# Presentation: 729494

## Focus Area 23:Public Health InfrastructureProgress ReviewRichard J. KleinNational Center for Health StatisticsApril 16, 2008

## 	Public Health Infrastructure--the resources needed to deliver essential public health services to every community

- 	Public Health Infrastructure--the resources needed to deliver essential public health services to every community

**Public Health **
**Response**

**Epidemic**
**Investigation**

**Surveillance**

**Laboratory**
**Practice**

**Workforce**
** ****Capacity & **
**Competency**

**Information**
**& Data**
** ****Systems**

**Organizational**
**& Systems**
**Capacity**

**Basic**
**Infrastructure**

**Essential **
**Capabilities**

- SOURCE: Public Health Foundation

**Notes:**
Pyramid-shaped graphic with Basic Infrastructure at base (with workforce capacity and competency, information and data systems, and organizational and system capacity) at base.  Next level is essential capabilities (with surveillance, laboratory practice, and epidemic investigation) in the middle, and public health response at the peak of the pyramid.

## Highlighted Objectives

**23-2.****	****     Access to information on health indicators**
**23-4.****	****     Data for all population groups**
**23-6.****	****     Objectives tracked at least every three years**
**23-7.****	****     Data release within one year of collection**

**Highlighted Objectives**

**Organizational & systems capacity**

**23-12. ****	****     Health improvement plans**
**	****a. Tribal**
**	****b. State **
**	****c. Local**
**	****d. Local linked to state**

**Workforce capacity & competency**

**23-11.       Performance standards**

- Improving

- Little or no progress*

- Note: *Percent of targeted progress achieved is between -10% and 10%.

- No data

- Baseline only

**Notes:**
Highlighted objectives with colored dots indicating status.
23-2 Access to information on health indicators, baseline only
23-4  data for all population groups, improving
23-6 objectives tracked at least every three years, little or no progress
23-7  data release within one year of collection, little or no progress
23-11 performance standards, improving
23-12 health improvement plans
Tribal, no data
State, baseline only
Local, little or no progress
Local linked to State, baseline only

## Examples of Access to Information

**Obj. 23-2**

**13.1**

**Examples of Access to Information**
**on Health Indicators**

- SOURCE: CDC, NCHS

_**Federal **_
**	**
_**Tribal **_**	**
_**State**_
**	**
_**Local**_

**Community Health Profile (Minnesota, Michigan, and Wisconsin Tribal Communities, Great Lakes EpiCenter)**

**Notes:**
Logos associated with web sites for federal, tribal, state, and local health indicator data.

## Community Health Status Indicators (CHSI)

**Mission: provide information on community health**
**More than 200 measures for each of the 3,141 U.S. counties**
**Peer counties based on population density, population size, poverty rate, and age distribution**
**Healthy People 2010 targets shown where applicable**
**Cooperative effort**
**Federal: Health Resources Services Administration, Centers for Disease Control and Prevention, National Library of Medicine **
**Foundations: Public Health Foundation and Robert Wood Johnson funds**
**Endorsed broadly**

**Obj. 23-2**

**Community Health Status Indicators (CHSI)**

## CHSI Peer Counties

**CHSI Peer Counties**

**Prince William County**

**Anne Arundel County**

**Obj. 23-2**

**Notes:**
Map showing counties in the DC area, with Anne Arundel County, MD and Prince William County, VA, highlighted.

## CHSI Peer Counties

- Lower than peer counties (median)
- Higher than peer counties (median)

**CHSI Peer Counties**

**Obj. 23-2**

**Notes:**
U.S. map with peer counties (of Anne Arundel Co, MD) in blue, with graphic showing selected causes of death for Anne Arundel, its peers, the US rate, and the Healthy People target.

## Minimum Template for Population-Based Objectives

**Race:****	****	****	****	****	****Socioeconomic Status:**
- American Indian or Alaska Native only		     **Family Income Level**
- Asian or Pacific Islander only
-      Asian only				     Poor
-      Native Hawaiian or Other Pacific Islander only	     Near poor
- Black or African American only			     Middle/high income
- White only
- 2 or more races
-      American Indian or Alaska Native; White		***or***
-      Black or African American; White
**Hispanic origin and race:**			     **Education Level**
- Hispanic or Latino
- Not Hispanic or Latino		          	      Less than high school
-     Black or African American		          	      High school graduate
-     White				          	      At least some college
**Gender:**
- Female
- Male

- Source:  Healthy People 2010, November 2000

**Obj. 23-4**

## Data Quality and Completeness

**2007**

**Data Quality and Completeness**

- Note: Baseline for 23-4 and 23-6 is 2004; 23-7 baseline is 2000.
- SOURCE:  DATA2010, Health Promotion Statistics Branch, NCHS

**Obj. 23-4, 23-6, & 23-7**

**Released w/in 1 year of collection**

**Tracked at least every three years**

**Data for all pop groups**

**26**

**49**

**65**

**2010 Target: 100**

**Percent**

**0**

**80**

**100**

**60**

**40**

**20**

**Notes:**
Bar graph showing increase for three measures related to data quality and completeness -- data for all pop groups, objectives tracked at least every three years, and data released within one year of data collection.

## Use of National Public Health Performance Standards: State Public Health Systems 

**9**

**Obj. 23-11a**

**2007 **

**Use of National Public Health Performance Standards: State Public Health Systems **

**2004**

**2010 Target: 35**

- Note: The PHPS are used by local and state public health systems as a tool in comprehensive health improvement initiatives, bioterrorism preparedness planning and other efforts. PHPS are considered to be a benchmark for public health practice.
- SOURCE:  National Public Health Performance Standards Program, CDC, Office of the Chief of Public Health Practice.

