Health boards support legislative agenda to change how public health is delivered and paid for, to make Kentucky healthier

By Melissa Patrick
Kentucky Health News

At their first-ever statewide meeting, Kentucky’s local boards of health voted for their state association to adopt a legislative platform aimed at modernizing the state’s public health systems in order to improve Kentucky’s overall health.

The “Kentucky’s Public Health 3.0” plan calls for local health departments to demonstrate measurable outcomes, a supportive framework of state laws, and secure funding for all the services the law requires them to provide. The goals match the recently launched national Public Health 3.0 initiative.

During the online meeting Jan. 12, former Pendleton County judge-executive Henry Bertram, the president of the Kentucky Association of Local Boards of Health, implored board members to support the plan as a way to improve the health of Kentuckians and to better use taxpayer dollars: “We’re not spending our money correctly.”

“It’s a call to action,” said Bertram, who has been a member of his local health board for 16 years. He added, “The biggest voice in Kentucky for public health is the board members. . . . And I say that because many of you are elected officials that sit on those boards of health. You’re county judges, you’re magistrates,” and medical professionals. “You’ve got a voice in your community.”

Bertram went on to say that while Kentucky has some excellent local health directors, “Many of us who sit on local boards of health don’t know what our responsibilities are.” He said that when he became judge-executive, he didn’t even know that he was on the health board by virtue of his office.

He said it is the responsibility of health board members to fully understand why Kentucky’s health is so poor and be able to explain why change is necessary.

“We’ve got to step up; we’ve got a challenge in front of us and we’ve got to hit it head-on,” he said.

The plan has also been endorsed by the Kentucky Public Health Association and the Kentucky Health Department Association.

What exactly is Public Health 3.0?

Georgia Heise, health director for the Three Rivers District Health Department in Northern Kentucky, opened the meeting by stressing that Public Health 3.0 is a “grass-roots initiative” meant to improve the health of Kentuckians, not part of “Obamacare.” She said in a telephone interview that such a false perception could cause some people, including legislators, to not even listen to the proposal.

“We have to separate population health, the health of our citizens, from politics. We have to. We cannot continue to do the same old, same old thing and expect different results,” said Heise, who is also the president of the National Association of County and City Health Officials.

Graphic from Kentucky Health Departments Association presentation

Heise said people must first realize that “public health is not clinical, medical care,” but is grounded in prevention through population-health initiatives.

“The work that has already been done with this initiative can be explained and it can be defended and that is what we need you board of health members to help us do with our legislators,” she said.

Dr. Karen DeSalvo, acting secretary for health in the U.S. Department of Health and Human Services, appeared via video recording and commended Kentucky for leading the way with this initiative. She focused her comments on the plans call for health departments to join forces with community stakeholders to address the social determinants of health, because “We know that health is more than health care. . . . Our goal is to change the conversation in this country and get every sector involved in improving health and well-being.”

For example, health department officials should be included in planning and zoning meetings to make sure newly developed properties include sidewalks, said Allison Adams, director of the Buffalo Trace District Health Department and the KHDA president. Health officials should advocate for “health in all policies,” she said.

Adams noted that social and economic factors, such as education, employment, income, family and social supports, and community safety, contribute to 40 percent of a typical person’s health, and “none of those things happen inside the walls of the health department. . . . But it’s our job to be conveners of bringing these groups that affect these health factors together and letting them know . . . decisions they make and the things they do, how that influences health and the opportunity to be healthy.”

The plan also calls for public-health leaders to be the chief health strategists in their communities; encourages health departments to work toward national accreditation; and calls for increased county-level health data so they can make more informed decisions.

What state law requires each Kentucky health department to do
(Click on image to view a larger version)

At the state level, the plan calls for “enhanced and substantially modified funding” for public health. Adams said it is largely funded programmatically, but departments get “very little funding” for their statutory requirements, the things that state law requires them to do. She estimated a $40 million gap between funding and what it costs to meet the requirements.

“There’s no doubt about it, our funding needs to be modified,” Adams said. “We need to figure out a way to spend $1 that affects 10 people, instead of $1 that only affects one person.” But she acknowledged, “Change is never easy. There will be difficult decisions to make.”

But as she described Kentucky’s dismal health statistics, noting that the state ranks 45th for health, she said it’s time to do something differently, because what we’ve been doing isn’t working.

“My goal is for us across the state of Kentucky to get as angry about the fact that we are 45th in the nation as we would when our basketball teams fall out of the top 25,” Adams said. “I think if we could all get angry about that, we could move mountains here in the state of Kentucky.”

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