Improving Public Health’s Infrastructure:

the Key to Improved Health Outcomes

Dennis Lenaway, PhD, MPHOffice of Public Health Systems Performance

Centers for Disease Control and Prevention

July 17, 2009

Health Care Crisis + Public Health Crisis

Aging Population

Re-emerging Diseases

Emerging Diseases

Obesity

Health Disparities

Access to Quality Health Care

Health Insurance Costs

Uninsured and Underinsured

Health Reform and Public Health

“Simply put, in the absence of a radical shift towards

prevention and public health, we will not be

successful in containing medical costs or improving

the health of the American people”

President Barak Obama

Health Reform and Public Health

“Public health is also essential to health reform. As

the nation’s lead prevention agency, CDC will play

a role to establish a health care system that is

more accessible, more cost-effective, and more

accountable”

Dr. Thomas Frieden

CDC Director

2006 U.S. National Health Expenditures

31%

31%

8%

13%

7%

7%3%

Hospital Care

Physician/ProfessionalServicesNursing Home andhome healthPrescription drugs andmedical productsAdministration

Research andInvestmentGovernment publichealth (prevention)

“The public health infrastructure has suffered from neglect…”

Institute of Medicine 2003

“Currently, serious gaps exist in the nation’s ability to safeguard

health…The country does not devote the resources needed to

adequately help prevent disease and protect the health of

Americans” TFAH “Shortchanging America’s Health” 2008

“Public health is chronically underfunded in the US. There is

currently a shortfall of $20 billion per year in spending on public

health” TFAH “Blueprint for a Healthier America” 2008

Question: Can Public Health fully deliver

on the “Promise of Prevention”?

Strong Recommendations from

the Institute of Medicine (2003)

• “Accreditation mechanisms may help to ensure the robustness

and efficiency of the governmental public health infrastructure,

assure the quality of public health services, and transparently

provide information to the public about the quality of the

services delivered.”

• “The performance standards (NPHPSP) effort is seen as one

way to help move the state and local components of the

nation’s public health system closer to the system envisioned

in the Future of Public Health IOM report (1988).”

And Strong Recommendations from

the Trust For America’s Health (2008)

“Today our public health system is not held as accountable as it should be for health outcomes, or for how taxpayers’

public health dollars are spent.”

“CDC should develop incentives and provide support for states and localities to pursue accreditation.”

“CDC would require a significant increase in resources both to manage its federal leadership role on accreditation and to fund PHAB and health department activities directly related to achieving accreditation…A special infrastructure grant…would require its own dedicated resources.”

Improving Accountability and Performance

of Public Health: Support from CDC

Setting Agency Standards Public Health Accreditation Board

Setting System Standards National Public Health Performance Standards Program

Engaging with Communities MAPP

Managing our Resource Portfolio Senior Management Officials

Strategic Management Agreements

Leadership and Workforce Development NPHLI, Regional Institutes, PHAP, I-Lead, Certification

Public Health Accreditation Board

Goal

Improve and protect the health of the public by

advancing the quality and performance of State,

local, and tribal public health departments

“The establishment of a voluntary national accreditation program

is desirable for many salient reasons. Chief among them is

the opportunity to advance the quality, accountability and

credibility of governmental public health departments”

Exploring Accreditation Project Steering Committee (2007)

“If you’re not keeping score, you’re just practicing"

Why Accreditation?

Strengthening systems,

improving the public’s health

• Mobilizing – community engagement

• Action – implementation of a Health

Improvement Plan

• Planning – built on strategic planning

concepts

• Partnerships – the public’s health is more

than the concern of the health department

Portfolio Management Program

PMP Priorities

Shared Leadership Dialogue and collaboration at an

executive level between CDC and it’s

public health partners

Alignment of CDC Goals Integration of CDC’s Health

Protection Goals to drive

performance, supporting continued

investment relevant to health impact

Improved Business

Services

Enhance efficiencies and encourage

increased flexibility in the use of CDC

funding without compromising

agency accountability

Leadership Development

NPHLI and Regional Leadership Institutes

EH and Lab

NACCHO’s “Survive and Thrive”

Competencies for Public Health professionals

Credentialing and certification

National Board of Public Health Examiners (2005)

Existing programs in nursing, EH, laboratories

Leadership and Workforce Development

Workforce

Development

Resource Management(SMO & SMA)

Community Engagement

(MAPP)

Public Health System(NPHPSP)

Public Health Agency(PHAB)

Improving Infrastructure for

State and Local Public Health Agencies

Accreditation

+

PH System

+

Community

Partners

+

Resources

+

Workforce

Performance and Accountability Framework

For Public Health

Operational

Capacity

(infrastructure)

Every

Community

Program and

Public Health

Activity

(Chronic Disease,

Inf Disease, EH)

Better Health

Outcomes

Reduced

Disparities

Better

Preparedness

Builds Impacts

Which

leads

to

Investments here Pay big dividends here

“If you want to travel fast, go alone.

If you want to travel far, go together."

Old African Proverb

“OK Fellas, we shoot first…. then Q and A”

Building Public Health Infrastructure

for a Healthier America