Lehigh Valley Board of Health
Presentation to the
Health Commission
October 17, 2011
Members of the Board of Health
David K. Bausch
Robert B. Black, M.S.
Eric J. Gertner, M.D., M.P.H.
Carol A. Kuplen, R.N., M.S.N.
David T. Lyon, M.D., M.P.H.
Ilene S. Prokup, M.S., R.N., PHCNS, BC
John F. Reinhart, M.Ed.
Halyna I. Stegura, R.N., M.S.N.
Vicky Kistler, M.Ed., Ex-Officio
Judith K. Maloney, J.D., M.P.H., Ex-Officio
Public health problems …
EVERYDAY
Vicky Kistler, M.Ed., Director,
Allentown Health Bureau
The Lehigh Valley is
NOT healthy.
County Health Rankings
• Lehigh County —
37/67 Pennsylvania Counties
• Northampton County —
60/67 Pennsylvania Counties
Low birth-weight babies
• Northampton County —
62/67 Pennsylvania Counties
Obesity
• Lehigh County — 26% of adults
• Northampton County — 30% of adults
Physical environment — Air quality
• Lehigh County —
54/67 Pennsylvania Counties
• Northampton County —
57/67 Pennsylvania Counties
The Lehigh Valley is
NOT healthy …
And we deserve better.
More than 2/3 of the Lehigh
Valley’s citizens have inadequate
access to public health services
The public wants regional
public health
Community Survey
• Muhlenberg College Institute of Public Opinion —
Dr. Christopher Borick
• Spring 2011 Quality of Life Survey
• Demographically representative of the residents
of the Lehigh Valley
• 68% of respondents supported the establishment
of a regional health department
48 community organizations
have committed their support to
the establishment of a regional
health department …
AIDSNET
American Red Cross of the Greater Lehigh Valley
Area Health Education Center (AHEC)
Cancer Support Community of the Greater Lehigh Valley
(formerly the Wellness Community)
Casa Guadalupe
Center for Humanistic Change
Children's Coalition of the Lehigh Valley
CJW and Associates
Community Action Committee of the Lehigh Valley
Community Services for Children
Connections for Women
Discover Lehigh Valley
(formerly Lehigh Valley Convention and Visitors Bureau)
(CACLV)
Dorothy Rider Pool Health Care Trust
Easton Weed & Seed Health Committee
Family Connection of Easton
Greater Lehigh Valley Chamber of Commerce
League of Women Voters of Lehigh County
League of Women Voters of Northampton County
Lehigh Carbon Community College
Lehigh County Conference of Churches
Lehigh County Medical Society
Lehigh County Senior Center
Lehigh Valley Academy of Family Physicians
Lehigh Valley Association of Independent Colleges
(Cedar Crest College, DeSales University, Lafayette College,
Lehigh University, Moravian College, Muhlenberg College)
Lehigh Valley Community Foundation
Lehigh Valley Economic Development Corporation
Lehigh Valley Nurse Practitioners' Association
Lehigh Valley Partnership
Methodist Services for Children & Families
National Association of County and City Health Officials (NACCHO)
Neighborhood Health Centers of the Lehigh Valley
New Directions Treatment Services
Northampton Community College
Northampton County Medical Society
Partnership for a Tobacco-Free Northeast Pennsylvania
Pennsylvania Association of School Nurses and Practitioners
Pennsylvania Public Health Association
Planned Parenthood of Northeast Pennsylvania
The Public Health Faculty of East Stroudsburg University
Slate Belt Communities that Care
Slate Belt Chamber of Commerce
Slater Family Network
Two Rivers Health and Wellness Foundation
United Way of the Greater Lehigh Valley
University of Pittsburgh, Center for Rural Health Practice
University of Pittsburgh School of Public Health
Weller Center
What will the
Lehigh Valley Department of Health
look like?
Lehigh Valley Health Department Clinical Sites
Bangor
Easton
Slatington
Bethlehem
Allentown
Personal Health Services
July 2012–July 2013
Chronic Disease Prevention Programs
Expected number of people served: 31,000
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Cancer prevention
Heart disease prevention
Osteoporosis prevention
Tobacco cessation and prevention
Nutrition education
Maternal and Child Health
Promotion Programs
Expected number of people served: 7,100
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Child/adolescent advocacy, home visitation
Childhood lead poisoning and prevention
Dental health
Teen pregnancy prevention
Child death review
Healthy woman program
Communicable Disease Control
Expected number of people served: 59,100
• Communicable disease investigations
• Community immunizations
• TB/STD/HIV/AIDS
Total Personal Health
Services Staff
5,100
33,000
21,000
60
Environmental Health Services
July 2012–July 2013
Food Protection Program
Expected inspections: 7,500
• Establishment inspection/licensing
– Food service establishments
• Temporary
• Mobile
• Retail
– Vending machines
• Food-borne disease surveillance
and investigation
• Food safety training and public awareness
Environmental Control
Expected inspections: 9,200
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Housing hygiene and sanitation
Lead source reduction
Vector control
Noise control
Indoor air quality
On-lot sewage disposal
Pollution incident response
Public health nuisances
Health Bureau Staffing Summary
Personal Health Services
Environmental Health Services
Health Bureau Physician Director,
Management, Quality Assurance
and Support
Total staff
60
32
12
104
Institutional Sanitation
Expected inspections: 1,500
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Child-care facility inspection
Public bathing place sanitation
School sanitation
Long-term care facility inspection
Total Environmental Health
Services Staff
32
Financial Plan
Lehigh Valley Health Department
Major Budget Assumptions
• Bethlehem and Allentown opt-in to new
bi-county health department
• Start date — July 1, 2012
• Current Allentown and Bethlehem staffs will be
retained in comparable positions and with
comparable benefits
• The counties will approve the Health
Department budget and service levels
annually through the Health Commission
Major Budget Assumptions
• Salaries will be increased at 2% per annum for
budget purposes
• Needs assessment will start immediately and
regional “satellite” offices will be established
• The Health Department will continue to receive
in-kind services from health care providers,
in the form of lab tests, x-rays, materials,
clinical personnel, etc.
