1. Focus Area 23: Public Health Infrastructure Progress Review Richard J. Klein National Center for Health Statistics April 16, 2008

2. Impact of Public Health Infrastructure Public Health Infrastructure--the resources needed to deliver essential public health services to every community Public Health Response Epidemic Investigation Surveillance Laboratory Practice Workforce Capacity & Competency Information & Data Systems Organizational & Systems Capacity Basic Infrastructure Essential Capabilities SOURCE: Public Health Foundation

3. Information & data systems 23-2. Access to information on health indicators 23-4. Data for all population groups 23-6. Objectives tracked at least every three years 23-7. Data release within one year of collection Highlighted Objectives Organizational & systems capacity 23-12. Health improvement plans a. Tribal b. State c. Local d. Local linked to state Workforce capacity & competency 23-11. Performance standards ImprovingLittle or no progress* Note: *Percent of targeted progress achieved is between -10% and 10%. No dataBaseline only

4. Obj. 23-2 13.1 Examples of Access to Information on Health Indicators SOURCE: CDC, NCHS Federal Tribal State Local Community Health Profile (Minnesota, Michigan, and Wisconsin Tribal Communities, Great Lakes EpiCenter)

5. Mission: provide information on community health –More than 200 measures for each of the 3,141 U.S. counties –Peer counties based on population density, population size, poverty rate, and age distribution –Healthy People 2010 targets shown where applicable Cooperative effort –Federal: Health Resources Services Administration, Centers for Disease Control and Prevention, National Library of Medicine –Foundations: Public Health Foundation and Robert Wood Johnson funds Endorsed broadly Obj. 23-2 Community Health Status Indicators (CHSI)

6. CHSI Peer Counties Prince William County Anne Arundel County Obj. 23-2

7. Lower than peer counties (median) Higher than peer counties (median) CHSI Peer Counties Obj. 23-2

8. Minimum Template for Population-Based Objectives Race:Socioeconomic Status: American Indian or Alaska Native only Family Income Level Asian or Pacific Islander only Asian only Poor Native Hawaiian or Other Pacific Islander only Near poor Black or African American only Middle/high income White only 2 or more races or American Indian or Alaska Native; Whiteor Black or African American; White Hispanic origin and race: Hispanic origin and race: Education Level Hispanic or Latino Not Hispanic or Latino Less than high school Black or African American High school graduate White At least some collegeGender: Female Male Source: Healthy People 2010, November 2000 Obj. 23-4

9. Baseline2007 Data Quality and Completeness Note: Baseline for 23-4 and 23-6 is 2004; 23-7 baseline is 2000. SOURCE: DATA2010, Health Promotion Statistics Branch, NCHS Obj. 23-4, 23-6, & 23-7 Released w/in 1 year of collection Tracked at least every three years Data for all pop groups 26 49 65 Increase desired 2010 Target: 100 Percent 0 80 100 60 40 20

10. 9 Obj. 23-11a 2007 Increase desired Use of National Public Health Performance Standards: State Public Health Systems 2004 2010 Target: 35 Note: The PHPS are used by local and state public health systems as a tool in comprehensive health improvement initiatives, bioterrorism preparedness planning and other efforts. PHPS are considered to be a benchmark for public health practice. SOURCE: National Public Health Performance Standards Program, CDC, Office of the Chief of Public Health Practice. 18 Number Six percent (n=1) of the 18 states that used the Public Health Performance Standards in 2007 met the standards.

11. Use of National Public Health Performance Standards: Local Public Health Systems LPHS that participate in the PHPS program LPHS that do not participate in the PHPS program Public Health Performance Standards Met Public Health Performance Standards not met 12% N=273 36% N=98 N = 2,315 LPHSN = 273 LPHS 2004 2007 2010 Targets = 50 Increase desired N = 2,315 LPHSN = 469 LPHS 20% N=469 46% N=214 Note: The PHPS are used by local and state public health systems as a tool in comprehensive health improvement initiatives, bioterrorism preparedness planning and other efforts. PHPS are considered to be a benchmark for public health practice. SOURCE: National Public Health Performance Standards Program, CDC, Office of the Chief of Public Health Practice. Obj. 23-11b and d LPHS that participate in the PHPS program LPHS that do not participate in the PHPS program Public Health Performance Standards Met Public Health Performance Standards not met

12. Implementation of a Health Improvement Plan: State and Local Health Agencies Percent Note: The Healthy People 2010 target will be determined by the Healthy People 2010 Steering Committee, at a later date. SOURCE: State, Association of State and Territorial Health Officials (ASTHO) and Local, National Profile of Local Health Departments (NACCHO) Obj. 23-12b-d States with a Health Improvement Plan (2007) Local Agencies with a Health Improvement Plan (2005) Local Plans linked with State Health Improvement Plans (2005) 56 54 37 Increase desired 2010 Targets: TBD

13. Public Health Infrastructure Objectives Information and data systems 23-2. Access to information on health indicators 23-3. Geocoding in major health data systems 23-4. Data for all population groups 23-6. Objectives tracked at least every three years 23-7. Data release within one year of collection Workforce capacity & competency 23-8. Core competencies in job descriptions a. Tribal b. Local 23-9. Core competencies: public health curricula 23-10. Continuing education a. Tribal b. State c. Local 23-11. Performance standards used a. State b. Local 23-11. Performance standards met c. State d. Local Organizational & systems capacity Getting worseBaseline onlyTarget metImprovingLittle or no progress* Objectives 23-1, 23-5, and 23-16 were deleted at the Healthy People 2010 Midcourse Review in 2005. Note: *Percent of targeted progress achieved is between -10% and 10%. 23-12. Health improvement plan a. Tribal b. States c. Local d. Local linked to State 23-13. Public health laboratory services a–k. 23-14. Epidemiology services a. formal training b. Tribes c. States d. Local 23-15. Evaluation of public health laws a. Turning Point b. Emergency Powers 23-17. Population-based prevention research No data

14. Summary All retained objectives are at least partially measurable Access to information on health indicators available at national, Tribal, state, and county level Data timeliness and completeness improved Participation in the National Public Health Performance Standards Program improved for state and local public health systems. Tribal data collection improving – challenges remain Future: Developing and refining PHI measurement in Healthy People 2020

15. Acknowledgements Tamyra Carroll Garcia Public Health Analyst CDC/National Center for Health Statistics tuc6@cdc.gov Susan Schneider Public Health Analyst CDC/National Center for Health Statistics sah4@cdc.gov Contributors: Nakki Price, CDC/OCPHP Beverly Smith, HRSA Liza Corso, CDC/OCPHP Christopher Barrett, HHS/ODPHP Joan Cioffi, CDC/OWCD Ellis Davis, HHS/ODPHP Elizabeth Jackson, CDC/NCHSJeff Pearcy, CDC/NCHS

16. Progress review data and slides are available on the web at: http://www.cdc.gov/nchs/hphome.htm