“It Takes A Region: the West Central Public Health and Environment Collaborative,

1. “It Takes A Region: the West Central Public Health and Environment Collaborative, “An innovative approach to public health practice” Peg Mewes, Director, Montrose County Health and Human Services Richard Thompson, Environmental Health Official, West Central Region

2. Delta * Gunnison* Hinsdale * Montrose * Ouray * San Miguel

3. About the region… • 9,569 sq miles of mostly mountainous terrain, much of which is public lands, on Colorado’s western slope • A rural, frontier region, population 93,440 • Region wages 67.3% of state av. with % of poverty higher than state • Region has highest number of uninsured in the state • Largest producer of coal (45.8% of coal mined in Co.) and increasing in oil and gas production • Tourism extremely important to region. Two major ski resorts and year round recreational and outdoor activities abound • Montrose County, most populous, regional trade center and agricultural hub • Delta County has the only health department in the region

4. West Central Region population by year and county, 1990-2005 • Region grew 52.2%, a rate of increase higher than the state in that time period (42.9%)

5. The beauty of it all…

6. Fall 2005, the growing problem… • A challenged public health and environment infrastructure • Growing population with largest number of uninsured in the state • Aging public health workforce (50% over age 50) and lack of qualified human resources to replace • Strained and inadequate financial resources • Healthy People 2010 priorities addressed based on funding and not good community assessment and strategic planning • Inadequate Environmental Health resources

7. The Colorado Trust… Mission: The Colorado Trust is dedicated to advancing the health and well-being of the people of Colorado “Colorado’s public health system is widely decentralized…This scattered system, combined with the continuing decline of federal, state, local public health budgets, has increased the need for the on-going coordination and provision of essential public health services. Weaknesses in the public health infrastructure, compromise the ability to protect Coloradoans from emerging health threats… The Colorado Trust 2005 annual report p. 15

8. The Opportunity…Fall 2005, The Colorado Trust’s Partnerships for Health Initiative “The Colorado Trust’s eight year (2005-2013) $8.6 million Partnerships for Health Initiative is designed to help improve the coordination of health services at the community level.”

9. Gunnison County takes the lead • Grant written Nov. 2005 for $10,000 six (6) month planning grant. Awarded by The Colorado Trust in Dec. 2005 • The goal: to initiate discussions regionally to address how to make the best use of existing and future resources and how to work together to assess our community and share resources to address all Healthy People 2010 focus areas and public health performance standards • Healthy People 2010 focus area #23 Public Health Infrastructure was chosen

10. Jan. 24, 2006 Gunnison County BOCC hosts regional BOCC representatives and county administrators. Public Health and Environment staff from the six counties and CDPHE local liaison staff also attend. Facilitation provided by The Trust. Results: Unanimous decision to move forward with strategic planning.

11. ““Strength is derived from unity. The range of our collective vision is far greater when individual insights become one.”Andrew Carnegie Successive meetings of the EH and PH staff in the six counties define: • The mission, vision and values of the Partnership • The role of the Partnership coordinator and organizational structure • The Intergovernmental Agreement • “Employees” of the Partnership • The strategic plan, collaborative ideas into goal areas

12. West Central Public Health PartnershipMission The mission of the West Central Public Health Partnership is to build and strengthen public health and environment infrastructure by identifying and implementing collaborative projects that benefit the counties of Delta, Gunnison, Hinsdale, Montrose, San Miguel and Ouray

13. West Central Public Health PartnershipVision We envision a public health partnership that protects the people and environment in our six county region, promotes health and prevents disease, resulting in optimal health for all our citizens as our region grows and becomes more diverse.

