Vanderburgh County Health Report 2013

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Vanderburgh County Health Report 2013

Section A

The Institute of Medicine (IOM) in 1988 reported an assessment of the public health system of the United States. The report was called The Future of Public Health. It described the network agencies of public health at the county, state and national levels as much disorganized. This called for a national debate of the national public health status. While questioning the capacity of public health systems to offer essential services to people, the report sought the establishment of a comprehensive framework that delineates the main functions of public health assessment, assurance, and policy development. Despite the accuracy with which health policy academicians understood the IOM framework, the language of the text was difficult for policymakers to apply. President Clinton formed a federal working-group in 1994 to review and add to the framework. Working under the Center for Disease Control and Prevention (CDC), the group sought the explanation of public health, the clarification of the functions of public health within the healthcare system at large, and the provision of accountability by health outcomes to public health performance. Consequent upon these efforts, the Essential Services of Public Health was published in late 1994 (US Center for Disease Control and Prevention, 2015). This paper seeks to analyze and assess the annual health report of Vanderburgh County 2013 for compliance with the Essential Services of Public Health.

Essential Service 1

The first essential service to consider is monitoring health status to determine community health problems. This essential service is all about public health surveillance. The healthcare system should provide continuous, systematic gathering, analysis and interpretation of data related to health. The service includes a number of public health activities: Firstly, threats to health should be identified and health service needs assessed accordingly. Secondly, there should be timely collection, analysis, and report of information about access, costs, outcomes, and utilization of personal health services. Thirdly, attention should be paid to crucial statistics and health statuses of particular groups that are more vulnerable than the rest of the population. In addition, there should be collaboration with private providers in managing integrated information systems.

Vanderburghs Communicable Disease (CD) Division is mandated to assess, investigate and promote sound prevention, surveillance, treatment and education methods to prevent the spread of communicable diseases. During the first quarter of 2013, CD staff took part in several conference calls and educational sessions about the Affordable Care Act. The staff also trained in readiness for the shift to electronic health recording system (EHR) for immunization, TB, and specialty clinics. The Division issued a public health alert for Tdap to encourage parents and caretakers of children under one year to get vaccination. This encouragement was also aimed at pregnant women at specific appropriate stages. These initiatives are in line with the identification and proper assessment of threats under the first essential service.

The Vital Records Division primarily registers vital events (deaths and births) within Vanderburgh. Statistics collected at this division are useful to ascertaining major health trends, identifying health problems and needs, evaluating the effectiveness of various health efforts, and health policy formulation. The Division managed to integrate its records to an online certificate system solely administered by the Indiana State Department of Health. This enabled the Division to file death certificates electronically. By 2010, funeral homes were already using the certificate system. The Finance Division also reports revenue and expenditure to give the public a clear picture of health expenses and the resulting health costs that have to pass to the public.

Vanderburgh healthcare system is administered across the county uniformly without realizing that certain places are more vulnerable than others. For instance, the initiatives of the Environmental Health Division were rolled out uniformly across the county. At one point the Division realized that bed bugs were a nuisance to Vanderburgh residents, especially those in rainy areas and poorly drained areas. Instead of focusing on the most vulnerable areas, the Division liaised with stakeholders from all over Vanderburgh, including landlords, community health organizations, and tenants regarding the best practices in prevention and elimination of bed bug infestations. It could be argued, however, that the Environmental Division and the healthcare system at large prefers to give the entire county equal attention to prevent chances of disease spread from one region to another. This move also showed that Vanderburgh health system collaborates with stakeholders in addressing various health challenges.

Essential Service 2

This service requires that there should be diagnosis and investigation of health problems and hazards within the community. A number of activities are carried out in ensuring that this service is implemented properly. Firstly, an epidemiologic identification should be done of emerging health threats. Secondly, the public health laboratory should be in a position to use modern technology in carrying out quick screening and conducting tests in large numbers. Thirdly, there should be active programs for infectious disease epidemiology. Finally, the health system should have an adequate technical capacity to investigate disease outbreaks, chronic disease and injury epidemiologically.

The primary goals of Vanderburghs Laboratory Division is to provide specimen testing of the highest quality to assist in diagnosing and preventing diseases within the community. In addition, the Division aims at promoting the health of the public by educating everyone in areas of safe water standards and lead poisoning. The Countys laboratory has received certification from the Health Care Financing Administration for Clinical Laboratory Amendments (CLIA) among other certifications for quality. This shows that the delivery of health s top-notch in the County.

