1
Assessment in Public Health:
Thoughts, Ideas and Discussion
Dennis Lenaway, PhD, MPH
Director, Office of Standards and Emerging Issues in Practice
Office of Chief of Public Health Practice
Centers for Disease Control and Prevention
October 28, 2005
2
3
Are We Ready for Challenges
of the 21st Century?
Aging population
Increasing diversity
Escalating health costs
Changes in access to health care
services
Health disparities
Global threats
Terrorism
Epidemic effects of chronic
diseases
4
Why do Assessments?
Even if you’re on the
right track, you’ll get
run over if you just
stand still.
- Will Rogers
5
3 Core Functions
(1988 IOM report)
• Assessment
• Policy Development
• Assurance
6
10 Essential Public Health Services
• Monitor health status • Enforce laws and
• Diagnose and regulations
investigate • Link people to needed
• Inform, educate, and services / assure care
empower • Assure a competent
• Mobilize community workforce
partnerships • Evaluate health
• Develop policies and services
plans • Research
7
1. Monitor Health to Identify and Solve
Community Health Problems
• Accurate, periodic assessment of the
community’s health status.
• Surveillance Systems
• Utilization of methods and technology (e.g.,
GIS) to interpret and communicate data
• Population health registries
8
2. Diagnose and Investigate Health Problems
and Hazards in the Community
• Timely identification of health threats (assessment?)
• Case investigation protocols
• Availability of diagnostic services
• Guidelines for handling specimens
• Response plans to address major health threats
9
Without assessment and
planning, where do you end up?
10
The BIG Picture
Assessment is part of a larger effort to
determine where we are, where we
want to go, and how we are going to
get there …and did we actually arrive?
11
The Basics
Assess
Impact Analysis
Action Plan
12
13
Agency Community National
Accreditation NPHPS LHA Profile
Preparedness MAPP Futures Initiative
Credentialing Preparedness National Surveys
Program Impacts PACE-EH
14
National Public Health
Performance Standards
15
Performance Standards
Vision and Goals
To improve the quality of public health practice and
performance of public health systems by:
1. Providing performance standards for public health
systems and encouraging their widespread use;
2. Engaging and leveraging national, state, and local
partnerships to build a stronger foundation for
public health preparedness;
3. Promoting continuous quality improvement of
public health systems; and
4. Strengthening the science base for public health
practice improvement.
16
Four Concepts Applied in
National Performance Standards
1. Based on the 10 Essential
Public Health Services
2. Focus on the overall public
health system
3. Describe an optimal level of
performance
4. Support a process of quality
improvement
17
The Assessment
Instruments
• State public health system
• Local public health system
• Local governance
18
Mobilizing Action
through Planning and
Partnership
19
Mobilizing for Action
through
Planning and Partnerships (MAPP)
• Community strategic planning tool
• Developed by NACCHO and CDC
• Development began in 1996, released in
2001
• Web-based tool – www.naccho.org
20
The MAPP Model
21
Performance Improvement
• Performance improvement at all levels:
– Organization, System, and Statewide
• Collectively discuss scores and results
• Refer to comments and ideas
generated during the assessment
• Identify priority areas to address
• Collectively develop strategies to
address priorities
22
Four components
of a performance
management
system
Source: Turning Point Performance
Management Collaborative, From Silos to
Systems: Performance Management in Public
Health (in press).
23
CDC’s Futures Initiative
24
CDC’s Futures Initiative
Input ideas implementation Impact
25
Outside-In Process
Partner Groups
Discussion and Organizations Interviews
Groups
Our Customers,
CDC’s the American
Stakeholders People
CDC Futures
Initiative
E-mail Focus
Feedback Groups
HHS,
Policymakers, Futures CDC Staff
Congress Web site
26
CENTERS FOR DISEASE CONTROL AND PREVENTION
CDC WASHINGTON
OFFICE
Then
OFFICE OF GLOBAL
HEALTH
OFFICE OF THE CHIEF
OPERATING OFFICER
OFFICE OF WOMEN’S
HEALTH
OFFICE OF
COMMUNICATION
OFFICE OF HEALTH AND
SAFETY
OFFICE OF EQUAL
EMPLOYMENT
OFFICE OF THE
OPPORTUNITY DIRECTOR OFFICE OF MINORITY
HEALTH
OFFICE OF EXECUTIVE
SECRETARIAT
OFFICE OF PROGRAM
PLANNING AND
OFFICE OF GENOMICS EVALUATION
AND DISEASE
PREVENTION OFFICE OF SCIENCE
POLICY AND
TECHNOLOGY TRANSFER
OFFICE OF CHIEF OF
STAFF
NATIONAL
NATIONAL NATIONAL
CENTER FOR NATIONAL PUBLIC HEALTH AGENCY FOR
CENTER ON NATIONAL NATIONAL NATIONAL NATIONAL INSTITUTE EPIDEMIOLOGY NATIONAL
CHRONIC CENTER FOR PRACTICE TOXIC
BIRTH CENTER FOR CENTER CENTER FOR CENTER FOR FOR PROGRAM IMMUNIZATION
DISEASE INJURY PROGRAM SUBSTANCES
