what is the kansas environmental public health …...chemical, and biological agents in air, water,...
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What is The Kansas Environmental Public Health System?
Kansas Association of Local Health Departments Board Meeting
Aug. 20, 2013
Jerry McNamar, MPH, RS Kansas Environmental Health Association KSEnvPHPS Assessment Program Coordinator
Why should KALHD be concerned about
environmental public health in Kansas?
1. Because EPH is part of the state public health
system in Kansas.
2. EPH is partly or solely delegated to the county level
public health system by statute.
3. EPH is part of the accreditation process.
4. EPH is part of the County ESF-8 response plan.
5. We as protectors of the public health cannot full fill
our mission without the inclusion of EPH.
Existing State Public
And Environmental
Health Infrastructure
Existing Workforce
And Public Health
Knowledge Base
Kansas History and
Vision for Public
Health
Improvement
Existing Local
Public Health,
Environmental
Health and Personal
Health System
Establishment of
Formal
Planning Office
Convene Partners
As Workgroup
Alliance
10 Essential Public
Health &
Environmental Health
Assessments
CHA, Monitoring,
Surveillance and
Hazard Analysis
State
Improvement
Plan
Improved
Partnerships across
Multiple Sectors
Integrated Statewide
Quality Improvement
Plan
Local Public Health,
Environmental Health
Personal Health
Improvement Plans
Public Health System
that Provides the 10
Essential Services
Public Health
Education and
Science Based
Training
Improved 10
Essential Services
delivery
Improvement towards
Public Health System
Accreditation
Improved Core
Competencies are
meet
Integrated
Community,
Environmental,
Public and Personal
Health System.
Participation in
Accreditation
Improvements in
Determinants of
Health
Improved Public
Health,
Environmental Health
and Personal Health.
Improved Quality and
Quantity of Life
Inputs
Strategies Outputs Short-Term
Outcomes
Intermediate
Outcomes
Long-Term
Outcomes
Statewide Public Health Improvement Logic Model
To help understand a common
identification and a common mission
• Shared goal of protecting the public health
• Shared definition
• Shared public health improvement model
• Shared legal basis
• Shared history
• Shared model of program delivery
• Shared challenges for the future
What is the definition of Environmental
Public Health?
• 30 Partners at the recent EPH Summit were posed
the question
• 50% described it as protecting the environment
• 50% described it as protecting people from the
environment
CDC National Center For Environmental
Health
• CDC's Environmental Health Program promotes
health and quality of life by preventing or
controlling diseases or deaths that result from
interactions between people and their
environment.
NACCHO, APHA, ASTHO, EPA
• “Environmental health and protection is the art and
science of protecting against environmental factors
that may adversely impact human health or the
ecological balances essential to long-term human
health and environmental quality.”
NEHA Definition
• Environmental health is the science and practice of
preventing human injury and illness and promoting
well-being by:
• identifying and evaluating environmental
sources and hazardous agents; and
• limiting exposures to hazardous physical,
chemical, and biological agents in air, water, soil,
food, and other environmental media or settings
that may adversely affect human health.
Organization of Public Health in Kansas
• Decentralized
o A combination of State, Local and Private authorities
Sole State Authority, as in Environmental Protection
Shared authority by devolution as in many public health
programs
Sole local authority, as in environmental health programs,
sanitary codes
Program State Jurisdiction County Jurisdiction Environmental Protection
Air Quality
Remediation
Solid Waste Management
Public Water
Public Wastewater
Watershed Management
Livestock Waste Management
Public Health
Child Care Foster Care
Epi & Informatics
Disease Control & Prevention
Family Health
Health Promotion
Community Health
Environmental Health
Lead EBL
Environmental Public Health Tracking
Radiation
Private Water
Private Wastewater
Healthy Homes, Indoor Air, Lead, Radon
Vectors
Food Inspection & Lodging (KDA)
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Kansas Statutes Annotated
• Chapter 19: Counties And County Officers
• Article 37: Sanitation Controls
• Statute 19-3701: Sanitary codes in certain counties; definitions. The term "sanitary code" as used in this act shall mean rules and regulations designed to minimize or control those environments and environmental conditions that may adversely affect the health and well-being of the public. Such environments and environmental conditions may include, but are not restricted to: Sewerage and sewage disposal; water supply; food and food handling; insects and rodents; refuse storage, collection and disposal; housing, trailers and trailer courts. The term "local health department" as used in this act shall mean any county, city-county, or multi-county health department created or organized by the county commissioners in this state for the purpose of protecting the public health and welfare of the citizens of the county and enforcing public health laws in the county and employing one or more full-time sanitation personnel.
• History: L. 1955, ch. 292, § 1; June 30.
Brief History
• 1907 Dr. Crumbine creates KS BOH, 4 Sanitarians
• 1929 Kansas Association of Milk & Food Sanitarians, 10 members
• 1959 Kansas Association of Sanitarians, 86 members
• 1986 LEPP Program Created, 65 counties
• 2003 Kansas Environmental Health Association, 195 members
• 2011 103 counties have Sanitary Codes, 167 members
• 2012 LEPP Eliminated, 105 members, 69 counties
• 2013 54 members, 69 counties with EPH
51 EPH Departments within County Public Health Departments
18 are stand alone or part of another agency
33% loss in counties with EPH services 72% loss in EPH workforce
2013 Kansas Environmental Public Health Summit
July 24, 2013
Topeka, Kansas
For State Public Health Partners
State and Local Participants
State Partner Survey
The Executive Directors and Boards of KALHD, KPHA, KAC, JCCS, KCE & KEHA.