The Division has been at the forefront in scaling up the number of tests to boost chances of detecting and preventing disease outbreaks. In 2013, for instance, the Division tested 542 samples of drinking water. It educated homeowners with wells and other water sources on drinking water safety. It tested wells freely to residents whose wells were flooded. Safe swimming pool water has also been the focus of the Laboratory Division. 3633 pools were tested in 2003 for bacteriological safety. These initiatives are synchronized with those of the Environmental Department to achieve common goals of eradicating disease and keeping the environment healthy.

Essential Service 3

This essential service is about informing, educating, and empowering people about health issues. It is similar to most social marketing and health promotion efforts conducted by various health systems all over the world. Various activities are involved in this essential health service. Firstly, there should be social marketing with targeted media public communication such as toll-free lines for obtaining health information. Secondly, the system should provide health information resources that can be accessed at community levels such as mobile health screening conducted freely. Thirdly, the system should collaborate actively with personal healthcare providers for purposes of reinforcing health programs and messages passed through promotional activities. Finally, the system should conduct education programs jointly with churches, schools, and worksites. These could incorporate stress reduction seminars, health fairs, and parenting support groups aimed at enhancing mental health.

The Environmental Division is was reported to have held its annual spring training for installers of sewage systems. During this training, 28 installers attended. The attendees were awarded credits for continuing their education. In addition, the Division trained public pool operators about pool sanitation and water chemistry. It consulted widely through electronic media, print media and interviews to gain in-depth understanding of the subject. Such training sessions are part of the overall promotional initiatives of Vanderburgh.

The Communicable Disease Division was not left behind in the promotional initiatives. Its staff took part in many conference calls and sessions of education on the Affordable Care Act as they trained in readiness for the electronic health recording. The Division also conducted web-based training with Nightingale Notes and CHAMP programs. Most clerks attended the CD clinics to benefit from these noble programs. The Division issued provider and public healthcare alerts for Tdap for purposes of encouraging parents and caretakers of children under one alongside pregnant women to obtain vaccination for Tdap at appropriate intervals. The Division also provided a telephone booth at Homeless Connect. It provided counseling and information on Hepatitis, TB, and STDs to 97 people during that period. Still in March the same year, the Divisions nurse epidemiologist carried out three training courses for smallpox vaccinator with the aim of meeting the set goal of training 180 LPNs and RNs. The report indicated that 166 smallpox vaccinators have undergone training since 2011.

The Health Promotion Division strives to provide essential education programs and services, which meet the needs of the public. The programs are also intended to educate all residents of Vanderburgh to equip them with the requisite knowledge, skills and tools to better their health and alleviate risk factors. The goal of the Division is to come up with free programs in line with the goals and objectives of the Healthy People 2020. These goals and objectives target five key areas, including physical activity, tobacco use, cancer education, nutrition and weight, educational and community-based programs.

The Division combined Health Education and Chronic Disease Program, which proved quite beneficial to the entire community. It decided to call itself Health Promotion for purposes of emphasizing the promotion of better health through good life choices such as increased physical activity and better nutrition. Diabetes has been its main area of concern. Vanderburgh Health Department rolled out the Nightingale Notes through the electronic recording system in all programs and clinics. The new system facilitates the collection and maintenance of client information by staff. Moreover, it produces HIPAA compliant health reports to facilitate future health services and programs.

The Division provided top class outreach opportunities in 2013, which enabled the community to take part in its lifestyle behavior programs. It continues to implement programs to address two priorities in Indiana reduce obesity and adult smoking. The Stop Smoking Program offers free nicotine patches to all participants subject to approval from the healthcare provider of the participant. The Weight Loss program gives useful information and supports participants to help them meet their weight loss targets. The Division collaborates with local physicians, businesses, and clinics to spread the opportunities. Some of these programs include Wellness Screenings, Handwashing, Stress Management, Cancer Information, Community Health Fairs, Yoga, STD education classes, Guest Speakers and many more. In 2013 alone, the Division reached 16,097 residents through its Health Education programs.

Essential Service 4

This essential service is concerned with the mobilization of community partnerships to identify and solve health problems. Activities here represent an extensive approach to community health whereby professionals and community sectors collaborate in entirety to plan, implement, observe, evaluate, modify, and repeat processes as necessary. Several activities are involved here. Firstly, the system should convene and facilitate community groups and associations such as those deemed to be health-related to carry out defined screening, preventive, support, and rehabilitation programs. Secondly, the system should have skilled coalition-building capacity to tap full range human and material resources when delivering community health services.

