1. Considerations for Shared Governance Structures www.health.state.mn.us/sslc Minnesota Department of Health Public Health in Minnesota

2. “Humankind has not woven the web of life. WE are but one thread within it. Whatever we do to the web, we do to ourselves. All things are bound together. All things connect.” Chief Seattle

3. Today’s Agenda Minnesota Public Health Structure Statutory Responsibilities Challenges and Opportunities

4. Definitions of Public Health “Public health is what we, as a society, do to collectively assure the conditions in which people can be healthy.” Institute of Medicine

5. Definitions of Public Health “Public health is the science and art of disease prevention, prolonging life, and promoting health and well-being through organized community effort.” CEA Winslow (1877-1957)

6. Public Health Impact 25 of the 30 years of life gained in the 20 th century resulted from public health accomplishments!

7. Ten Greatest Public Health Achievements United States, 1900-1999 Vaccinations Motor vehicle safety Safer workplaces Control of infectious diseases Fluoridation of drinking water Safer and healthier foods Healthier mothers and babies Family planning Decline in deaths from heart disease and stroke Recognition of tobacco use as health hazard

8. Levels of Government US Capitol BuildingMinnesota State Capitol Building Label

9. Public Health and the Supreme Court “The preservation of the public health is one of the duties devolving upon the state as a sovereign power, and cannot be successfully controverted or delegated. In fact, among all the objects to be secured by government laws, none is more important than the preservation of the public health.” Schulte v. Fitch, NW 717, 1925 Protecting the public’s health is so basic, and the consequences of not protecting the public’s health are so serious, that both the state and federal constitution contain provisions to ensure this protection.

10. Minnesota Department of Health Protecting, maintaining, and improving the health of all Minnesotans.

11. Federally Recognized Tribes in Minnesota ■ Anishinaabe Bois Forte Fond du Lac Grand Portage Leech Lake Mille Lacs Red Lake White Earth ■ Dakota Lower Sioux Prairie Island Shakopee Mdewakanton Upper Sioux

12. Origins of County Public Health Nursing

13. State Boards of Health (c. 1950) 1.Creation of the boards was encouraged 2.Purpose: Assess health Create policies to prevent communicable diseases Assure sanitary conditions Boards of Health Before 1976

14. Community Health Act (1976) Community Health Services System (CHS System) Community involvement Local control Integrated statewide system Adequate population base / economies of scale Funding, with multi-county incentive

15. Purpose of CHS System “’Community health services’ [denotes] activities designed to protect and promote the health of the general population within a community health service area by emphasizing the prevention of disease, injury, disability, and preventable death through the promotion of effective coordination and use of community resources, and by extending health services into the community.” Minn. Stat. § 145A.02, subd. 6 (Local Public Health Act)

16. Community Health Boards in Minnesota c. 2015

17. Considerations for Shared Governance Structures www.health.state.mn.us/sslc Minnesota Department of Health Minnesota’s State-Local Partnership

18. State Community Health Services Advisory Committee (SCHSAC) STATE COMMUNITY HEALTH SERVICES ADVISORY COMMITTEE Hallmark of Local Public Health Act Advise Commissioner of Health Representatives from each community health board Work performed by workgroups

19. Local Public Health Act of 1987 Minnesota Legislature further clarified roles and responsibilities of the state and local public health system Replaced the Community Health Services Act with the Local Public Health Act, also known as Minnesota Statute § 145A Focuses accountability for funding on set of statewide outcomes

20. Local Public Health Act of 2014 Again modified to clarify public health responsibilities and accountability Eliminate unnecessary and obsolete language Align statute with current public health practices Require community health boards to engage in performance management

21. Elected Official’s Public Health Responsibilities Policy development Resource stewardship Legal authorization Partner engagement Continuous improvement Oversight

22. Considerations for Shared Governance Structures www.health.state.mn.us/sslc Minnesota Department of Health Local Public Health Assessment and Planning

23. Minnesota Local Public Health Assessment and Planning Process Implement Plans ■ Monitor Progress ■ Revise Plans as Needed Quality Improvement Planning Process Community Health Improvement Planning Process Organizational Strategic Planning Process Organizational Self- Assessment Community Health Assessment Ten Most Important Community Health Issues DELIVERABLE Three Standards Most in Need of Improvement DELIVERABLE QI Plan DELIVERABLE Strategic PlanCHIP DELIVERABLE Implement Plan Prioritize Assess

24. Areas of Public Health Responsibility in Minnesota Assure an adequate local public health infrastructure Promote healthy communities and healthy behaviors Prevent the spread of communicable disease Protect against environmental health hazards Prepare for and respond to emergencies Assure health services

25. Essential Public Health Services In Minnesota, these services refer to activities that are conducted to accomplish the areas of public health responsibility.

26. Examples: Assure an Adequate Local Public Health Infrastructure These planning meetings Agency strategic planning process Recruiting and retaining staff with appropriate expertise

27. Examples: Promote Healthy Communities and Healthy Behaviors Statewide Health Improvement Program (SHIP) Healthy Families America Chronic disease management Asthma programs

28. Examples: Prevent the Spread of Communicable Disease H7N9 (avian influenza) Pertussis reemergence Norovirus Enterovirus D68

29. Examples: Protect Against Environmental Health Hazards Regional mold plan Food, beverage, and lodging delegation Radon identification and mitigation Public health nuisance

30. Examples: Prepare for and Respond to Emergencies Community planning for flu centers and ILI local surveillance Mass dispensing clinics Vaccination promotion campaign

31. Examples: Assure Health Services MN CHOICES Family planning Early Childhood Dental Network Fluoride varnish Mental health initiatives for children and adults

32. Public Health Challenges & Opportunities Challenge is a dragon with a gift in its mouth. Tame the dragon, and the gift is yours. Noela Evans