ASTHO Survey Results
Linked to PHAB Accreditation Domains
Jim Pearsol,
Chief Program Officer
Public Health Performance
Association of State and Territorial Health Officials
May, 2008
Executive Summary
Eighty-two percent of states and territories responded to ASTHO’s
State and Territorial Public Health Survey, which examined the
central functions of state and territorial public health agencies.
In addition to informing the Public Health Accreditation Board’s
(PHAB) standard development work, survey results will inform
the branding and marketing of public health to policymakers and
the general public, and serve as the foundation for a public
health information and analysis system.
In this presentation, survey results are linked directly to
Accreditation domains – created by PHAB and similar to the ten
Essential Public Health Services.
Background
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Survey Partners:
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Robert Wood Johnson Foundation (RWJF)
Centers for Disease Control and Prevention (CDC)
Public Health Foundation (PHF)
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Goal: Define the purposes, functions, roles and
responsibilities of state public health agencies.
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Results: 47 responses (46 states and District of
Columbia, 82% response rate)
Survey Purposes
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Describe State and Territorial Health Agency
(STHA) structure and function
Contribute to development of PHAB STHA
Accreditation Standards & Measures
Inform STHA marketing “message” to policy
makers and general public
Populate a S/T Public Health Information and
Analysis System at ASTHO
Survey Subheadings
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Respondent Information
Activities
Organization for Federal
Initiatives
STHA Descriptors
STHA Personnel
State Organizational
Structure
Agency Mission
STHA Scope of Work
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75 + survey questions
Web survey tool
Planning and Quality
Improvement
Relationship with Local
Public Health Agencies
STHA Training
Emergency Preparedness
Infrastructure
Partnership and
Collaboration
STHA Performance Activities
STHO Qualifications and
Experience
Link ASTHO Survey Results with PHAB
Accreditation Domains*
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Compiled aggregate survey results for each
item in the ASTHO Survey
Linked aggregate ASTHO survey results to
PHAB accreditation domains
Created a draft list of standards for PHAB
workgroup review and evaluation
* “Accreditation Domains” are similar to the ten
Essential Public Health Services
1. Monitor health status
STHA Epidemiology/Surveillance Activities (>90%):
98% Communicable Diseases, Injury
96% Vital Statistics, Cancer Incidence, Perinatal events/risk factors, Behavioral Risk Factors
92%, Chronic Diseases,
90% Syndromic Surveillance
STHA Electronic data exchange (>65% send and receive data):
96% Reportable diseases
92% Vital records, Lab reporting
90% Childhood immunizations
85% WIC
80% MCH reporting
75% Outbreak management
73% Geo-coded data for mapping
65% Medicaid billing
STHA Exchange information of any type (>73%) with: LHDs, Hospitals, providers, CHCs, other
HC providers, health insurers, cancer societies, emergency responders, environmental health orgs, coop ext,
schools, parks and rec, transportation, CBOs/nfps, faith-based, universities, businesses and media
STHA created a state Health Improvement Plan (HIP) using a state health
assessment (HA) (>56%)
STHA conducted an overall state health assessment (67%)
2. Protect people from health problems and
health hazards
STHA has a stronger infrastructure due to emergency preparedness
efforts (>88%)
94% Communication system, epi & surv, planning, surge
92% Workforce and relationships with other fed, state and local agencies
88% Lab services
83% Legal basis for public health action
STHA engaged in preparedness activities (>96%)
98% Bioterrorism, Natural disaster, Nuclear disaster, and Chemical disaster response
96% Explosion disaster response
STHA environmental protection activities (>48%):
92% Food safety education
83% Environmental epidemiology
70% Toxicology
69% Radiation control
60% Radon control
48% Private & Public Water Supply and Indoor Air
Assuring preparedness for a health emergency (Ranked #2, in priority
activities planned for current fiscal year – Health Reform was #1)
3. Provide people with health information
Media: STHA exchanged info (96%) or worked on joint projects (63%)
STHA increased collaboration & exchange information, last 3 years
(>47%)
55% Business
53% health insurers
51% Community health centers
49% Community-based organizations and schools
47% Other health care providers and faith communities
STHA expenditures: Non-clinical prevention (69%), clinical (31%)
STHA primary prevention services (>54%)
92% Tobacco prevention
85% Obesity
81% Injury prevention
79% STD counseling
77% HIV counseling
71% Diabetes
65% Violence prevention
58% Hypertension
54% Unintended
pregnancy
4. Engage community to solve ph problems
STHA has a strategic plan (73%)
Used MAPP in some capacity (73%) – state, reference, or collaboration
State HIP: within 3 years (56%); 3 years ago (23%); no (21%)
Plan to update HIP in next 3 years (81%)
State HIP linked to LHD HIP- yes (25%); some (27%); no (15%)
State provides policy engagement (>65%)
79% Emergency responders and Local health departments
65% Hospitals and community –based organizations
STHA works together on activities/projects (>61%): Universities, schools,
hospitals, community-based organizations, community health centers, cancer societies, faithbased, other health care providers, local health departments, health insurers, physicians,
cooperative extensions, businesses, environmental and conservation groups, media, parks and
recreation, and tribal.
