By Steven J. Huleatt, MPH, RS, Director of Health, West Hartford-Bloomfield (CT) Health District
The Evolving Landscape of Local Public Health Preparedness
The 21st century in local public health has presented challenges and opportunities. The early years of this new century have been the “best of times and the worst of times.” During the start of the century, local health departments became involved in public health preparedness planning, training, and exercising to respond to public health threats from natural or manmade events. Some were saying the time of science fiction about public health threats had now emerged into science fact. Passenger planes were used as weapons of destruction, and ordinary mail became a vector to deliver morbidity and mortality into businesses and even people’s homes. On a national level, a branding of local public health based upon prevention, promotion, and protection was established.
The need to prepare for threats of the reintroduction of diseases of the past such as smallpox into an unprepared and unprotected population produced projections of morbidity, mortality, and disruption to all. Congress acted swiftly in providing funding for Public Health Emergency Preparedness (PHEP) and the Hospital Preparedness Program to build capacity, competency, and capabilities to respond to and mitigate the threats to the public’s health. The addition of new staff and skills into the public health system increased the capacity and the competency at local health departments of all sizes across the country. Local health departments were trained in the proven practice of incident command at local, regional, state, and federal levels of government. The healthcare system was tasked to prepare to extend beyond its capacities and prepare for mass casualties and medical surge by opening alternative care facilities. The need for local health departments and the healthcare system to work together to prepare for, respond to, and recover from public health threats evolved, and funding objectives began to align.
Conducting exercises and drills and reporting on real events have become the norm in the new century. Local health departments are expected to evaluate their responses to identify areas for improvement and improve the effectiveness and efficiency of plans. Real events such as SARS and novel H1N1 have challenged local health departments and the healthcare system. Through dutiful surveillance, the next challenges of MERS CoV and H7N9 are being thoughtfully monitored through a global lens. This new century has humbled most parts of the country with forces of nature such as swift and violent tornadoes, bone-chilling cold, excessive drought, wind-driven wildfires, devastating floods, or ferocious hurricanes. Climate change has communities using resources to recover and to harden their infrastructure for the future.
The Growing Health Disparity Gap in Local Public Health and Healthcare Systems
While preparedness planning and response activities were increasing, a growing health disparity gap remained. The burden of chronic disease was increasing. The healthcare system needed resources to care for insured and uninsured populations. Individual states began to make systemic changes to the way they would provide and fund Medicaid programs. On the national level, some were concerned about the direction of Medicare. The cost of chronic disease increases were demonstrated to be an issue of health equity attributable to social factors or social determinates of where people lived, race or ethnicity, work, level of education, and income. The evaluations of exercises and real events identified the emergency health concerns for persons living independently in a community with access or functional health needs. National branding of local health departments to prevent, promote, and protect reflected local health departments’ priorities to engage in public health preparedness, reduce the incidence and prevalence of chronic disease, and increase the health equity for all in the community. Opportunities to do so exist. For example, communities with populations with access or functional needs could benefit from a public health approach to addressing the needs of these populations to reside independently as long as practical and to be prepared in case of a real threat event. The movement toward electronic health records and claims databases could provide planning data for the nature and severity of health access and functional needs in a community in relative real time. Planning for shelters to know the potential number of wheelchair- or oxygen-dependent guests to expect would add to the quality of the experience for guests and shelter workers.
Affordable Care Act and the Intersection of Public Health Preparedness and the Healthcare System
The Affordable Care Act (ACA) is another new 21st century requirement that will affect both local health departments and the healthcare system. The ACA is most publicly noted for providing access to health insurance through state or federal health insurance exchanges. The ACA also provides the inclusion of the Community Benefit Provisions incentives. These provisions reflect an assumption that implementation will decrease the need to provide uncompensated charity care to uninsured patients. Non-profit hospitals have traditionally used uncompensated care to qualify for tax-exempt status with the Internal Revenue Service. Many local health departments and their communities have participated in a Community Health Needs Assessment (CHNA). The CHNA is a requirement of the Community Benefit Provisions. The ACA and PHEP may bring opportunities to local health departments, local hospitals, and their communities in new ways through improved communications, shared health data, and development of community health improvement plans. Local health departments and hospitals can share their capacity and competency to develop community health improvement plans.
The current challenges and opportunities in the ACA and PHEP provide a mechanism for local health departments to change how they work with the healthcare system to communicate about population health, share data, and plan to improve the health of the public. Demonstrating community benefit through working together to improve wellness visits to persons with access or functional needs could be critical to those individuals through preventing unnecessary risks in their homes, promoting healthy behaviors, and in protection during a response to a real public health threat. Demonstrating community benefit through working together to address social determinant barriers to health equity will give the whole community the opportunity to be healthy and safe.
This article was originally published in NACCHO Exchange. To read the entire issue, download the newsletter from NACCHO’s online bookstore. (Login required).