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Summer 2012 Vol. 4, No. 4
Sustaining and Increasing the Benefits of Public Health
Public health is the practice of preventing disease and promoting good health within groups of people, from small communities to entire countries. In the current economic environment, public health seeks to improve its effectiveness and efficiency to produce a sustainable health system.
Public health professionals work to prevent population-wide health problems through educational programs, policies, services, regulation of health systems and some health professions, and research. In contrast, clinical professionals, such as doctors and nurses, focus primarily on treating individuals after they become sick or injured. The dramatic achievements of public health in the 20th century have improved our quality of life, increased life expectancy, reduced infant and child mortality, and eliminated or reduced many communicable diseases.
A strong public health infrastructure to prepare for and respond to both acute (emergency) and chronic (ongoing) threats, protects the nation's health. To become more coordinated, efficient and effective, public health must identify and sustain “core” services; increase adherence to national public health standards; coordinate among health departments and other sectors, especially health care; stabilize funding for basic infrastructure and core services; and explore shared services.
A series of Institute of Medicine (IOM) reports from 2010 to 2012 highlight leverage points to improve the public health system and explore its integration with primary care to improve population health. In the April 2012 report For the Public's Health: Investing in a Healthier Future, the IOM identifies “essential ingredients” to renew the public health system:
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Adequate and sustainable funding for governmental public health;
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Reform of governmental public health infrastructure and operations to align spending with need; and
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Using public health knowledge to help improve delivery and quality of clinical care and integrate it with public health’s population-based efforts.
Public health organizations at the federal, state, tribal, local and territorial levels already are taking steps to increase effectiveness and efficiency. Through its National Public Health Improvement Initiative (NPHII), the Centers for Disease Control and Prevention supports improvements in 74 health departments’ systems, practices, and essential services. Early successes include:
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New Jersey’s faster reporting time for influenza test results from 2–3 weeks to 2–3 days;
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Tennessee’s strengthened public health data system for vital records; and
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Virginia’s consolidation of critical data measures from 119 public health system databases into one real-time user interface serving all offices.
Another effort, Voluntary Public Health Accreditation to improve quality and performance of public health departments, was launched in December 2011 supported by CDC and private funding. Efforts to integrate public health and health care are also becoming more prevalent as public health offers assets such as information on community health status, delivers economical and effective prevention, delineates evidence-based practice guidelines and assists individuals in making healthy choices. |
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Upcoming Events and NCSL Resources
The 2012 NCSL Legislative Summit in Chicago, August 6-9, will bring together some 6,000 men and women from all 50 states and around the world. This meeting will feature 160 sessions on every major issue being debated in state legislatures today. Legislators, legislative staff members, corporate representatives, unions, government officials, foundation members and others will discuss critical state issues, innovations, cost-saving measures and share ideas that shape the country.
NCSL's State Actions to Promote Healthy Communities and Prevent Childhood Obesity report summarizes state legislation enacted in two broad policy categories—healthy eating and physical activity, and healthy community design and access to healthy food.
Technical Assistance
NCSL can provide testimony to legislatures on chronic disease prevention; health promotion; preventing injuries and violence; reducing health disparities; access to health care; community health centers; and other health policy topics. Contact Alise Garcia at Health-info@ncsl.org.
NCSL Health Reform Database
NCSL continues updating its Federal Health Reform: State Legislative Tracking Database tracking the actions of state legislatures related to some of the major provisions in the Affordable Care Act. This database has been used by state legislators, legislative staff, the media and the public since it was launched in 2011. It includes both carry-over measures from 2011 legislative sessions and legislation introduced in 2012.
References
10 Essential Public Health Services
American Public Health Association’s “What is Public Health? Our Commitment to Safe, Healthy Communities”
Association of Schools of Public Health’s “What is Public Health?”
Healthy People 2020 – Public Health Infrastructure Chapter
Public Health Infrastructure Resources
CDC: Office for State, Tribal, Local and Territorial Support
National Public Health Performance Standards Program
National Voluntary Accreditation for Public Health Departments
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In the News
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, announced a call for proposals for grants to conduct health impact assessments (HIAs). HIAs identify and address potential health effects and make recommendations to improve health and inform policy decisions. More information, including frequently asked questions, details about eligibility, and other resources are available by clicking here. -July 2012
The U.S. Preventive Services Task Force (USPSTF) recently revised guidelines recommending that clinicians screen all adults ages 18 and older for obesity, and offer intensive, multi-component behavioral interventions for patients with a body mass index of 30 or higher. All new health plans under the ACA are required to provide coverage for obesity interventions recommended by the USPSTF. –Kaiser Health News July 2012
According to a study published in the Annals of Internal Medicine and conducted by officials from the New York City Department of Health and Mental Hygiene, diners have consumed 2.4 fewer grams of trans fats per lunch since 2008 when the city prohibited all restaurants from serving food prepared with partially hydrogenated vegetable oil or dishes that contain more than 0.5 gram of trans fat per serving. The study also shows that coffee shops, fast-food convenience locations and other eateries can play a major role in improving the public's health. -July 2012
On June 13, 2012, the U.S. Department of Health and Human Services released The National Prevention Council Action Plan outlining the commitment to implementing the vision, goal, priorities, and recommendations of the nation’s first ever National Prevention Strategy. These prevention efforts range from contributing to safe community environments and improving access to recreation areas to supporting safe and healthy workplaces—all actions intend to make health and wellness a part of everyday life for all. The National Prevention, Health Promotion and Public Health Council also released its annual status report highlighting the activities and accomplishments of the National Prevention Council between June 2011-June 13, 2012.
