1. Susan Allan, MD, JD, MPH Working Effectively with State, Local and Tribal Public Health Agencies

2. Session Overview 8:45 to 9:00 AM Overview of Session and PH agencies 9:00 to 9:30 AM PANEL 1: National Practice Orgs: Each panelist will offer three practical suggestions 9:30 to 9:45 AM PANEL 2: PHTC: Each panelist will offer two suggestions 9:45 to 10:05 AM Questions, General Discussion 10:05 to 10:30 AM Break out sessions –STATE SESSION- Roosevelt Room (O’Keefe) –LOCAL SESSION- Madison Room (Troutman) –TRIBAL SESSION- Plaza II&III (D’Ambrosio) 10:30 to 10:45 AMReport out (Tilson)

3. State and Local Public Health Agencies

5. State Public Health Agencies >100,000 state health agency employees –27,778 work in local health departments –17,333 work in regional or district offices 27% of employees eligible for retirement in FY14 Federal funds are the largest source of state health agency revenue

6. Number of FTEs by State Population Average # of FTEsAverage # of FTEs per 100,000 population State Size# of statesMean# of statesMean Small168761682 Medium172,0451747 Large163,5671627

7. Environmental Health (n=51) Health Activity

8. Other Public Health Activities (n=51)

9. Public Health Competencies Used – State PH Agencies (n=49)

10. Training by State PH Agencies -Topics (n=49) Topic

11. Local Public Health Departments 2,565 total LHDs in the US 63% serve populations <50,000 –These small jurisdictions account for only 11% of the US population Approx 5 % of LHDs serve 49% of the US population

13. Local PH Workforce (2010) Median number of FTEs - 17 –~87% of LHDs had <100 FTEs –15% of LHDs had <5 FTEs 31 %of LHD staff was a race other than white –12 percent of LHD staff was Hispanic. 28% of all LHDs have used the Core Competencies for Public Health Workers

16. Types of Services provided by LHDs varies greatly

17. # of states in which more than half of LHDs had budget cuts late 2008 -7 mid 2009-20 late 2010-28 mid 2011-30 early 2012 -15

18. Tribal Public Health Organizations

19. American Indian/Alaska Native populations 2010 Census Over 2.9 million American Indian/Alaska Native Only Over 5.2 million AI/AN alone or in combination with other races/ethnicities >60% of AI/AN people live in urban areas Over 560 federally recognized tribes Each is sovereign Great degree of variability in size of tribe, resources, governance, and public health programming

20. Source of public health services to tribal communities varies greatly Tribal Health Departments Indian Health Service (IHS) Facilities, Area Indian Health Boards (12) Urban Indian Health Centers Some tribes also receive services by agreement from local or state health depts

21. Tribal Health Organizations - Employees 54% have less than 50 employees 10 %have more than 200 employees The average number employees is 64

22. Tribal Health Department Services THDs provide more health screenings and behavioral health services than LHDs LHDs provide more environmental health and regulatory functions (e.g., food service inspections) THDs are often more integrated with the health care delivery system than LHDs

23. INDIAN HEALTH SERVICE The Indian Health Service (IHS) is the principal federal health care provider and health advocate for Indian people Significant variations in tribal governance, population size, land base, and access to public health services exists among IHS Areas

24. IHS Areas Albuquerque PortlandBillings California Phoenix Oklahoma Nashville Navajo Tucson Alaska AberdeenBemidji

25. Summary Significant overlap in roles among state, local and tribal Extreme variability in structure, governance, resources and service “If you’ve seen one *** health department, you’ve seen one *** health department”

26. Sources for Additional Information NACCHO “The National Profile of Local Health Departments” ASTHO “Profile of State Public Health” NIHB “2010 Tribal Public Health Profile "and “A Profile of Tribal Health Departments”

27. Break Out Sessions STATE -- Roosevelt Room Resource Person – Lacy M. Fehrenbach, MPH, CPH Facilitator – Elaine O’Keefe, MS LOCAL -- Madison Room Resource Person – David Dyjack, DrPH Facilitator – Adewale Troutman, MD, MPH, CPH TRIBAL -- Plaza II&III Resource Person – Donald K. Warne, MD, MPH Facilitator – Luann D’Ambrosio, MEd