From Patchwork to Package: Implementing Foundational Capabilities for State and Local Health Departments

摘要

Daily public health responses are threatened by the inadequate capacity of public health agencies. A 2012 Institute of Medicine report defined a package of foundational capabilities that support all programs and services within a health department. Standardizing foundational capabilities may help address the increasing disparity in health department performance nationally. During the Fall of 2013, we collected information on how much state and local health departments knew about foundational capabilities. To our knowledge, this was the first study to assess current health department infrastructure as it relates to foundational capabilities. The recent economic recession further destabilized the already fragile public health infrastructure in the United States. 1 Nationally, local and state health departments have lost 10%–12% of their staff since 2008 as a direct result of budget reductions and cost-saving strategies. 2,3 Although departments across the United States did not all experience losses equally, these workforce reductions exacerbated an existing disparity in public health funding, services, and staffing. 4 The continued erosion of public health agencies’ capacity across the United States threatens their ability to deliver timely clinical and population-based services, as well as address day-to-day public health needs. Although public health services have been credited with providing 25 of the 30 years of increased life expectancy in the 20th century, 5 the eroding public health infrastructure challenges our ability to maintain these gains and threatens our capacity to confront the mounting epidemics of chronic disease and emerging infectious disease. 6 In 2009, the Institute of Medicine (IOM) formed a committee to consider the structure, functions, and financing of the governmental public health system. The committee’s findings, published in the 2012 For the Public’s Health: Investing in a Healthier Future , 7 recommended a “minimum package of public health programs and services” to complement and reinforce the minimum package of clinical health care services created by the Patient Protection and Affordable Care Act (ACA). A key part of the public health minimum package was a set of foundational capabilities; these are the cross-cutting skills essential to the governmental public health infrastructure needed everywhere for the governmental public health system to work anywhere, such as disease surveillance, communications, policy development, and financial management. In short, a public health response is only as robust as the individual health departments engaged in addressing a threat; therefore, all must have the requisite capacity and capabilities for the larger public health system to function effectively. Efforts to develop and maintain these capabilities in public health departments are often unfunded despite many ongoing initiatives dedicated to supporting them. Following the IOM report, national funders and public health organizations developed the concept of a minimum package of capabilities for public health agencies into the Foundational Public Health Services (FPHS) model ( Figure 1 ). This model also incorporated the idea of “Foundational Areas,” which are core public health programs and activities. 8 The states of Washington and Ohio led groundbreaking work to define and to determine the cost of the specific skills and services that would comprise a “package” of the FPHS. 9,10 Despite the development of the foundational capability concept and FPHS model, little concrete information is available about the degree to which health departments are familiar with or are establishing or funding related services. In our study, we collected information about “how much” and “what” leaders of state and local health departments know about the concept of foundational capabilities in public health practice. These findings will be useful to policymakers and practitioners as they move from defining the concepts to securing sustainable funding for FPHS programs and services. Open in a separate window FIGURE 1— Foundational Public Health Services model. Note. HD = health department; HR?=?human resources; IT?=?information technology; QI?=?quality improvement.