Edwin Fonner,
Jr., DrPH
A One Hundred Year “Turning Radius” for Public Health? Years ago in a Wall Street Journal editorial on social change in the United State, an author asked, “what is the turning radius of a society?” As the country moves into the 21st century, we find a fragile, outdated public health system just barely equipped to deal with society’s health problems. In the face of an aging population, increasing numbers of uninsured and minorities, and other social and financial pressures, how many years will it take to adopt a population-based, preventive paradigm and implement needed changes? As Barry Levy, past president of the American Public Health Association said, “life can be understood backward, but must be lived forward.” Fifty years from now society may see the benefits of public health and preventive approaches. Will it be too late?
Grant History. The initiative underlying this document is another stop in a ten year history of advocacy for public health improvement planning in the U.S. Beginning with the Institute of Medicine report in 1988, many states have attempted to halt the slide in their public health infrastructures. Kansas has made similar attempts with the publication of Protecting and Promoting the Health of Kansans: Kansas Public Health System Study in 1991 and Healthy Kansans 2000: State Health Objectives for 2000 in 1996. Currently the Robert Wood Johnson, W.K. Kellogg, and Kansas Health Foundations have teamed up to undertake a state wide public health improvement plan for Kansas in 1998-1999. Thirteen other states are pursuing similar efforts. In Kansas, a steering committee worked from 1996 to 1997 to secure funding and set a direction for the work of the Governor’s Public Health Improvement Commission. The steering committee was comprised of leaders from state and local public health agencies, the hospital and medical community, nursing, academia, and other key stakeholders in public health.
Purpose. This synopsis of the state of public health in Kansas is meant for non-technical readers concerned with the health of the public in Kansas. It addresses how well-equipped state and local governments and other organizations are to protect health and prevent illness. This document fulfills the charge to develop a public health improvement plan for Kansas. A second document will focus on the state’s public health improvement plan. It will contain a set of recommendations for state wide progressive change to enhance delivery of public health to Kansans.
The Governor’s Public Health Improvement Commission hopes this document will lend momentum to the change process. A call is being issued for the leadership and the political will to tackle the challenges lying before us. Change occurs most successfully within a window of opportunity. We feel that we have such a window now and urge readers to respond in a timely manner.
The Commission and its staff wish to thank participants of eight task forces, technical assistants, and others for their willingness to share information on the system of public health in Kansas. Your input has helped us improve our collective understanding and make a great stride toward accomplishing our objectives.
Executive Summary
Health Status – The health of Kansans is the same as the U.S. average and the U.S. is no longer a standard of excellence. Population-based health problems in Kansas are likely to increase due to aging, growing numbers of uninsured, and increased immigration by minority groups. In addition to the lack of attention to current, unaddressed needs, there are significant gaps between the health status of minority groups and the general population.
Effective Delivery of Services – Many local health departments are under stress and not able to effectively provide adequate on-going surveillance, policy planning, and assurances of care. The state’s system for delivering health services is highly fragmented and varies considerably from one community to another. Most local health departments serve very small population bases. As presently structured, the state’s health care system is not able to reduce the existing level of disease and social problems in the population. Public health organizations have limited capacity to turn this around.
Finances – Local health departments operate on a shoe string budget due to limited support from county and state government. Local public health organizations are experiencing declining fee income from delivery of personal care services. Large portions of state agency budgets lack flexibility and have restricted uses. This lack of flexibility is due to limited funding from the state general fund and is a serious impediment to innovation. The flow of funds from federal to state and local health organizations is complex and administratively burdensome. Incentives must be developed to promote health along with more resources for disease prevention.
Information Systems – There is lack of agreement on a minimum data set. Basic indicators broadly useful for defining health are not available. There is a need for more information sharing across organizations, both state and local. Limited data are available to help local decision-makers, legislators, and other leaders develop a clear picture of population health and set priorities. There is no framework for unifying information systems and data across organizations. Networks, hardware, software, data are not integrated. Many organizations lack basic equipment, skills, and have little if any local data.
Workforce – Many public health organizations are shorthanded. While the state’s MPH and MHA programs are making headway, staff need more accessible, and affordable basic public health and continuing education. There is a “disconnect” between local public health organizations and their county commissioners and state agencies. Technical assistance from state to local entities is limited or non-existent. Public health wages, especially in some rural areas, are well below the norm.
Communications – Due to specialization, health professionals are isolated from one another and everyone “speaks a different language.” Collaboration across organizations, communities, and professional groups is limited, so problems aren’t addressed comprehensively. There are no on-going state wide health “summits” spanning multiple professions in Kansas where information is exchanged and priorities set. Partnership development in Kansas, both at state and local levels, is for the most part undocumented. Most groups that meet on a voluntary basis operate without budgets, professional facilitation, and often on “single intervention” initiatives.
Policy Development in Public Health – There is no long-term policy-making process in Kansas where objectives are set, time frames established, and methods for approaching solutions detailed. Public health functions are not well understood and operate in relative obscurity. Public health voice is not normally included in discussions on health care reform. There is an absence of a coordinated strategic planning process at local, regional, and state levels, and between public and private organizations. Improvement is needed in the process of formulating policy to address health and social issues needs, and implement good ideas.
Leadership – Many of the challenges facing public health in Kansas have been exacerbated by turnover of senior managers. Minority leaders need better representation in local health care decisions. Executives in health organizations have a limited understanding of “best practices” used by business to re-engineer, remain competitive, and manage organizations effectively. [Back to Main Page]