Assessment in Public Health: Thoughts, Ideas and Discussion

2. Assessment in Public Health:Thoughts, Ideas and Discussion Dennis Lenaway, PhD, MPH Director, Office of Standards and Emerging Issues in Practice Office of Chief of Public Health Practice Centers for Disease Control and Prevention October 28, 2005

3. ANTHRAX BIOTERRORISM Flu West Nile Virus SMALLPOX SARS Monkeypox Hurricanes

4. Are We Ready for Challenges of the 21st Century? • Aging population • Increasing diversity • Escalating health costs • Changes in access to health care services • Health disparities • Global threats • Terrorism • Epidemic effects of chronic diseases

5. Why do Assessments? • Even if you’re on the right track, you’ll get run over if you just stand still. - Will Rogers

6. 3 Core Functions(1988 IOM report) • Assessment • Policy Development • Assurance

7. 10 Essential Public Health Services • Enforce laws and regulations • Link people to needed services / assure care • Assure a competent workforce • Evaluate health services • Research • Monitor health status • Diagnose and investigate • Inform, educate, and empower • Mobilize community partnerships • Develop policies and plans

8. 1. Monitor Health to Identify and SolveCommunity Health Problems • Accurate, periodic assessment of the community’s health status. • Surveillance Systems • Utilization of methods and technology (e.g., GIS) to interpret and communicate data • Population health registries

9. 2. Diagnose and Investigate Health Problems and Hazards in the Community • Timely identification of health threats (assessment?) • Case investigation protocols • Availability of diagnostic services • Guidelines for handling specimens • Response plans to address major health threats

10. Without assessment and planning, where do you end up?

11. The BIG Picture Assessment is part of a larger effort to determine where we are, where we want to go, and how we are going to get there …and did we actually arrive?

12. The Basics Assess Impact Analysis Action Plan

14. Agency Community National LHA Profile Futures Initiative National Surveys Accreditation Preparedness Credentialing Program Impacts NPHPS MAPP Preparedness PACE-EH

15. National Public Health Performance Standards

16. To improve the quality of public health practice and performance of public health systems by: Providing performance standards for public health systems and encouraging their widespread use; Engaging and leveraging national, state, and local partnerships to build a stronger foundation for public health preparedness; Promoting continuous quality improvement of public health systems; and Strengthening the science base for public health practice improvement. Performance Standards Vision and Goals

17. Four Concepts Applied in National Performance Standards 1.Based on the 10 Essential Public Health Services 2. Focus on the overall public health system 3. Describe an optimal level of performance 4. Support a process of quality improvement

18. The Assessment Instruments • State public health system • Local public health system • Local governance

19. Mobilizing Actionthrough Planning and Partnership

20. Mobilizing for Action throughPlanning and Partnerships (MAPP) • Community strategic planning tool • Developed by NACCHO and CDC • Development began in 1996, released in 2001 • Web-based tool – www.naccho.org

21. The MAPP Model

22. Performance Improvement • Performance improvement at all levels: • Organization, System, and Statewide • Collectively discuss scores and results • Refer to comments and ideas generated during the assessment • Identify priority areas to address • Collectively develop strategies to address priorities

23. Four components of a performance management system Source: Turning Point Performance Management Collaborative, From Silos to Systems: Performance Management in Public Health (in press).

24. CDC’s Futures Initiative

25. CDC’s Futures Initiative Input ideas implementation Impact

26. Outside-In Process Partner Groups and Organizations Interviews Discussion Groups Our Customers, the American People CDC’s Stakeholders CDC Futures Initiative Focus Groups E-mail Feedback HHS, Policymakers, Congress CDC Staff Futures Web site

27. CENTERS FOR DISEASE CONTROL AND PREVENTION Then CDC WASHINGTON OFFICE OFFICE OF GLOBAL HEALTH OFFICE OF THE CHIEF OPERATING OFFICER OFFICE OF WOMEN’S HEALTH OFFICE OF COMMUNICATION OFFICE OF HEALTH AND SAFETY OFFICE OF THE DIRECTOR OFFICE OF EQUAL EMPLOYMENT OPPORTUNITY OFFICE OF MINORITY HEALTH OFFICE OF EXECUTIVE SECRETARIAT OFFICE OF PROGRAM PLANNING AND EVALUATION OFFICE OF GENOMICS AND DISEASE PREVENTION OFFICE OF SCIENCE POLICY AND TECHNOLOGY TRANSFER OFFICE OF CHIEF OF STAFF NATIONAL CENTER ON BIRTH DEFECTS & DEVELOPMENTAL DISABILITIES NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION & HEALTH PROMOTION NATIONAL CENTER FOR ENVIRONMENTAL HEALTH NATIONAL CENTER FOR HEALTH STATISTICS NATIONAL CENTER FOR INFECTIOUS DISEASES NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL NATIONAL CENTER FOR HIV, STD, AND TB PREVENTION NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY EPIDEMIOLOGY PROGRAM OFFICE NATIONAL IMMUNIZATION PROGRAM PUBLIC HEALTH PRACTICE PROGRAM OFFICE

