The Future of Franklin County Public Health

The Future of Franklin County Public Health

September 30, 2013

Our Public Health Story

The success or failure of any government in the final analysis must be measured by the well being of its citizens. Nothing can be more important to a state than its public health; the state’s paramount concern should be the health of its people.

Franklin D. Roosevelt

Purpose of Today’s Meeting

• The Value of Public Health• Driving Forces – Challenges &

Changes• Financial Picture• Our Vision for the Future• Next Steps – Asking for your input

What is a Health Department?

• General Health District – Townships and Villages

• City Health District – At least 5,000 population – can contract

Governed by a Board of Health

• General Health District

– 5 members appointed by District Advisory Council (DAC) – 5 year term

• Must have a Physician • Must have a Licensed Entity represented

Franklin County Public Health

• Serves 435,999 citizens in 17 townships, 14 cities and 9 villages

• Is the 6th largest health district in Ohio

• Has 65 employees

Our Public Health Story

What is Public Health? Prevention

• The child who didn’t get whooping cough

• The restaurant that served safe food and didn’t make people ill

• The creek for canoeing that wasn’t contaminated with sewage

Our Public Health StoryThe Value of Public Health

Many national studies show:

• While medical care can prolong survival and improve prognosis for disease, it doesn’t address the disease upstream (prevention)

• U.S. health spending is mostly on medical care

• Spending more on public health results in measurable improvements in health

Our Public Health Story

For every 10% increase in local public health spending, you get:

• 3.2% decrease in Heart Disease deaths per 100,000 population (800 Ohioans)

• 1.4% decrease in Diabetes deaths (50 Ohioans)

• 1.1% decrease in Cancer deaths (280 Ohioans)

G. Mays, S. Smith. Health Affairs, 2011; 30 (8) 1585-1593

Our Public Health Story“Prevention delivers real value as a cost-effective way to keep Americans healthy and improve their quality of life. Everyone wins when we prevent disease rather than treating people after they get sick. Health care costs go down, our local neighborhoods are healthier and provide more economic opportunity, and people live longer, healthier, happier lives.”

J. Levi, Trust for America’s Health

Our Public Health Story

What is Public Health?

• The only resource in our communities responsible for the health of everyone (not just those who choose us)

• Controlling the factors that individuals can’t control, that control health

Our Public Health Story

Driving Forces

• National Public Health Trends

• 2 Critical Reports driving change in Ohio

• Regionalization, Consolidation, Mergers

• Public Health Accreditation

Driving Forces - TrendsNational Public Health Trends

• “Sinks and Toilets” (and vaccines) in the 20th century improved life expectancy and quality of life

• More sophisticated issues requiring more specialized workforce

• Use of technology

• Economic and social stressors

Driving Forces - ReportsPublic Health Futures: Consideration for a New Framework for Local Public Health in Ohio

• Local public health capacity, services and quality

• Jurisdictional structure

• Financing

• Implementation

Association of Ohio Health Commissioners (AOHC), June 2012

Public Health Futures - June 2012

Core Public Health Services

• Environmental Health

• Communicable Disease Control

• Epidemiology

• Birth and Death Records

• Health Promotion and Prevention

• Emergency Preparedness

• Linking People to Health Services

• Community Engagement

Public Health Futures - June 2012

Foundational Capabilities• Quality Assurance

• Information Management & Analysis

• Policy Development

• Resource Development

• Legal Support

• Laboratory Capacity

• Support & Expertise for community engagement strategies

Driving Forces - Reports

Legislative Committee on Public Health Futures (Am.Sub.H.B. 487)

• Recommendations for legislative and policy changes to include in the 2014-2015 state biennium budget

October 2012

Driving ForcesRegionalization, Consolidation, Mergers

• Both Reports:– do NOT recommend population requirement for

consolidation– do NOT recommend forced consolidation– DO recommend feasibility studies to address local

conditions, sustainable funding and core services– DO recommend to continue current trend toward

voluntary consolidation and shared services

• Franklin County & Columbus?

Driving Forces

Public Health Accreditation• Voluntary recognition by a credible body

– the Public Health Accreditation Board (PHAB) – for meeting a set of national public health standards

• New – introduced in 2011

• MANDATORY for local health departments in Ohio to continue receiving funds

(2018-2020)

Our Future State

We envision that: • We are rooted in strong community

engagement.

• We have strong public health promotion, education and community health nursing to achieve “winnable battles”.

• We have healthy homes and neighborhoods through environmental health.

Our Future State

We envision that: • We are supported by adequate resources

and capabilities that align with community need and public health science.

• That we all reap the benefits of measurable improvements in health, well-being and prosperity for every community we serve.

Our Financial Picture

2013 Total Budget - $ 7,194,932

Townships, Villages, Cities - $ 2,446,258

Contract Cities »$5.93 per capita

Townships & Villages »Property valuation (inside millage)

Our Financial Picture2013 Budget – Revenues by Category

Administration, Environmental & Nursing Funds Only

Con-tract

Cities, Town-ships

and Vil-lages41%

Inter-gov-ern-

mental11%

Con-tract Re-

ceipts19%

Charges for Ser-vices2%

Licenses & Permits27%

Our Financial Picture

2013 Budget – Expenditures by Category

Personal Services

52%

Fringe Bene-fits23%

Materials & Services

25%

Capital Outlays & EquipmentLess than 1%

Our Financial Picture

Local Health Department Expenditures per Capita – 2010

• For the U.S. overall, the median per capita expenditure for local health departments was $41

• Ohio had a median per capita expenditure of $33

• Franklin County Public Health had a per capita expenditure of $16.50

Our Financial PictureStrengthening Public Health in Franklin County: A Proposal to Fund Core Public Health Services

• Additional Annual Investment needed - $3.00 per capita ($1,308,000)

• Franklin County Public Health would increase to a per capita expenditure of $19.50, still $13.50 below the Ohio median of $33

October 2012

Summary

Public Health delivers real value as a cost-effective way to keep people and communities healthy and productive.

Franklin County Public Health is an exceptional value – we are already a model for shared services.

Summary

We want to continue the mission of public health in the communities we all serve

and . . .

We need your help to acquire the resources to accomplish our mission

Next Steps

We need to hear from you…

• Questions / Comments about today

• Electronic Survey in October

• Planning Session in early 2014

Next StepsElectronic Survey

• One per jurisdiction

• Your choice who or how you complete survey

• Questionnaire will be sent by e-mail from Saperstein Associates, subject line: FCPH Survey

• Will not require you to open an attachment

• Will take no longer than 10 minutes to complete

Thank You!