14. Criteria for projects • Must have some degree of benefit to all six counties • Must be measurable • Must be demonstrated best practices and/or evidenced based • Must not ultimately add to the current work load of the individual counties • Must be realistic and attainable

15. How do we meet the goal areas of the strategic plan In July 2006, Gunnison County received the Implementation grant from The Colorado Trust for the region to complete the strategic plan. $187,500 over two and a half years with additional $187,500 grant to follow for additional 2 ½ years

16. Goal areas of the strategic plan • Formalization of the regional partnership • Development criteria and initiate regional health assessment • Prevention and decreasing the incidence of food borne illness • Maximize public health resources for pandemic planning

17. Goal #1: Formalization of the Partnership Accomplishments: • An IGA (Intergovernmental Agreement) was signed by the BOCC in each of the six counties • Partnership coordinator job description was written and coordinator for the Partnership hired • Operating guidelines for the Partnership

18. Goal #2: Regional Health Assessment Accomplishments: • Indicators to be assessed and tracked for the regional health assessment were identified • Staff obtained • First regional health assessment was completed December 2007

19. Goal #3 Improve safe food preparation practices in retail establishmentsAccomplishments: • Expanded Partnership to include CSU Extension Service and developed available, consistent food safety classes in each county throughout the region. Classes available in English and Spanish • Hired regional EH official and purchased regional equipment for EH

20. Goal #4 Maximize Pandemic Planning resourcesAccomplishments: • Regional pandemic planner hired to assist counties in completing phase 1 and scope of work as outlined in the pandemic planning contract to each county

21. Challenges • Geographic and weather related travel to meetings • Time away from the office, especially for the agencies with one staff • Not all counties benefit equally from all projects • Communication is slower • All six counties are not equally invested in the Partnership • Greater need in some counties • Implementation of SB 194

22. Accomplishments • All six counties met their emergency preparedness deliverables within the timelines as required. • Successfully completed community needs assessment with comparable data for the six counties against the region and the state.

23. Accomplishments • Determined indicators that need additional research, and Colorado School of Public Health is taking the lead. • Have been able to produce cost effectiveness data related to services being provided throughout the region.

26. Regional EH, Accomplishments • Regional Environmental Health official hired part time and progressed to full time with additional part time staff • Food safety classes in each county • Regional radon testing and education • School chemical safety awareness and monitoring

27. Public Health Revitalization SB 08-194 What are the Personal Health and Environmental Health requirements for a local Public Health Agency? Colorado BOH has not announced what these are. Expectation is that it may provide for a ranking or assessment for phasing in Personal Health and Environmental Health Services. The required and Optional Services profiles from 1984 may provide a clue.

28. EH Accomplishments continued • Equipment purchased for use within region laptop, GPS devices, indoor air quality equipment, etc. • Partnership developed with septic haulers regionally. The first Wastewater/Biosolids conf. held • Regional consumer protection contracts and agreements • Additional EH capacity and support for all counties in the region when needed

29. New Partnerships… • Consideration to contract for services between the counties to meet the SB-194 public health and environmental health service requirements. • Will “Director” qualifications require increased requests for waivers or can regional partnerships expand to provide shared directorship or districts formed?

30. CORE BELIEFS A competent, qualified, functioning health department consist of Public Health Nursing and Environmental Health collaborating together with support from specialized state support functions such as Epidemiology. Public Health delivered in this way saves $$$. Delivery of services is best done when conducted at a local level. Cost savings at the local level for counties to cooperate and still retain many of the benefits of local services. Enables smaller counties to have services and expertise not otherwise available.

31. The Future… • Regional Educational/Marketing campaign to educate region’s population on results of assessment and indicators needing improvement. • Regional Public Health Educator to address chronic disease prevention, injury prevention, marketing, and collaborative grant projects. • Build relationship with Colorado School of Public Health as means of keeping regional assessment indicators current and updating assessment annually to show trends and emerging issues. • Environmental Health planning, regional contracts. • Build on baseline assessment of Public Health and Environmental Health infrastructure, programs and funding in preparation for SB194 implementation. • More structure for the Partnership for long-term stability of public health and environmental health regional services.

32. “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”Margaret Mead, Am. Anthropologist