CELEBRATING TWENTY YEARS IN “The Future of Public Health” OPPORTUNITIES FOR TOMORROW’S LEADERSHIP

1. CELEBRATING TWENTY YEARS IN “The Future of Public Health” OPPORTUNITIES FOR TOMORROW’S LEADERSHIP Ned Baker Annual Lecture, NALBOH Bowling Green, Ohio April 3, 2008

2. CELEBRATING TWENTY YEARS IN ‘THE FUTURE OF PUBLIC HEALTH’ Hugh H. Tilson MD, DrPH Public Health Leadership Program UNC School of Public Health and Member of the Panel, IOM, 1988

3. But FIRST … a word about the Health of the Public in the 21st Century“The Future of the Public’s Health” 2003 A Report from the Institute of Medicine Follow-up Study of the 1988 “Future of Public Health” and its implications for NALBOH’s Public Health Leadership

4. THEFUTUREOF THE PUBLIC’S HEALTH in the 21st Century INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Committee on Assuring the Health of the Public in the 21st Century

5. What’s “ASSURING”??Whaddya’ mean “keeping pace”? In THIS mess?

6. We regret that the program … originally scheduled for this time … could not be CANCELLED!!

7. The National Academies The National Academy of Sciences (1863) The National Research Council (1916) The National Academy of Engineering (1964) The Institute of Medicine (1970)

8. Why a new study about the future of public health? NOT BECAUSE THE ‘OLD’ REPORT WAS WRONG

9. Why a new study about the future of public health? NOT BECAUSE THE ‘OLD’ REPORT WAS WRONG …IN FACT, IT IS ‘EVERGREEN’!!

10. IOM’s LANDMARK REPORT ON “THE FUTURE OF PUBLIC HEALTH” 1988

11. CELEBRATING TWENTY YEARS OF PROGRESS: 1988-2008

12. Why a new study about the future of public health? NOT BECAUSE THE ‘OLD’ REPORT WAS WRONG … IT IS ‘EVERGREEN’!! And DEFINITELY worth a careful look

13. The LANDMARK report on the “Future of the Public Health” IOM 1988: BACKGROUND --The Swine Flu fiasco of 1976 --The Model Standards for Community Preventive Health Services weak response --The inability of the local infrastructure to respond to the Model Standards --The crumbling of Federal support --The politicization of the Federal Public Health leadership

14. The 1988 Panel 21 of the Brightest and the Best (plus me) All the right domains represented All the public health professions Elected officials Superb high level professional staffing Adequate resources … Kellogg, CDC, HRSA funding

15. The 1988 Report: the approach “check your assumptions at the door” Used classic social science methods … broad fact finding, literature reviews, expert testimony, and field site visits Asked: what is your definition of public health Used: “tracers”: what was the problem, what did you do about it, who made it happen?

16. 1988: The Big News “… this nation has lost sight of its public health goals and has allowed the system of public health activities to fall into DISARRAY!”

17. 1988: the critical re-conception of public health “The committee defines the mission of public health as fulfilling society’s interest in assuring conditions in which people can be healthy” “The committee finds that the core functions of public health agencies at all levels of government are assessment, policy development, and assurance”

18. 1988: the Core Functions Assessment: … regularly and systematically collect, assemble, analyze, and make available information on the health of the community … Policy Development: … Agencies must take a strategic approach, developed on the basis of a positive appreciation for the democratic political process

19. 1988: The core functions Assurance: … assure their constituents that services necessary to achieve agreed upon goals are provided … encouraging actions by other entities …. Requiring such action through regulation, or by providing services directly … a set of high-priority personal and communitywide health services that governments will guarantee to every member …

20. IOM 1988: Recommendations States: “… are and must be the central force in public health” Localities: “no citizen from any community, no matter how small or remote, should be without identifiable and realistic access to the benefits of public health protection, which is possible only through a local component of the public health delivery system.” “the AGPALL” concept

21. 1988: Fulfilling the Government Role: Implementing Recommendations Statutes: … reform; delineate responsibilities and authorities and a core set of functions Organizational Structure: … an identifiable state department of public health … state health council .,.. Establish standards for local public health functions

22. 1988: Organizational Structure Localities: “… the larger the population served by a single multipurpose government, as well as the stronger the history of local control, the more realistic … promote local accountability

23. 1988: Organizational Structure Localities: “… the larger the population served by a single multipurpose government, as well as the stronger the history of local control …… clear focal point: “where the scale of local government activity permits, localities should establish public health councils to report to elected officials on local health needs and on the performance of the local health agency.” (NOTE TO NALBOH … what happened THREE years after this recommendation?)

24. 1988: Special linkages Environmental health Mental Health Social Services Care of the indigent: “… until adequate federal action is forthcoming, public health agencies must continue to serve …to the best of their ability, the priority personal health care needs of the uninsured, underinsured, and Medicaid clients.”