5. Develop ph policies and plans
STHA has specific authority (>46%)
100% Collect health data
98% Manage vital statistics
79% Conduct health planning
77% Declare an emergency
63% License health professionals
56% Issue certificates of need
46% operate health facilities
Within past year, STHA adopted new public health regulation (83%)
Created a state HIP using a state HA (>56%)
State HIP: within 3 years (56%); 3 years ago (23%); no (21%)
Plan to update HIP in next 3 years (81%)
STHA has a strategic plan (73%)
State HIP linked to LHD HIP- yes (25%); some (27%); no (15%)
6. Enforce ph laws and regulations
Authority to adopt public health laws and regulations (STHA, 47%)
83% State legislature
44% STHA
33% Governor
21% State board of health
Educate about laws and regulations (>51%)
77% Local health departments
75% Emergency responders
67% Laboratories
56% Hospitals
50% Community-based organizations
Regulation, inspection or licensing (>52%)
77% Laboratories
73% Hospitals
71% Food service establishment
69% Swimming pools
65% Hospice and long term care
60% Lead inspection
54% Campgrounds/RVs, assisted living, other h facility
52% Body Piercing/Tattooing
STHA environmental protection activities (>48%):
92% Food safety education
83% Environmental epidemiology
70% Toxicology
69% Radiation control
60% Radon control
48% Private & Public Water Supply and Indoor Air
Other (>67%)
73% Veterinarian PH activities; 69% trauma system; and 67% IRB
7. Help people receive health services
Role of STHA in Access to health care (>25%)
85% Health disparities initiatives
81% Minority health
65% Rural health
48% Certifying authority for federal reimbursement
46% Outreach and Enrollment for Med. Ins.
40% EMS and oral health
29% SCHIP
25% Tribal health & faith-based programs
Created a state HIP using a state HA (>56%)
State HIP – last 3 years (56%); 3 years ago (23%); no (21%)
Plan to update HIP in next 3 years (81%)
Specialized MCH services (>23%)
67% CSHCN
48% WIC
42% Early intervention
29% Family planning/prenatal care
27% Non-WIC nutrition counseling
29% School health (non-clinical)
23% EPSDT
8. Maintain a competent ph workforce
Sources of STHA workforce development (rank order)
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STHA in-house training
Schools of Public Health/Public Health Graduate Programs
Federal Government
National associations
Other state agencies
Health professional agencies
STHA has a designated training coordinator (63%)
STHA provides workforce technical assistance (>29%)
73% Local health departments
69% EMR
46% Hospitals
42% Community-based organizations
29% Laboratories
STHA oversees professional licensing (>22%)
27% Nurses; 25% Physicians and PAs; and 23% Dentists
*See also ASTHO 2007 State Public Health Workforce Survey
9. Evaluate and improve ph programs
STHA maintains registries (>85%)
78% Cancer registry and Childhood Immunization
74% Birth Defects
Overall health assessments (67%)
STHA has its own quality improvement (QI) process in place
36% Fully or partially department-wide
56% Fully or partially in specific programs
19% No
STHA has a formal performance management program in place
(standards, measures, progress reports, and QI process)
42% Fully or partially department-wide
35% Fully or partially in specific programs
23% No
Created a state HIP using a state HA (>56%)
STHA provides QI/Performance technical assistance (>60%)
79% LHDs; 77% Labs; 75% EMRs; 73% Hospitals; and 60% Community-based organizations
10. Contribute to/apply evidence base
Top priorities for STHA for current fiscal year (rank order)
 Health system reform
 Assuring preparedness for a health emergency
 Assuring a local public health presence throughout the state
 Developing effective health policy
 Developing innovations in any area
 Focusing on early detection or population protection measures
 Monitoring the state’s population health
 Implementing quality improvement programs
 Other
 Attaining workforce stability
11. Manage resources
STHA has primary responsibility for federal initiatives (>50%)
96% TANF & HPSA
94% Mental Health Block Grant
92% Vital Statistics and PHHS Block Grant
90% HIV Pharmacies (ADAP)
88% Cancer prevention & control
77% Rural health & WIC
71% HRSA & CDC Preparedness
69% Healthy people
60% HIV Title V & Family Planning Title X
STHA sources of revenue
45% Direct federal funds
4% Regulatory fees
24% State (excluding pass through)
16% Medicaid
8% Other (Inter-agency transfers, other dedicated or shared funds)
STHA has authority to establish fees for services (60%)
STHA has a system for LHDs to report to state (71%)
12. Govern resources
Structure of the STHA:
58% Free-standing independent agency
40% Under a larger agency
Organizational relationship between STHAs and LHDs:
40% Decentralized control (local services provided through local gov’t or boards)
18% Mixed control (some local services provided by state and some by locals)
17% Shared control (local services are subject to shared authority of state and local entities)
15% Centralized control (local services provided through units of state)
10% No local health departments
Authority in states (highest percentages, STHA percentages)
Hire or appoint agency head: 81% Governor; 0% STHA
Approve STHA budget: 88% State legislature; 19% STHA
Adopt public health laws and regulations: 83% State legislature; 44% STHA
Establish fees for services: 85% State legislature; 60% STHA
Establish taxes (millage, levy, etc.): 85% State legislature; 0% STHA
Place public health levy on ballot: 69% State legislature; 2% STHA
Closing thoughts….
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This is just a “tip of the iceberg” report of the ASTHO
STHA survey data
Other ASTHO surveys to consider – Minority
health/health disparities survey of STHA Offices of
Minority Health (pending), ASTHO Workforce
Survey, ASTHO/NACCHO Survey of RHIOs,
ASTHO preparedness surveys, etc.
For more information, please contact: Jim Pearsol,
Lindsey Caldwell, or Michael Dickey at ASTHO
www.astho.org or 202-371-9090