The Health Department continuously leads the community partners in the review process by providing the coordinator and a number of committee members. Title V grant is among the part-time Public Health Nurses (PNHs) funded by the Maternal Child Health. It abstracted data and hosted meetings twice every year. The Case Review Team conducts reviews for case summaries, highlights issues, and recommends various changes in the community whenever necessary. In the team are a variety of representative drawn from the nurses, genetic counselors, university professors, coroners, physicians, bereavement counselors and others in the community. Most of the infant and fetal deaths reported in Warwick and Vanderburgh counties were reviewed to incorporate two local hospitals, which offer obstetrical services.

Full time PNHs with Bachelor degrees of nursing alongside community health workers went to client homes to execute the key health functions of assessment, assurance, and policy development. The nurses assisted residents within the county of all ages in accessing resources to promote and maintain their highest health levels. The home visits paid particular attention to demonstrating to individuals and families the various ways of improving their lifestyles depending on the needs of the clients. They did this through teaching and providing educational information on a wide range of topics such as parenting skills, pregnancy, wellness, lifestyle changes, normal growth and safety.

Essential Service 5

This essential service is about developing policies and plans that support individual and community health efforts. Accountability is at the heart of public health programs because most of these are funded partially by Federal dollars. For this reason, public health programs document their progress towards any positive changes in health status indicators or health behaviors. Data of this nature can be tabled before policymakers to ascertain a programs value or effectiveness. Such data can then be resourceful in program modification and continued planning. Activities here are very important. Firstly, there should be leadership development across all levels of the system. Secondly, there should be systematic community level planning for health improvement. Thirdly, measurable health objectives should be developed and tracked as part of strategies for progressive quality improvement. In addition, joint evaluations should be conducted with the medical healthcare system to define policy concerning treatment and prevention services. Lastly, codes, regulations and legislation should be developed to guide public health practice.

Vanderburgh Health Department did not demonstrate compliance with this essential service in entirety. However, its vital records and financial statements showed some higher level of accountability for the public funds spent. These records could help the County formulate key policies to govern various health programs. On the other hand, the County had distinct measurable health objectives that could be achieved easily through calculated and well-managed approaches. For instance, the Vision 2020 Healthy People objective could form a terrain through which the County capitalizes on opportunities and resources to deliver quality health services to the public.

Section B

The Vanderburgh Health Department has proven to observe most of the essential services as recommended by the IOM. However, certain obvious obstacle prevented the Department from achieving its clear set goals. These include, among other things, the failure to utilize partnerships with other Counties and agencies to achieve quicker results. Moreover, the Department had fewer staff to implement various programs on large scale. Certain programs took long to complete and were implemented in a smaller geographical or population coverage.

To surmount these challenges, the Department needs to factor in certain recommendations. Staffing is key to the delivery of healthcare services at all levels (Mando & Saleh, 2014). Good staffing could be the difference between deteriorated services and world-class services. The Department should employ more staff to boost the implementation of its programs. Nurses, physicians, and counselors should be employed in large numbers. Although this would mean an increased wage burden, the kind of services offered will improve a great deal and public satisfaction will be heightened. Moreover, the workload will be spread among many workers hence eliminating fatigue and stress that cause poor performance among staff.

The Department should also capitalize on partnerships with other Departments and agencies. Partnerships have been proven to help healthcare providers pull their skills and expertise together, which bring about positive results. Through partnerships, the Department can learn new ways of solving problems. It can also sail through difficult financial times by spending the collective monetary resource of the partnership. Moreover, partnerships bring new ideas of health practice such as vaccination, treatment methods, and various equipment.

Conclusion

The Essential Services as put forth by the Institute of Medicine have continued to revolutionize healthcare provision in America. Health Departments have utilized most of the provisions, especially the public health providers out of fear of negative consequences that may arise. This paper has analyzed and assessed the applicability of five essential service principles to the Vanderburgh Health Department. Findings have revealed that the Department adheres to most of the provisions of the report save for a few areas that have posed challenges. These challenges have been identified as absence of partnerships and staffing shortages. Recommendations have been put forward to the effect that partnerships should be formed to boost knowledge and practice base. On the other hand, an expansion of staff has been found to benefit the Department a great deal, because programs will be implemented faster in a stress-freer way. Vanderburgh and other US Health Departments should maximize on the essential services if healthcare delivery in the US is to transform.

References

Mando, J. and Saleh, G. (2014). Overcoming the Challenges in Public Health. Retrieved 4

February 2015 from HYPERLINK http://www.lean.org/LeanPost/Posting.cfm?LeanPostId=136 http://www.lean.org/LeanPost/Posting.cfm?LeanPostId=136

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Vanderburgh County (2015). Vanderburgh County Health Department Annual Report. Retrieved

4 February 2015 from HYPERLINK http://www.evansville.in.gov/index.aspx?page=2041 http://www.evansville.in.gov/index.aspx?page=2041

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