25. 1988: Strategies for Capacity Building Technical: uniform data set; Institutional home for new knowledge; research Political: relationships with elected officials; competence in community relations; working partnerships and support among local, state, and national medical and professional societies …

26. 1988: Strategies for Capacity Building Managerial: … training … on managerial and leadership skills; demonstrated management competence … should be a requirement; salaries and benefits Programmatic: … more emphasis on “factors that influence health-related behavior …” Fiscal: … Fed to State and State to local, with incentives and sanctions

27. 1988: Education for Public Health Schools … firm practice links; resources to governments; students “an opportunity to learn the entire scope of public health practice”; research … applied and implementation; full advantage of other faculties; full support to other faculties Education programs … should be informed by comprehensive and current data on public health personnel…”

28. Why a new study about the future of public health ? 2000: IOM commissioned a systematic review of progress as part of its commitment to follow-through. Progress was dramatic on every front. However, challenges and frustrations abounded as well. IO

29. Why a new study about the future of public health ? IOM commissioned a systematic review: PROGRESS is IMPRESSIVE Conceptualization: The public health working group and the ten essential services Organization: NACCHO, NALBOH, Council on Linkages Workforce: PHLI, Management Academy IO

30. Why a new study about the future of public health in 2000-2003? Still, due to the rapidly changing (“flat”) world, public health systems were under greater stress than ever before Additionally, these changes bring increasingly diverse demands, expectations, opportunities, and resources for public health Oh, yes … and then there’s the MONEY $$$$$$$$$$$$$$$$$$$

31. WE interrupt this program for the following announcement

32. Why a new study about the future of public health in 2003? And then came September 11th … And the Anthrax attacks that followed … that changed ‘everything’ … and for the IOM Committee, the urgency for a report to galvanize to concerted action was CLEAR

33. Why talk about a twenty year old and a five year old study about the future of public health HERE/NOW? …because the Nation and States need help from our leadership …a.k.a. YOU !

34. But first... a word from our sponsors!

35. Centers for Disease Control and Prevention (CDC) Substance Abuse and Mental Health Services Administration (SAMHSA) Health Resources and Services Administration (HRSA) National Institutes of Health (NIH) Office of the Secretary, Assistant Secretary for Planning and Evaluation (OS/ASPE) Office of Disease Prevention and Health Promotion (ODPHP) The 2003 study sponsors

36. Assuring the Health of the Public in the 21st Century Who?

37. Jo Ivey Boufford Christine Cassel Kaye Bender Lisa Berkman JudyAnn Bigby Thomas Burke Mark Finucane George Flores Lawrence Gostin Pablo Hernandez Judith Lave John Lumpkin Patricia Peyser George Strait Thomas Valente Patricia Wahl Gail Warden Hugh Tilson (Liaison) George Isham (Liaison) The 2003 Committee

38. Assuring the Health of the Public in the 21st Century Who? What? When? Where? How?

39. Addressing the charge required...JUST WHAT YOU REQUIRE TODAY … thinking outside the

40. Methodology Literature review on all relevant topics Hearings and expert testimony at Committee meetings Input from the Committee’s Liaison Panel and from the general public Qualitative and quantitative data from • Federal, state, and local public health systems • State and local community organizations • National and professional organizations Site visits Futures visioning and scenario building

41. Today’s forecast is limited by lack of vision ….

42. Futures visioning and scenario building The committee examined the drivers, or the forces that are likely to shape the future, and used “visioning” to generate scenarios, or potential realities for which public health must be prepared.

43. Futures visioning and scenario building The committee ascertained the drivers, or the forces that are likely to shape the future, and used visioning to generate scenarios, or potential realities for which public health must be prepared. .. AND a great way for YOU to LEAD, too”

44. Some important “drivers” of population health Changes in the environment Disparities in health status and access to care Infectious disease threats Globalization A social and political environment that prioritizes health Advances in biotechnology and information technology

45. Some important “drivers” of population health Changes in the environment Disparities in health status and access to care Infectious disease threats Including MAN-MADE ONES!! Globalization A social and political environment that prioritizes health Advances in biotechnology and information technology

46. Public health is preparing for whatever comes next.

47. Some important “drivers” of population health Changes in the environment Disparities in health status and access to care Infectious disease threats Including MAN-MADE ONES!! Globalization A social and political environment that prioritizes health Advances in biotechnology and information technology glumbert/media/shift

48. THEFUTUREOF THE PUBLIC’S HEALTH in the 21st Century INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES WWW.NAP.EDU

49. The Context for the Report • 1988 report is ‘evergreen’ and there is GREAT National Health Achievement in the 20th Century BUT … • US falling short in international comparisons • Poor return on investment in health • Concern about the government public health infrastructure’s ability to meet future health challenges, both local and global

50. Background in the Report • Health = Public Good • Government has fundamental, statutory duty to assure the health of the public