Context, change, and a longer view

Robert M. Pestronk

Executive Director

National Association of County and City Health Officials

rpestronk@naccho.org

2014 North Carolina State Health Director’s Conference

January 23, 2014

•

Once…

Then…

Forces for Convergence

Jackson Pollack, “Convergence”, 1952

Perspective is important

Local health department directors and departments

Personal experience

Five Navigating relationships

Striking a balance

• the three challenges underlying local health department practice…

The first challenge

New Yorker magazine, 2012

The second challenge…

Assessment Policy development Assurance

The third challenge…

Relationships (constituency and politics)

Science

and/or

The national context: state health departments

Accessed 1/19/14, http://www.50states.com/us.htm#.UtwYd2co6P8

North Carolina within the national context

Accessed 1/19/14, http://geology.com/county-map/north-carolina.shtml

Percentage of LHDs that are Part of a Health and Human Services Agency for all LHDs and North Carolina, by Size of Population Served , and Type of Governance

All LHDs North Carolina LHDsLHD is part of HHSA 20% 12%

Size of Population Served <25,000 15% 9%

25,000—49,999 19% 13%

50,000—99,999 25% 5%

100,000—499,999 25% 11%

500,000+ 26% 100%

Type of GovernanceState 42% --

Local 12% 12%

Shared 30% --n=1,966 n=78

Source: 2013 National Profile of Local Health Departments

Percentage of LHDs where the Organizational Structure Changed within the Past Two Years for All LHDs and North Carolina, by Size of Population Served and Type of Governance

All LHDs North Carolina LHDsLHD Changed Structure

11% 12%

Size of Population Served <25,000 7% 9%

25,000—49,999 12% 13%

50,000—99,999 11% 9%

100,000—499,999 16% 15%

500,000+ 20% 0%

Type of GovernanceState 9% --

Local 10% 12%

Shared 19% --n=1,967 n=78

Source: 2013 National Profile of Local Health Departments

Percentage of LHDs with a Local Board of Health for All LHDs and North Carolina, 2010 and 2013

All LHDs North Carolina LHDs2010 2013 2010 2013

LHDs has LBOH 75% 70% 100% 87%

Size of Population Served <25,000 76% 69% 100% 100%

25,000—49,999 84% 78% 100% 81%

50,000—99,999 79% 76% 100% 91%

100,000—499,999 67% 65% 100% 85%

500,000+ 54% 50% 100% 50%

Type of GovernanceState 43% 46% -- --

Local 86% 79% 100% 87%

Shared 54% 52% -- --n=2,099 n=1,974 n=79 n=78

Source: 2010 and 2013 National Profile of Local Health Departments

Percentage of LHDs that are Local Governed with Select Local Board of Health Functions for ALL LHDs and North Carolina, 2010 and 2013*

LBOH Function All LHDs North Carolina

LHDs2010 2013 2010 2013

Advise LHD or elected officials on policies, programs, and budgets 87% 86% 94% 97%

Set policies, goals, and priorities that guide the LHD 81% 79% 95% 99%

Adopt public health regulations 79% 76% 97% 97%

Approve the LHD budget 74% 75% 77% 82%

Set and impose fees 73% 71% 77% 82%

Hire or fire agency head 65% 65% 96% 96%

Request a public health levy 39% 37% 11% 10%

Impose taxes for public health 18% 19% 0% 3%

n=1,565 n=1,371 n=79 n=67*Among LHDs with a Local Board of Health

Source: 2010 and 2013 National Profile of Local Health Department

Teutsch, IOM Roundtable on Population Health Improvement, 2013

Making use of what we know

and water

(climate, earth, air, water)

• Preparedness

The panel:

Gibbie HarrisDirectorBuncombe County Health Department

David StanleyDirector Brunswick County Health Department

Carolyn MoserDirectorPender County Health Department