Final Report of the Public Health Support Workgroup To the Executive Leadership Group

June 4, 1999
(Revised September 1, 1999)

EXECUTIVE SUMMARY

It is imperative that a national public health presence continues, and that it be enhanced in specific functions. However, the traditional model of finding solutions for local problems at a national level is no longer valid, nor is the belief that any national function in Indian public health can only be provided by I H S. I H S, tribes, or Indian organizations possessing the necessary competencies could carry out the majority of the national functions. Regardless, adequate resources need to be preserved for these purposes, even with additional assistance from other entities.

The Executive Leadership Group (E L G) gave the P H S W G five charges. The first two charges required the identification of an appropriate model to ensure continuation of public health services to direct, compacted and contracted tribal organizations. The P H S W G created a matrix of public health responsibilities to be carried out at the local, regional and national service levels that address these essential public health services. This matrix was based upon the ten essential public health services identified by the D H H S Public Health Functions Steering Committee. The P H S W G recommends that these defined responsibilities be met at their respective levels.

The maintenance of a national public health infrastructure is a critical element in the Workgroup’s response to charges one and two. Using the above-mentioned matrix, the P H S W G identified the necessary national services and type of staff to meet each role, as well as an estimate of the public health residual. While recognizing that the I H S remains underfunded to fully carry out its mission and goal, the Workgroup proposes this mix as the absolute minimum staff required to maintain the public health infrastructure at the national level. In order not to be misinterpreted, these recommendations must be considered only in conjunction with the assumptions and conditions that accompany them.

The third charge required the identification of critical health data to assess and track public health. If the Agency does not adequately maintain information systems, it will not be able to maintain an effective public health system. Acknowledging the maxim that what gets measured gets done, the PHSWG designed a dynamic data collection model. This model maps the recommended minimal data elements for specific reporting requirements and/or advocacy needs. The Workgroup recommends that this method be used to maintain and update a list of minimal data elements, and serve as a basis to negotiate ongoing reporting agreements with tribes and urban programs. Furthermore, the Workgroup recommends that the responsibility for maintaining this list for all Indian health systems be delegated to the Information Systems Advisory Committee (I S A C).

The fourth charge required the development of new models for the delivery of public health services that emphasize collaboration. The P H S W G collected and examined many current programs that are successful in this respect. There are common elements among these varied models. The P H S W G identified some of the similarities that can lead to successful implementation of a variety of community-initiated public health programs. A template is provided in the main report to serve as a guide to maximize the potential success of new programs.

The fifth charge required a process to provide for public health needs within a managed care environment. In order for a managed care program to include a public health perspective, it must have the capability to provide data collection and community driven public health services, in addition to appropriate individual care. If an I H S/Tribal/Urban (I/T/U) managed care program meets these criteria, the I/T/U delivery system can serve as an integrated community-oriented primary care model for the rest of the country. The P H S W G strongly recommends that the Agency maintain and expand its dialogue with the managed care community to promote public health concepts, and that it measure its level of needed funding by taking into account both individual and public health needs.

In December 1998, the Workgroup received an informal request (a sixth charge) from the Indian Health Leadership Council (I H L C) to amplify its original scope by making recommendations to the Internal Evaluation Team (I E T) regarding any potentially residual public health functions within IHS Headquarters in a hypothetical 100% self-governance environment. The Indian health care landscape has been changing. Tribes and tribal organizations with new competencies and capabilities will begin to provide certain functions to I H S direct care programs and Area and Headquarters offices, instead of the other way around, including some public health functions. The Workgroup not only welcomes, but also deems as essential, increased tribal and Indian organization leadership in national public health functions. Nonetheless, it was the conclusion of the P H S W G that a small amount of residual public health responsibilities and functions would remain, even in a 100% compacted environment.

The adoption of the P H S W G recommendations throughout the Agency would result in increased organizational public health competency, which should be measured, tracked and reported. Communication of this report, as well as the follow-up actions, is critical to this process. The P H S W G believes that increased sharing of information and “best of practice” models are critical to the public health future of the Indian health care system.

We would like to thank the E L G for this unique opportunity to help influence the future of public health within the Indian health system. We believe that the health status of American Indian and Alaskan Native (A I/A N) communities can and will continue to improve through improved public health competency.

Members of the Public Health Support Workgroup

Chairperson: Dr. Theresa Cullen – Clinical Director, Sells Service Unit
Dr. Eric Broderick – I H S, Office of Public Health, Rockville
Dr. James Cheek – I H S, Office of Public Health, Albuquerque
RADM Richard Church – I H S, Chief Information Officer, Rockville
Dr. Stanley Griffith – I H SS, Office of Public Health, Albuquerque
Dr. Clark Marquart – Chief Medical Officer, Portland Area I H S
Ms. Nancy Miller-Korth – Nursing Consultant, Great Lakes Tribal Consortium
Ms. Sherrianne Moore – Ponca Health Center Director
Dr. Doug Peter – Chief Medical Officer, Navajo Area I H S
Ms. Muriel Segundo, Tohono O’Odham Nation, N I H B representative
Dr. Mary Beth Skupien – I H S, Office of Public Health, Rockville
Ms. Maggie Terrance – St. Regis Mohawk Tribe
Facilitator: Dr. Mary Beth Kinney, Clinical Support Center.

Complete Executive Summary (PDF, 19 pgs. 86KB)
Executive Summary Attachment 2 (PDF, 4 pgs. 15KB)
Final Report (PDF, 29 pgs. 116KB)
Final Report Appendices A-J (PDF, 35 pgs. 124KB)
Final Report Appendix F (PDF, 4 pgs. 13KB)