The Emergence of District Public Health in Maine Mark Griswold, M.Sc Maine CDC Office of Local Public Health

Taking the long journey to make Maine the healthiest state requires an organized public health infrastructure that is strategic and reliable across Maine. A well developed and organized infrastructure is intimately related to our ability to achieve our goal of ensuring that all Mainers have access to affordable, quality care that will help individuals maximize their personal health status and productivity Maine State Health Plan

Co-Conveners Healthy Maine Partnerships –Prevention activities: tobacco physical activity and nutrition chronic disease screening & self-management substance abuse prevention coordinated school health –Essential Public Health Services, including work with DCCs Primary provider of public health services at the local level –Community health assessment: Mobilizing for Action through Planning and Partnerships: Achieving Healthier Communities (MAPP) –Funded through Fund for Healthy Maine, with other diverse funding sources

Maine CDC Office of Local Public Health –Purpose: coordinate & strengthen local public health infrastructure –Projects for year 1: Convene district public health units of Maine CDC field staff Provide local health officer training and support Co-convene DCCs Assist with public health-related assessments Link with county and state emergency management –Has both central office and field staff District Public Health Liaisons (3 of 8 districts) –Funded through reallocation of central office positions throughout Maine CDC Co-Conveners, continued

Public Health Challenges for the Central District Lower Population density Median income Adult H.S. graduates Higher Families living in poverty Kids on free or reduced school lunch Single-parent households with kids Acute MI hospitalizations ED visits for asthma Reported rapes Reported domestic assaults

The Funding Picture: How Maine Ranks 60% of Maine CDC budget is federal –Rank about ½ among 50 states for per capita federal PH funding 48 th for per capita state funds for public health Bottom line: we must be effective, efficient, coordinated

Public Health Workgroup Led by Governor’s Office of Health Policy and Finance 40 Members, broad representation and input Charged by 2 legislative resolves: –Make recommendations about core public health work for Healthy Maine Partnerships (CCHCs) –Make recommendations about district-level public health infrastructure Maintained focus on the 10 Essential Public Health Services Now called the Statewide Coordinating Council

Recommended by PHWG: 8 DHHS Districts Strengthened Local Health Officer system Core public health functions carried out by Healthy Maine Partnerships 8 District Coordinating Councils (DCCs) District Public Health Units MCDC Office of Local Public Health

Maine’s local public health infrastructure, a simplified view Statewide Coordinating Council Maine CDC/DHHS Office of Local Public Health District Liaison and Public Health Unit District Coordinating Council District health partner District health partner District health partner District health partner Local Health Officers

District Health Partners DCC City Health Dept. County Gov’tMaine CDC Emerg. Mgmt. Agencies Emerg. Med. Svs. HospitalsTribesHMPs School Districts Local Health Officers Higher Ed. Clinics/Comm. Health Voluntary Health Orgs Family Planning Area Agencies on Aging Health care Providers Mental Health Servs. Substance Abuse Servs. CBOs, Civic Org. Municipal Gov’t

Maine Public Health Infrastructure Governor’s Office of Health Policy and Finance Statewide Coordinating Council State Public Health Agency 2 City Health Departments 4 Tribal Health Systems 8 DHHS Districts 28 Healthy Maine Partnerships 492 Municipal Local Health Officers 500 Maine CDC contracts for local public health services (~50 per district)

More About DCCs Integral part of Maine’s local PH structure Established by SCC & Maine DHHS/CDC with input from District stakeholders Functions: –District-wide representative body for PH-related planning & coordination –Deliver, through its members, specific, district-level PH services –Mobilize partnerships to combine efforts and resources within the district for more effective and efficient delivery of the EPHS –Advise about allocation of certain district-level PH funds

Leadership: –Operating principles, transparent decision-making –Small volunteer Steering Committee –Linkage with the Maine CDC/DHHS Local Public Health Liaison –Assure appropriate membership Potential activities for Year 1: –Establish process for planning and decision-making –Assess access to PH services Health disparities: population-based and geographic –Begin development of a district public health improvement plan DCC Vision: –A healthy population served by comprehensive, well-coordinated public health services

Desired DCC competencies: –District-wide convening, fostering collaboration, mobilizing across communities, organizations, and sectors –Leveraging local assets and securing external resources –Interpretation and use of health assessment data –District-level and issue-specific planning –Evaluation design, analysis, use of evaluation findings –Working with fiscal agents capable of accepting and administering funds on behalf of the district

Value of DCC Broad-based, inclusive –Address regional PH issues more effectively and efficiently Identify resources and gaps at the district level Convene non-traditional PH partners Strong influence on local and state policy Help allocate money Create collaborations to attract funding Address health disparities and –reach underserved populations and geographic areas

December ‘07 PHWG report to the Maine Legislature April – May ‘08 Co-conveners Plan meeting June ’08 Convene DCC (describe process, orient members) July-August ’08 Continue planning Process: membership, group process, assessments, etc. Central DCC Timeline, A work in progress Fall ’08 DCC Meeting: Determine leadership Advise about Allocation of some District PH funds Conduct Assessment (PH needs, existing services, gaps) Address health disparities Vision: A healthy population served by comprehensive, well-coordinated public health services Create District PH Improvement Plan