The Emergence of District Public Health in Maine

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The Emergence of District Public Health in Maine

• Mark Griswold, M.Sc
• Maine CDC Office of Local Public Health

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• 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.
• --2007 Maine State Health Plan

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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

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Co-Conveners, continued

• 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

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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

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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
• 48th for per capita state funds for public health
• Bottom line we must be effective, efficient,
  coordinated

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Public Health Workgroup 2005-2007

• Led by Governors 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

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• 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

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Maines 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
Local Health Officers
District health partner
District health partner
District health partner
District health partner
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District Health Partners
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Maine Public Health Infrastructure

• Governors 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)

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More About DCCs

• Integral part of Maines 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

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• 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

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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

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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

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