According to a study published in Pediatrics, citing CDC National Health and Nutrition Examination Survey data, approximately one in four U.S. teens ages 12-19 has type 2 diabetes or pre-diabetes, its precursor condition. The number increased from nine percent in 1999 to 23 percent in 2008. Overweight and obese teens are at increased risk for developing a number of cardiovascular risk factors. The study also found that normal weight teens have at least one cardiovascular risk factor. - June 2012
On May 8, 2012, the Institute of Medicine released a report, Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation estimating that the U.S. spends $190.2 billion each year on obesity related illnesses. Among its recommendations to make healthy choices routine, the report suggests a systems approach messaging strategies to strengthen obesity prevention efforts in the areas of physical activity, food and beverage, health care and work, and schools.
According to a study published in the American Journal of Preventive Medicine, "Obesity and Severe Obesity Forecasts through 2030," about $550 billion in U.S. medical expenditures can be saved over the next two decades if obesity rates do not rise. However, the study predicts that although increases in obesity are slowing, there may be 32 million more obese Americans by 2030. - May 2012
A report from the Trust for America’s Health and the Robert Wood Johnson Foundation, The Facts Hurt: A State-By-State Injury Prevention Policy Report, concludes that millions of injuries may be prevented each year if more research-based injury prevention policies, such as requiring bicycle helmets for children and prescription drug monitoring programs, were fully implemented; and teen dating violence laws enforced. –May 2012
The National Association for County and City Health Officials released a brief, Local Health Department Job Losses and Program Cuts: Findings from the January 2012 Survey, with self-reported data showing that in 2011, more than half of local health departments reduced or eliminated services in at least one program area. The survey found that clinical health services, emergency preparedness, and maternal and child health programs were cut. –May 2012
The interactive County Health Calculator map, designed by the RWJF and the Virginia Commonwealth University Center on Human Needs, can help policymakers create a customized snapshot of how income and education affect the health of constituents, including associated healthcare costs of diabetes and death rates. –May 2012
A study conducted by the U.S. Department of Agriculture, Are Healthy Foods Really More Expensive? It Depends on How you Measure the Price, shows that it is not necessarily cheaper to eat foods high in saturated fat, sugar and salt. When comparing the cost of foods by weight or portion size, instead of price per calorie, the study indicates that grains, fruits, vegetables and dairy items are less expensive than meats, food high in saturated fat, sugars or salt. – May 2012
A study published in Stroke, Dietary Sodium and Risk of Stroke in the Northern Manhattan Study, provides evidence for a strong relationship between excess sodium intake and increased stroke risk in a multiethnic population. –April 2012
In addition to the Robert Wood Johnson Foundation public health services and systems research (PHSSR) projects, a new online journal, Frontiers in Public Health Services and Systems Research, is being developed to speed dissemination of preliminary study results and quality improvement projects that address organization, financing and delivery of public health services, and highlights practice and policy relationships. –April 2012
Public Health Project Partner News
NCSL collaborates with the Centers for Disease Control and Prevention and other national organizations—including the National Governors Association, the Association of State and Territorial Health Officials and the Society for Public Health Education—on public health projects. Recent resources available from partner organizations on public health topics include the following.
According to ASTHO’s issue brief, The Economic Case for Health Equity, there are economic benefits when the health and business sectors comprehensively address health inequities in clinical, workplace and community settings to reduce racial and ethnic disparities in health. -June 2012
According to the CDC, whooping cough cases in the U.S. are rising to an epidemic level, the highest in more than five decades. Nearly 18,000 cases have been reported so far this year - more than twice the number seen at this point last year. At this pace, the number for the entire year will be the highest since 1959, when 40,000 cases were reported. In 2010, there were 27 whooping cough deaths in children younger than one year old. -July 2012
According to CDC’s Morbidity and Mortality Weekly Report, State Tobacco Revenues Compared with Tobacco Control Appropriations—United States, between 1998 and 2010, states received a combined total of nearly $244 billion in tobacco industry settlement payments and cigarette excise taxes, however they invested only $8 billion in anti-smoking and tobacco control programs. Money that wasn’t spent on tobacco control was used to pay general expenses or fund other programs. The 1998 Tobacco Master Settlement Agreement requires tobacco companies to reimburse state Medicaid programs for tobacco treatment costs. –May 2012
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