Lehigh Valley Health Department
Expense budget for first full year — 2013
Salaries and Benefits
$7,469,549
Operations
$2,131,615
Total Expense
$9,601,164
5% less than previous budget proposal
Incremental budget increase of $4,344,242
over combined Allentown and Bethlehem
2010 budgets
• 104 full-time employees (FTEs) — an increase of
40 FTEs over Allentown/Bethlehem 2010 levels
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Lehigh Valley Health Department
Funding sources
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PA Act 315 @ 4.11 per capita (of 6.00 p.c.available)
PA Act 12 and Act 537 (Sewage Facilities Act)
Cities (ABE) contributions @ 3.75 per capita
Community contributions
In-kind services from local health providers
Categorical grants
Fees
County contributions — fixed at $450,000 each
through FY2016
Lehigh Valley Health Department Comparisons
with 3rd-Class Pennsylvania Counties
Alberto Cardelle, MPH, Ph.D.,
East Stroudsburg University
Grant from Two Rivers Health
and Wellness Foundation
Are communities served by public
health departments healthier than
those which are not?
YES
53 Pa. Counties Without
Health Departments have
significantly lower health
rankings than 322 U.S.
“Peer” Counties With
Health Departments
Counties with local health departments . . .
64th percentile in Pa. Health Outcome Rankings
Peer Counties without local health departments . . .
37th percentile in Pa. Health Outcome Rankings
New Study by Mays and Smith Shows Increased
Public Health Spending can Save Lives
Mortality rates
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Percent change per
10% increase in spending
Infant deaths per 1,000 live births
Heart disease deaths per 100,000 population
Diabetes deaths per 100,000 population
Cancer deaths per 100,000 population
-6.85%
-3.22%
-1.44%
-1.13%
Asthma Impact is Significant
• Annual cost to U.S. — $20 billion
• Average annual cost to asthma sufferers — $3,300 each
• Pa. asthma patients have over 10,000
hospitalizations per year
• 60% of children and 35% of adults with asthma miss
school or work on the average of 12 days a year
• Conservative estimate: $27 million in annual loss of
income to Lehigh Valley asthma sufferers
Public Health Education
Interventions will Help
• Examples: medications, asthma triggers,
self management/monitoring techniques
• Example of successful intervention: Gallefross, 2011
– $122 cost per adult to administer
– 71% reduction in loss of work days
• Targeted intervention administered to 5,000 LV adults:
– Cost:
– Savings:
– ROI:
$600 thousand
$3.7 million (in lost work days @ 25% percentile income level)
478%
Cardiovascular Disease (CVD)
• Accounts for 1 of every 2.9 deaths in the U.S. — one death
every 39 seconds
• Total costs in U.S. estimated at over $500 billion per year
• Heart disease leading cause of death in PA — over 26% and
over 40,000 deaths a year
• In LV, over 120,000 adults suffer from hypertension and
60,000 from CVD — 15,000 are hospitalized per year
• LV sufferers miss over 400,000 workdays each year at a
cost of over $15 million
Public Health Prevention
Programs will Help
• Education-based programs to alter knowledge and attitudes
• Teach skills to make behavioral changes for a healthier lifestyle
• Conservative example: Farquhar Program – 1990
– Cost to administer: about $20/adult
– Result: 16% reduction in prevalence of CVD
and associated lost work days
• Prevention program administered to 10,000 LV adults
– Cost:
– Savings:
– ROI:
$200,000
$1.1 million
480%
(in reduced lost work days only)
Numerous Studies have Shown
That Every Dollar Spent on
Prevention Yields As Much As $20 in
Reduced Health Care Costs
East Stroudsburg University
Economic Impact Analysis
Using multipliers established by the
U.S. Department of Commerce, Bureau of Economic Analysis
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Net Additional Spending
Net Additional Employees (FTEs)
Total Economic Impact
Total New Jobs Created
$4,344,242
40
$7,895,225
85
A bi-county health department will . . .
• Create a healthier Lehigh Valley and improved
quality of life
• Be the first ever in Pennsylvania
• Extend public health services to over 450,000
Lehigh Valley citizens (over 2/3 of the population)
• Provide over $9.6 million in services annually by
leveraging $450,000 in County contributions, a small
fraction of both county budgets
A bi-county health department will . . .
• Provide a strong return on invested public dollars
through effective disease prevention/health
promotion programs
• Insure that all local restaurants are inspected at
least annually
• Provide a comprehensive, coordinated response
to a communicable disease outbreak, natural disaster,
or other public health emergency
• Inject nearly $8 million into the LV economy and
create 85 new jobs