity to bill for services, they report that billing is unlikely to fully replace program revenue should program funds be reduced. Many respondents discussed that some health departments may need to continue providing preventive services, especially in areas where there is an insufficient number of providers. While concerned, health departments are also looking at new, unique opportunities within the ACA, including expanding billing capabilities and partnering with accountable care organizations.   Health department leaders expressed concern that reduced utilization of key public health services may make it difficult to sustain programs seen as important to maintaining the public's health. Further, they note that the resulting loss of revenue could have additional impacts on health department functions and response capacity. NORC is providing voice to state and local public health leaders concerns about the impacts of the ACA, while also capturing strategies for program planning, sustainability, and adaptation.

5.3. Tackling Tobacco Use Among the Underserved, Overlooked and Addicted: A Basic Duty of Public Health

8/12/2016 9:30 AM - 10:45 AM

5.3.  Tackling Tobacco Use Among the Underserved, Overlooked and Addicted:  A Basic Duty of Public Health
Kerry Cork - Public Health Law Center / Tobacco Control Legal Consortium, St. Paul, MN
Cheryl Sbarra - Massachusetts Association of Health Boards, Plainville, MA

Tobacco products have a disparate health impact on our most vulnerable populations:  those suffering from mental illness or substance use, as well as the young, the elderly, and the socioeconomically disadvantaged.  The tobacco industry targets these populations in a variety of ways (such as promoting products in locations and at prices that are particularly appealing to the most susceptible groups).  One of the basic roles of local boards of health (and public health governance in general) is to protect public health and to ensure health equity for all community members particularly those whose health is most at risk.

This presentation by two seasoned tobacco control attorneys will look at a spectrum of underserved and overlooked populations that are disproportionately addicted to tobacco.  The presenters will describe state and local challenges in addressing tobacco use by these groups, and will provide examples of several policy solutions that public health authorities, such as boards of health, might consider. The presenters will focus throughout on public health roles, functions and responsibilities regarding tobacco control and health equity.

6.1. Board of Health's focus on the CDC's 6 public health threats focus for 2016

8/12/2016 10:45 AM - 11:30 AM

6.1.  Board of Health's focus on the CDC's 6 public health threats focus for 2016
Christina Dokter - Ingham County Board of Health, Lansing, MI
Nancy Terwood - Premier Health, Cincinnati, OH

CDC listed the following as health threats to focus on for 2016: Ebola, antibiotic resistance, global health security, smoking and tobacco use, prescription drug overdose, and lab safety. We will expand on these 6 issues and how we as Board of Health members can play a role in mitigating these health threats. We will present at least three issues for discussion and in-depth exploration.

6.3 The Local Board of Health Toolkit

8/12/2016 10:45 AM - 11:30 AM

6.3  The Local Board of Health Toolkit
Drew Beckett, MPH - Bourbon County Health Department
Brandi Gilley, MPH, RDN, LD- Laurel County Health Department
April Harris, MPH, CHES - Three Rivers District Health Department

A group of local health department professionals from Kentucky saw a need to help educate local boards of health as part of a Public Health Leadership Institute project.  What we developed is an easy to use resource for both Local Health Department directors to help train their boards and for board members themselves to gain knowledge.  We included PHAB accreditation resources, state laws related to public health, curriculums for boards, and resources to help health department directors educate board members.  We believe the basic template and/or outline is something that could be used as a model nationwide to help local boards of health.