**18**

**Number**

**Six percent (n=1) of the 18 states that used the Public Health Performance Standards in 2007 met the standards.**

**Notes:**
Bar chart showing nine states using National Public Health Performance Standards in 2004 and 18 in 2007.

## Use of National Public Health Performance Standards: Local Public Health Systems

**Use of National Public Health Performance Standards: Local Public Health Systems**

- LPHS that participate in the PHPS program
- LPHS that do not participate in the PHPS
- program

- Public Health Performance Standards Met
- Public Health Performance Standards not met

**12%**
- N=273

**36%**
- N=98

**N = 2,315 LPHS**

**N = 273 LPHS**

_**2004**_

_**2007**_

**2010 Targets = 50**

**N = 2,315 LPHS**

**N = 469 LPHS**

**20%**
- N=469

**46%**
- N=214

- Note: The PHPS are used by local and state public health systems as a tool in comprehensive health improvement initiatives, bioterrorism preparedness planning and other efforts. PHPS are considered to be a benchmark for public health practice.
- SOURCE:  National Public Health Performance Standards Program, CDC, Office of the Chief of Public Health Practice.

**Obj. 23-11b and d**

- LPHS that participate in the PHPS program
- LPHS that do not participate in the PHPS
- program

- Public Health Performance Standards Met
- Public Health Performance Standards not met

**Notes:**
Pie charts showing 12% of Local Public Health Systems participating in the PHPS program, and 36% of those meeting the PHPS in 2004.  For 2007, 20% of LPHS participating, 46% of those meeting.

## Implementation of a Health Improvement Plan: State and Local Health Agencies

**Implementation of a Health Improvement Plan: State and Local Health Agencies**

**Percent**

- Note: The Healthy People 2010 target will be determined by the Healthy People 2010 Steering Committee, at a later date.
- SOURCE:  State, Association of State and Territorial Health Officials (ASTHO) and Local, National Profile of Local Health Departments (NACCHO)

**Obj. 23-12b-d**

**States with a Health Improvement Plan (2007)**

**Local Agencies with a Health Improvement Plan (2005)**

**Local Plans linked with State Health Improvement Plans (2005)**

**56**

**54**

**37**

**2010 Targets: TBD**

**Notes:**
Bar chart showing 56% of States have a Health Improvement in 2007, 54% of Local agencies have a Health Imrpovement Plan, and 37% have local plans linked with the State Health Improvement plan.

## Public Health Infrastructure Objectives

***Information and data systems***

- 23-2. Access to information on health indicators
- 23-3. Geocoding in major health data systems
- 23-4. Data for all population groups
- 23-6. Objectives tracked at least every three years
- 23-7. Data release within one year of collection

***Workforce capacity & competency***

-  23-8.   Core competencies in job descriptions
-        	a. Tribal      b. Local
-  23-9.   Core competencies: public health curricula
-  23-10. Continuing education
-           	a. Tribal      b. State      c. Local
-  23-11. Performance standards used
-               a. State       b. Local
-  23-11. Performance standards met
-               c. State       d. Local

***Organizational & systems capacity***

- Getting worse

- Baseline only

- Objectives 23-1, 23-5, and 23-16 were deleted at the Healthy People 2010 Midcourse Review in 2005.
- Note: *Percent of targeted progress achieved is between -10% and 10%.

- 23-12. Health improvement plan
-   a. Tribal        b. States      c. Local
-   d. Local linked to State
- 23-13. Public health laboratory services
-   a–k.
- 23-14. Epidemiology services
-   a. formal training
-   b. Tribes       c. States      d. Local
- 23-15. Evaluation of public health laws
-   a. Turning Point
-   b. Emergency Powers
- 23-17. Population-based prevention
- research

- No data

**Notes:**
Graphic showing the status of the non-highlighted PHI objectives.

## All retained objectives are at least partially measurable 
Access to information on health indicators available at national, Tribal, state, and county level
Data timeliness and completeness improved
Participation in the National Public Health Performance Standards Program improved for state and local public health systems.
Tribal data collection improving – challenges remain 
Future: Developing and refining PHI measurement in    Healthy People 2020

**All retained objectives are at least partially measurable **
**Access to information on health indicators available at national, Tribal, state, and county level**
**Data timeliness and completeness improved**
**Participation in the National Public Health Performance Standards Program improved for state and local public health systems.**
**Tribal data collection improving – challenges remain **
**Future: Developing and refining PHI measurement in    Healthy People 2020**

## Acknowledgements

**Tamyra Carroll Garcia****	**
**Public Health Analyst**
**CDC/National Center for Health Statistics**
**tuc6@cdc.gov**
**Susan Schneider**
**Public Health Analyst**
**CDC/National Center for Health Statistics**
**sah4@cdc.gov**
- Contributors:
- Nakki Price, CDC/OCPHP  	Beverly Smith, HRSA
- Liza Corso, CDC/OCPHP*** ***		Christopher Barrett, HHS/ODPHP
- Joan Cioffi, CDC/OWCD*** ***		Ellis Davis, HHS/ODPHP
- Elizabeth Jackson, CDC/NCHS	Jeff Pearcy, CDC/NCHS

## http://www.cdc.gov/nchs/hphome.htm

**Progress review data and slides**
**are available on the web at:**

**http://www.cdc.gov/nchs/hphome.htm**