Public Health in Minnesota
Considerations for Shared Governance Structures
www.health.state.mn.us/sslc
Minnesota Department of Health
“Humankind has not woven the web
of life. WE are but one thread within
it. Whatever we do to the web, we
do to ourselves. All things are bound
together. All things connect.”
Chief Seattle
Today’s Agenda
• Minnesota Public Health Structure
• Statutory Responsibilities
• Challenges and Opportunities
Definitions of Public Health
“Public health is what we, as a
society, do to collectively assure
the conditions in which people
can be healthy.”
Institute of Medicine
Definitions of Public Health
“Public health is the science
and art of disease prevention,
prolonging life, and promoting
health and well-being through
organized community effort.”
CEA Winslow (1877-1957)
Public Health Impact
Life expectancy at birth, United States, 1900-1998
90
80
Age
70
60
Female
50
Male
40
1996
1993
1990
1987
1984
1981
1978
1975
1972
1969
1966
1963
1960
1957
1954
1951
1948
1945
1942
1939
1936
1933
1930
1927
1924
1921
1918
1915
1912
1909
1906
1903
1900
30
25 of the 30 years of life gained in the 20th century
resulted from public health accomplishments!
Ten Greatest Public Health Achievements
United States, 1900-1999
• Vaccinations
• Motor vehicle safety
• Safer workplaces
• Control of infectious
diseases
• Fluoridation of drinking
water
• Safer and healthier foods
• Healthier mothers and
babies
• Family planning
• Decline in deaths from
heart disease and stroke
• Recognition of tobacco use
as health hazard
Levels of Government
US Capitol Building
Minnesota State
Capitol Building
Label
Public Health and the Supreme Court
“The preservation of the public
health is one of the duties
devolving upon the state as a
sovereign power, and cannot
be successfully controverted or
delegated. In fact, among all
the objects to be secured by
government laws, none is more
important than the
preservation of the public
health.”
Schulte v. Fitch, NW 717, 1925
Protecting the public’s health
is so basic, and the
consequences of not
protecting the public’s health
are so serious, that both the
state and federal constitution
contain provisions to ensure
this protection.
Minnesota Department of Health
Protecting, maintaining,
and improving the health
of all Minnesotans.
Federally Recognized
Tribes in Minnesota
■ Anishinaabe ■ Dakota
Bois Forte
Lower Sioux
Fond du Lac
Prairie Island
Grand Portage
Shakopee
Mdewakanton
Leech Lake
Upper Sioux
Mille Lacs
Red Lake
White Earth
Origins of County Public Health Nursing
State Boards of Health (c. 1950)
1. Creation of the boards was
encouraged
2. Purpose:
• Assess health
• Create policies to prevent
communicable diseases
• Assure sanitary conditions
Boards of Health
Before 1976
Community Health Act (1976)
Community Health Services System (CHS System)
• Community involvement
• Local control
• Integrated statewide system
• Adequate population base / economies of scale
• Funding, with multi-county incentive
Purpose of CHS System
“’Community health services’ [denotes] activities
designed to protect and promote the health of the
general population within a community health service
area by emphasizing the prevention of disease, injury,
disability, and preventable death through the
promotion of effective coordination and use of
community resources, and by extending health
services into the community.”
Minn. Stat. § 145A.02, subd. 6
(Local Public Health Act)
Community Health Boards in Minnesota
c. 2015
Minnesota’s
State-Local Partnership
Considerations for Shared Governance Structures
www.health.state.mn.us/sslc
Minnesota Department of Health
State Community Health Services
Advisory Committee (SCHSAC)
STATE
COMMUNITY
HEALTH
SERVICES
ADVISORY
COMMITTEE
• Hallmark of Local Public
Health Act
• Advise Commissioner of
Health
• Representatives from each
community health board
• Work performed by
workgroups
Local Public Health Act of 1987
• Minnesota Legislature further clarified roles and
responsibilities of the state and local public health
system
• Replaced the Community Health Services Act with the
Local Public Health Act, also known as Minnesota
Statute § 145A
• Focuses accountability for funding on set of statewide
outcomes
Local Public Health Act of 2014
• Again modified to clarify public health responsibilities
and accountability
• Eliminate unnecessary and obsolete language
• Align statute with current public health practices
• Require community health boards to engage in
performance management
Elected Official’s Public Health
Responsibilities
• Policy development
• Resource stewardship
• Legal authorization
• Partner engagement
• Continuous improvement
• Oversight
Local Public Health
Assessment and Planning
Considerations for Shared Governance Structures
www.health.state.mn.us/sslc
Minnesota Department of Health
Minnesota Local Public Health Assessment and Planning Process
Assess
Organizational SelfAssessment
Community Health
Assessment
Three Standards Most in
Need of Improvement
DELIVERABLE
DELIVERABLE
Prioritize
Ten Most Important
Community Health
Issues
Plan
Quality Improvement
Planning Process
DELIVERABLE
QI Plan
Organizational Strategic
Planning Process
DELIVERABLE
Strategic Plan
Community Health
Improvement
Planning Process
DELIVERABLE
Implement
Implement Plans ■ Monitor Progress ■ Revise Plans as Needed
CHIP
Areas of Public Health Responsibility
in Minnesota
• Assure an adequate local public health infrastructure
• Promote healthy communities and healthy behaviors
• Prevent the spread of communicable disease
• Protect against environmental health hazards
• Prepare for and respond to emergencies
• Assure health services
Essential Public Health Services
In Minnesota, these
services refer to activities
that are conducted to
accomplish the areas of
public health responsibility.
Examples: Assure an Adequate Local
Public Health Infrastructure
• These planning meetings
• Agency strategic planning process
• Recruiting and retaining staff with appropriate expertise
Examples: Promote Healthy Communities
and Healthy Behaviors
• Statewide Health Improvement Program (SHIP)
• Healthy Families America
• Chronic disease management
• Asthma programs
Examples: Prevent the Spread of
Communicable Disease
• H7N9 (avian influenza)
• Pertussis reemergence
• Norovirus
• Enterovirus D68
Examples: Protect Against Environmental
Health Hazards
• Regional mold plan
• Food, beverage, and lodging delegation
• Radon identification and mitigation
• Public health nuisance
Examples: Prepare for and Respond
to Emergencies
• Community planning for flu centers and ILI local
surveillance
• Mass dispensing clinics
• Vaccination promotion campaign
Examples: Assure Health Services
• MN CHOICES
• Family planning
• Early Childhood Dental Network
• Fluoride varnish
• Mental health initiatives for children and adults
Public Health Challenges & Opportunities
Challenge is a dragon with a gift in its mouth.
Tame the dragon, and the gift is yours.
Noela Evans