29. CDC Today OFFICE OF CHIEF SCIENCE OFFICER OFFICE OF THE CHIEF OPERATING OFFICER OFFICE OF CHIEF OF PUBLIC HEALTH PRACTICE CDC WASHINGTON OFFICE OFFICE OF THE DIRECTOR OFFICE OF STRATEGY & INNOVATION OFFICE OF CHIEF OF STAFF OFFICE OF ENTERPRISE COMMUNICATION OFFICE OF EQUAL EMPLOYMENT OPPORTUNITY OFFICE OF WORKFORCE & CAREER DEVELOPMENT GLOBAL HEALTH TERRORISM PREPAREDNESS & EMERGENCY RESPONSE ENVIRONMENTALHEALTH & INJURY PREVENTION HEALTH INFORMATION & SERVICES HEALTH PROMOTION INFECTIOUSDISEASES NCIPC NCIPC NCHS NCHPDP NCHPDP NCID NCID NIOSH NCEH NCEH NCHM NCHM NCBDDD NIP NIP NCPHI NCPHI NCHSTP NCHSTP

31. GOALS MANAGEMENT Assessment of Evidence Input Mission Feasibility Comparative Impact Goals Health Impact Evidence-based action plan Accountability & responsibility assignments Resource allocation Performance Management

32. Strategic Imperatives • Health Impact • Customer-focus • Public Health Research • Leadership in the nation’s health system • Increased focus on Global Health • Effectiveness and Accountability

33. New Strategic Goals Preparedness: All people in communities will be protected from infectious, environmental, and terrorist threats. Health promotion and prevention of disease, injury, and disability: All people will achieve their optimal lifespan with the best possible quality of health in every stage of life.

34. National Surveys

35. Leading Causes of Mortality (2001) * (number of deaths) Source: National Center for Health Statistics, National Vital Statistics Report 2003.

36. Actual Causes of Death (2001) Tobacco (435,000)* Poor diet/Lack of exercise (400,000) Alcohol (85,000) Infectious Agents (75,000) Pollutants/Toxins (55,000) * (number of deaths) Motor Vehicles Crashes (43,000) Firearms (29,000) Sexual Behavior (20,000) Illicit Drug Use (17,000) Percentage of all deaths Source: Mokdad AH, Marks JS, Stroup DF, and Gerberding JL. Actual Dauses of death in the United States, 2000. (Submitted to JAMA)

37. Agency Accreditation

38. Implementation Broad Buy-in Accreditation of Public Health Agencies Accreditation Incentives for Participation Building Broad Buy-in Implementation Questions State and Local Agency Standards Partnership Development Other Accreditation Programs State PH Accred. Standards Program NPHPSP Operational Definition of a LPHA Growing Interest (IOM Recs., NACCHO Res.)

39. Voluntary Peer- Controlled Incentivized Based on Foundations Already Laid Accreditation of Public Health Agencies Principles

40. No matter how much assessment and planning there is, some things don’t change….

41. Subject: software for Husband 1.0 Dear Tech Support, Last year I upgraded from Boyfriend 5.0 to Husband 1.0 and noticed a distinct slow down in overall system performance particularly in the flower and jewelry applications, which operated flawlessly under Boyfriend 5.0. In addition, Husband 1.0 uninstalled many other valuable programs, such as Romance 9.5 and Personal Attention 6.5, and then installed undesirable programs such as NFL 5.0, NBA 3.0. and Golf Clubs 4.1. Conversation 8.0 no longer runs, and Housecleaning 2.6 simply crashes the system. I've tried running Nagging 5.3 to fix these problems, but to no avail. What can I do? Signed, Desperate

42. Dear Desperate: First keep in mind, Boyfriend 5.0 is an Entertainment Package, while Husband 1.0 is an Operating System. Please enter the command: http://www.ithoughtyoulovedme.html/ and try to download Tears 6.2 and don't forget to install the Guilt 3.0 update. If that application works as designed, Husband 1.0 should then automatically run the applications Jewelry 2.0 and flowers 3.0. But remember, overuse of the above application can cause Husband 1.0 to default to Grumpy Silence 2.5, Happy Hour 7.0, or Beer 6.1. Beer 6.1 is a very bad program that will download the Snoring Loudly Beta. Whatever you do, DO NOT install Mother-in-law 1.0 (it runs a virus in the background, that will eventually seize control of all your system resources).

43. Also, do not attempt to reinstall the Boyfriend 5.0 program. These are unsupported applications and will crash Husband 1.0. In summary, Husband 1.0 is a great program, but it does have limited memory and cannot learn new applications quickly. You might consider buying additional software to improve memory and performance. We recommend Hot Food 3.0 and Lingerie 7.7. Good Luck, Tech Support

44. Achieving Health Impact

45. Office of Chief of Public Health Practice WEBSITE: www.cdc.gov/od/ocphp