DEFECTS & ENVIRONMENTAL FOR HEALTH INFECTIOUS HIV, STD, AND OCCUPATIONAL OFFICE PROGRAM
PREVENTION PREVENTION OFFICE AND DISEASE
DEVELOPMENTAL HEALTH STATISTICS DISEASES TB PREVENTION SAFETY
& HEALTH AND CONTROL REGISTRY
DISABILITIES AND HEALTH
PROMOTION
27
28
CDC Today OFFICE OF CHIEF
SCIENCE OFFICER
OFFICE OF THE
CHIEF OPERATING
OFFICER OFFICE OF CHIEF
OF PUBLIC HEALTH
PRACTICE
CDC
WASHINGTON
OFFICE OFFICE OF
OFFICE OF THE STRATEGY &
DIRECTOR INNOVATION
OFFICE OF CHIEF
OF STAFF
OFFICE OF
ENTERPRISE
COMMUNICATION
OFFICE OF EQUAL
EMPLOYMENT
OPPORTUNITY OFFICE OF WORKFORCE
& CAREER
DEVELOPMENT
TERRORISM ENVIRONMENTAL HEALTH
GLOBAL PREPAREDNESS HEALTH & HEALTH INFECTIOUS
INFORMATION
HEALTH & EMERGENCY INJURY PROMOTION DISEASES
& SERVICES
RESPONSE PREVENTION
NCIPC NCHS NCHPDP NCID NIOSH
NCEH NCHM NCBDDD NIP
NCPHI NCHSTP
29
30
GOALS MANAGEMENT
Assessment of Evidence
Input
Mission
Feasibility
Comparative Impact
Goals
Health
Impact
Evidence-based action plan
Performance Accountability & responsibility
Management assignments
Resource allocation
31
Strategic Imperatives
Health Impact
Customer-focus
Public Health Research
Leadership in the nation’s health
system
Increased focus on Global Health
Effectiveness and Accountability
32
New Strategic Goals
Preparedness: All people in communities
will be protected from infectious,
environmental, and terrorist threats.
Health promotion and prevention of
disease, injury, and disability: All
people will achieve their optimal lifespan
with the best possible quality of health in
every stage of life.
33
National Surveys
34
Leading Causes of Mortality (2001)
Heart Disease (700,142)*
Malignant Neoplasms (553,768)
Cerebrovascular (163,538)
Chronic Low Respiratory Disease (123,013)
Unintentional Injuries (101,537)
* (number of deaths)
Diabetes Mellitus (71,372)
Influenza @ Pnuemonia (62,034)
Alzheimer's Disease (53,852)
0 5 10 15 20 25 30 35 40
Percentage of all deaths
Source: National Center for Health Statistics, National Vital Statistics Report 2003.
35
Actual Causes of Death (2001)
Tobacco (435,000)*
Poor diet/Lack of exercise (400,000)
Alcohol (85,000)
Infectious Agents (75,000)
Pollutants/Toxins (55,000) * (number of deaths)
Motor Vehicles Crashes (43,000)
Firearms (29,000)
Sexual Behavior (20,000)
Illicit Drug Use (17,000)
0 5 10 15 20
Percentage of all deaths
Source: Mokdad AH, Marks JS, Stroup DF, and Gerberding JL. Actual Dauses
of death in the United States, 2000. (Submitted to JAMA)
36
Agency Accreditation
37
Accreditation of Public Health Agencies
Accreditation
Incentives for
Participation
State and Local
Agency Standards
Partnership Development
Other State PH Accred. Operational
Accreditation Standards NPHPSP Definition Growing
Programs Program of a LPHA Interest
(IOM Recs., NACCHO Res.)
38
Accreditation of Public Health Agencies
Principles
Voluntary
Peer- Controlled
Incentivized
Based on Foundations
Already Laid
39
No matter how much
assessment and planning
there is, some things don’t
change….
40
Subject: software for Husband 1.0
Dear Tech Support,
Last year I upgraded from Boyfriend 5.0 to Husband 1.0 and noticed a
distinct slow down in overall system performance particularly in the
flower and jewelry applications, which operated flawlessly under
Boyfriend 5.0.
In addition, Husband 1.0 uninstalled many other valuable programs,
such as Romance 9.5 and Personal Attention 6.5, and then installed
undesirable programs such as NFL 5.0, NBA 3.0. and Golf Clubs 4.1.
Conversation 8.0 no longer runs, and Housecleaning 2.6 simply
crashes the system.
I've tried running Nagging 5.3 to fix these problems, but to no avail.
What can I do?
Signed, Desperate
41
Dear Desperate:
First keep in mind, Boyfriend 5.0 is an Entertainment Package, while
Husband 1.0 is an Operating System. Please enter the command:
http://www.ithoughtyoulovedme.html/ and try to download Tears 6.2
and don't forget to install the Guilt 3.0 update.
If that application works as designed, Husband 1.0 should then
automatically run the applications Jewelry 2.0 and flowers 3.0.
But remember, overuse of the above application can cause Husband 1.0
to default to Grumpy Silence 2.5, Happy Hour 7.0, or Beer 6.1. Beer
6.1 is a very bad program that will download the Snoring Loudly Beta.
Whatever you do, DO NOT install Mother-in-law 1.0 (it runs a virus in the
background, that will eventually seize control of all your system
resources).
42
Also, do not attempt to reinstall the Boyfriend 5.0 program. These
are unsupported applications and will crash Husband 1.0.
In summary, Husband 1.0 is a great program, but it does have limited
memory and cannot learn new applications quickly.
You might consider buying additional software to improve memory and
performance. We recommend Hot Food 3.0 and Lingerie 7.7.
Good Luck,
Tech Support
43
Achieving Health Impact
44
Office of
Chief of Public Health Practice
WEBSITE:
www.cdc.gov/od/ocphp
45