State & Local Health Departments Challenges & Opportunities

Transcription

1 State & Local Health Departments Challenges & Opportunities Judith A. Monroe, MD, FAAFP Deputy Director, Centers for Disease Control and Prevention Director, Office for State, Tribal, Local and Territorial Support March 28, 2011 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2 Factors that affect health Smallest Impact Largest Impact Counseling & Education Clinical Interventions Long-lasting Protective Interventions Changing the Context To make individuals default decisions healthier Socioeconomic Factors Examples Eat healthy, be physically active Rx for high blood pressure, high cholesterol, diabetes Immunizations, brief intervention, cessation treatment, colonoscopy Fluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax Poverty, education, housing, inequality

3 Public Health Achievements & Urgent Realities

4 Economic Climate Threatens Progression

5 Sources of Data 2010 ASTHO Profile Survey conducted by ASTHO, April-November 2010 Responses from 50 state health agencies, DC and 2 territories Complete financial data from 47 agencies Territories excluded for this analysis ASTHO Budget Cuts Survey Ongoing survey of budget cuts at state health agencies from July 2008 to present 5 waves of data, including August 2010 Responses from 50 state health agencies, DC and 4 territories

6 Sources of Revenue: State Health Agencies, FY 2009 Source: ASTHO Profile Survey, 2010

7 Per capita expenditures OR WA ID MT WY ND SD MN WI MI NY VT NH MA CT M E RI CA NV UT CO NE KS IA MO IL IN OH KY WV PA MD VA NJ DE DC AZ NM TX OK AR LA MS TN AL GA NC SC LEGEND <$50/person $50-$75/person AK FL $75-$100/person >$100/person Insufficient Data HI Shared Governance Centralized or Largely Centralized Source: ASTHO Profile Survey, 2010

8 Expenditures: State Health Agencies, FY 2009 Source: ASTHO Profile Survey, 2010

9 Budget Cuts Source: ASTHO Budget Cuts Surveys,

10 Budget Cuts -- Workforce Over 15,000 state health agency jobs lost Total of 37,000 jobs lost in state and local health agencies 17% of the workforce State health agency jobs in central offices 14,000 jobs or 20% of workforce Over a third of SHAs have imposed furloughs Almost 120,000 furlough days Equivalent to another 500 workers *Some positions may have been created with one-time ARRA, H1N1 or ACA funding. These data only include layoffs and positions that were lost due to attrition and were not filled due to budget cuts or hiring freezes.

11 Budget Cuts -- Programs Programs Disease-specific programs (e.g., heart disease, Parkinson s, Alzheimer s, tuberculosis, cystic fibrosis, asthma, epilepsy) HIV, AIDS and STDs 16 Tobacco prevention and control 15 Immunization 14 Teen pregnancy prevention 13 Public health hospitals and clinics 12 Workforce and quality improvement 12 Cancer programs 11 Family health and nutrition (including WIC) 10 Prevention programs (including health education and promotion) 10 Laboratory services 9 Number of agencies making cuts 16 Source: ASTHO Budget Cuts Surveys,

12 Per capita expenditures Mean Median All State Health Agencies $95.30 $76.16 Centralized governance $ $ Decentralized governance $67.23 $67.83 Free-standing, independent agency $ $84.25 Under an umbrella agency $80.00 $74.38 Source: ASTHO Profile Survey, 2010

13 Sources of Data on Local Health Department Finances National Profile of Local Health Departments Study Periodic survey of all local health departments (LHDs) in the U.S. Presenting data from 2008 Profile study 2010 Profile data are currently being analyzed Economic surveillance surveys Twice-yearly survey of LHD budget, staffing, and program cuts Began in Dec 2008; most recently completed in Feb 2011

14 Percentage Distribution of Total Annual LHD Revenues, by Revenue Source

15 Mean Percentage of Total LHD Revenues from Selected Sources, by Type of LHD Governance Source: 2008 NACCHO Profile of Local Health Departments

16 Percentage of LHDs with Budget Cuts ( ), Including and Excluding Government Assistance Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction ( ).

17 LHD Budget Cuts 2008 Percentage of LHDs with Lower Budget in December 2008 as Compared to Previous Year Late 2008: More than half of LHDs have budget cuts in 7 states Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (January 2009).

18 LHD Budget Cuts Percentage of LHDs with Lower Budget in July 2009 as Compared to Previous Year Mid-2009: More than half of LHDs have budget cuts in 20 states Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (July 2009).

19 LHD Budget Cuts Early 2010 Percentage of LHDs with Lower Budget in January 2010 as Compared to Previous Year, Excluding One-Time Funding such as ARRA or H1N1 Funding Early 2010: More than half of LHDs have cuts to core funding in 26 states Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (January 2010).

20 LHD Budget Cuts Late 2010 *Percentage of LHDs with Budget Decrease in late 2010 Compared to Previous Year, Excluding One-Time Funding Such as ARRA or H1N1 Funding WA MT ND ME OR ID WY SD MN WI MI NY NH MA VT CA NV AZ UT CO NM NE KS OK TX IA MO AR LA IL MS IN TN AL PA OH WV VA KY NC SC GA FL DE NJ MD CT LEGEND 0-25% 26-50% 51-75% % Insufficient data Late 2010: More than half of LHDs have cuts to core funding in 28 states Source: 2010 NACCHO National Profile of Local Health Departments survey.

21 Percentage of LHDs Losing Workforce Capacity in 2010, Overall and by Type Source: NACCHO Survey of LHD Workforce Reduction (January 2011).

22 Estimated Number of LHD Jobs Lost and Adversely Affected ( ) Total Jobs Lost to Layoffs or Attrition 7,000 16,000 6,000 29,000 Jobs Affected by Hours Reduced or Mandatory Furlough Not known More than 13,000 18,000 Cannot calculate Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction ( ).

23 Percentage of LHDs that Cut Program Areas (July 2009 June 2010) Source: 2010 NACCHO National Profile of Local Health Departments survey.

24 It is not necessary to change. Survival is not mandatory. -W. Edwards Deming

25 Current Changes q Transition away from direct care delivery q Shared services q Redesign (Regionalization) q Increasing use of technology q More attention to business processes and revenues q Integration of programs q Quality Improvement q Performance management q Accreditation

26 Opportunity PUBLIC HEALTH PRIMARY CARE

27 Integrated Curriculum and Training q Medical School q Residency Training q MPH Programs q Academic Health Department q Leadership Training

28 Shared and Integrated Resources q Staff q Teams q Leadership q Communications q Community Health Centers and Health Departments

29 Use of Technologies to Create an Integrated Prevention System

30 Aligning Forces

31 Thank you For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support