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Across the nation, constant improvement in public health is carried out via continuous cycles of assessment, planning, action, and evaluation. Nationally, assessment efforts such as the County Health Rankings help determine health issue areas for celebration and improvement. Likewise, the National Public Health Performance Standards Program structures assessment of our ability to provide essential health services. Initiatives like the Center for Disease Control’s Winnable Battles identify focus areas for planning efforts. Healthy People 2020 and similar efforts orient action and evaluation efforts by providing baseline measures, standards and goals to which to aspire, and indicators to measure progress. At the state level, the Colorado Public Health Act was signed into law in 2008 to assure that core public health services are available to every person in Colorado with a consistent standard of quality. The state of Colorado has developed a comprehensive public health improvement plan that outlines how quality public health services will be provided. At the county level, the Colorado Public Health Act also mandates that each local health department conduct a community health needs and system capacity assessment and develop its own corresponding local public health improvement plan. At the agency level, BCPH develops operational plans for each program that respond to the local, state, and national needs and capacity. Further, over the next few years, BCPH will develop an agency strategic plan and will apply for accreditation as a local public health department. The operational name for these nested processes is the Public Health Improvement Process, or PHIP. The various PHIP cycles span periods of one, five, and ten years. PHIP requires closely- coordinated work at the state and county levels to develop health improvement plans. 2
At the same time that the nation and the state move forward with public health improvement, Boulder County moves forward with our PHIP. Here’s our “road map.” • Essentially, we assessed health needs, then assessed the capacity of our health system to address those needs. • We then chose a few focus areas on which to concentrate system-wide health improvement efforts over the next few years. • Now, we’re ready to engage the community in unified, integrated strategic planning around those focus areas. • After that, we’ll take action. • We’ll close out the cycle by evaluating how we are doing. • Every 5 years, we start the cycle over again. 3
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To identify our top health needs, the idea was to draw on existing literature and experience, secondary data (no primary data collection this time), and staff and community partner expertise to first define the broad realm of health issues and subsequently to whittle those down to a manageable number of issues, for each of which we could explore the local data behind it and use a transparent process to prioritize them to yield a small number of health improvement focus areas. How did we do this? First, given the plethora of health issues, the size of our health system, and the intricacies of prioritization, we hired consultants: Primetime Research & Evaluation. This was a key decisions, as it allowed us to come to the table and sit next to our community partners and listen and contribute to the discussion rather than directing it. Primetime did an archival and literature review on the public health improvement process at the national, state, and local levels, of tools available for this task, of means of prioritization, etc. They conducted one-on-one and group interviews with staff and community partners. In this process, Primetime engaged more than 200 people representing over 50 entities in our local public health system, many of which are represented here today. At the same time that Primetime reached into our community, an internal BCPH team reached into the data. We studied the range of health issues and focus areas at the national, state, and local levels. We looked at everything from the CDC’s 6 winnable battles to the state health department’s focus areas, to local strategic planning efforts. We were able to assemble a list of 40 broadly-recognized health outcomes that Primetime then took back to staff and community for your thoughts. Primetime collected input on these 40 issues as well as other health issues that arose, and analyzed it in both quantitative and qualitative terms. This analysis yielded recommendations for 7 potential health improvement focus areas. 5 5
Mental health, substance abuse, unplanned pregnancy, and obesity were recommended based on the community input. Cancer, heart disease, and unintentional injury were recommended as these are the top 3 causes of death in Boulder County. Further, Primetime urged us to adopt mental health and substance abuse due to the very broad and deep staff/public sentiment about the need in these areas. Because it can take significant time, resources, and support to impact health trends, we voted to take on just three focus areas. An internal BCPH team studied the quantitative and qualitative data collected from literature, staff, and partners, and were tasked with prioritizing the 7 recommended areas on the basis of: • the number of people they impact • the degree to which they cause poor quality of life and death • the degree they are perceived as serious health issues among our staff and community stakeholders • the degree to which they are actionable (there are existing, demonstrated practices that could improve outcomes) [Additional notes on each focus area if necessary.] Mental Health: Almost everyone interviewed identified Mental Health as a top health issue area and indicated that they felt current resources were inadequate to meet the need in Boulder County. Discussion of the impact of mental health on physical health, as well as the wide spread impact depression and other mental health problems have on those around the sufferer were also mentioned. Substance Abuse: People also agreed that substance abuse was an issue in Boulder County. Many people felt that this fell under mental health; many others identified it as a separate issue. Again, the primary feeling was that there were drastically limited resources compared to the need they see within the county. Unplanned and Teen Pregnancy: This was mentioned by many as a fundamental problem that needs to be addressed due to major consequences for the parents and children involved and for the county and its monetary output in services for these families. In addition, this was frequently cited as an underlying issue for many of the health problems on the outcomes list and was directly connected to both mental health issues and substance abuse. Obesity: This was identified as a major health concern despite its absence from the original list of outcomes. Most people felt that this was an underlying cause of most of the health outcomes on the list presented to them. They also felt that this was an area that was specifically a problem in East Boulder County and among the Latino population, and that it is an important one to address in order to improve communitywide health. 6
From the 7 issue areas brought forth by Primetime, BCPH identified 3 focus areas for system-wide public health improvement in Boulder County: mental health (including depression and suicide), substance abuse, and obesity (healthy eating and active living, aka HEAL). These 3 focus areas do not necessarily aligned with any one single program or organization; rather there is overlap between programs, divisions, and the work of our community partners. Rather than replacing programs, these focus areas complement ongoing health and wellbeing work by providing a system-wide, unified focus for the next 5 years. Focus areas will help us to integrate services, activities, and communication between programs and partners. Our goal is to see county-level improvements in these focus areas within the next five years. As you’ve heard, these focus areas are both the recommendation of the local public health system and the shared responsibility of the system, including BCPH and all who work to improve health in Boulder County. So, if moving the needle on these focus areas is a shared responsibility of our public health system, the next thing we needed to know is what our system capacity is to address public health needs. Simultaneous with the health needs assessment then, was a health system capacity assessment. Again, Primetime helped us out. 7 7
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