The Secretaries and Division Directors of KDHE and KDA.
The MPH Program Directors from KU, KSU and WSU.
Total Requests 35
Responses (n) 25
Return rate 71%
Local Survey
Local Environmental Health Services from Kansas.
County, Multi-County, Tribal and Municipal 63
Local County Public Health Department Administrators 100
Total Requests 163
Responses (n) 88
Return rate 54%
Requests 198 Responses 113 Total Return Rate 57%
10 Essential Environmental Public Health Services Monitor environmental and health status to identify and solve community environmental public health problems Diagnose and investigate environmental public health problems and health hazards in the community Inform, educate, and empower people about environmental public health issues Mobilize community partnerships and actions to identify and solve environmental health problems Develop policies and plans that support individual and community environmental public health efforts Enforce laws and regulations that protect environmental public health and ensure safety Link people to needed environmental public health services and assure the provision of environmental public health services when otherwise unavailable Assure a competent environmental public health workforce Evaluate effectiveness, accessibility, and quality of personal and population-based environmental public health services Research for new insights and innovative solutions to environmental public health problems
How well did the Kansas system perform the ten
Essential Environmental Public Health Services?
21222217 8 12
0
O…K
Score or percentage, (0-100)
20
18
22
21
25
29
14
7
8
19
29
0 5 10 15 20 25 30 35
Overall Performance Score
10. Research insights and solutions.
9. Evaluate EPH services.
8. Assure competent EPH workforce.
7. Link people to EPH services.
6. Enforce EH laws.
5. Develop policies and plans.
4. Mobilize community partnerships.
3. Inform, educate and empower.
2. Diagnose and investigate.
1. Monitor EPH status.
Summary of essential service scores and overall score
Ranked State Average Scores From NEnvPHPSP Assessments
• New York 70.0
• Tennessee 69.9
• North Carolina 69.9
• Florida 69.5
• Georgia 69.3
• Michigan 62.3
• Arizona 62.3
• California 59.6
• Nevada 59.6
• Hawaii 59.6
• New Mexico 55.8
• Kentucky 53.6
• Arkansas 50.5
• Oklahoma 47.5
• Maine 43.1
• New Hampshire 38.7
• Missouri 37.4
• Virginia 36.7
• Montana 25.0
• Alabama 22.5
• Kansas 20.0
* CDC, Bohan, P., 2013
0
10
20
30
40
50
60
70
80
90
Mon. Diag. Inform Mob. Policy Enforce Link Workforce Eval. Research Avg.
KsEnvPHPSP compaired to KsPHPSP
KSEnvPHPS KsPHPSP
0 10 20 30 40 50 60 70 80 90
Yes
No
*ES 1 To what level has Kansas MONITORED its environmental public health status and identified
community environmental health problems? Scores Local Admin. 25 Local EPH staff 30 State Partners 33 State average 29 Has an environmental health assessment been completed for your community?
?
*ES 2 To what level has Kansas Diagnosed and Investigated its Environmental Public Health hazards at the community level?
LHD Admin. score 6.9
Local EH Staff score 25.9
State Partner score 23.9
Avg. Score = 19
*ES 2b Does the environmental public health program operate or participate in an environmental health surveillance system?
Yes 7.2% No 29.0% Don’t know 50.72% Hazards most often investigated from most to least. Onsite Sewage Private drinking water Nuisances Burning Violation/Air Haz-Mat spills Lead in homes Mold Food Borne Illness Dog Bites Hoarding Dead Animals Pools Vectors
*ES 3 To what level has Kansas
Informed, Educated and Empowered its communities about
environmental public health issues.
LHD Admin. score 2.2
Local EPH Staff score 4.8
State Partners score 30.0
State avg. 8.1
Only 6% of respondents scored this question 1, 2, or 3.
94% of respondents scored this question 0 or don’t know.
*ES 3a Do you have a health communications system which routinely
provides the public with EPH results and education?
Local Public Health Admin. 33% yes
Local EPH Staff 25% yes
State Partners 45% yes
Avg. 34%
Most Mentioned by Locals State Partners
University Publications Association Speakers
Monthly Newsletter KS-HAN
Website Food Safety Classes
In the lobby Facebook
Printed Public Notices PH Connections Newsletter
Health Fairs & Home Shows
?
*ES 4
To what level does Kansas Mobilize partnerships to
identify and solve EPH problems and issues?
Local PH Admin. 3
Local EPH Staff 1
State Partners 29
State Avg. 7
Mobilize = Community Action
*ES 5 To what level has Kansas developed policies and plans that support community EPH efforts?
Local PH Admin. 22.2
Local EPH Staff 4.8
State Partners 29.0
Avg. 13.9
Local PH Admin. Local EPH Staff State Partners 1. Served on LEPP Board 1. Don’t know. 1. Regulatory Compliance
2. Limited to none 2. We do inspections 2. Program funding/grants
3. Assist with assessments
4. Public Info/Education
5. Support EH Bureau
6. Coordinate with lab
7. Collaborative input
*ES 6 To what level has Kansas enforced laws and regulations that protect citizens from environmental health issues?
Local PH Admin. 25.6
Local EPH Staff 26.9
State Partners 38.0
Average 28.8
34% of County Sanitary Codes have been revised within 5 yrs.
77% of Local EPH Staff have assisted with an enforcement action.
*ES 7 To what level has Kansas linked Environmental
Public Health services to all populations?
Local PH Admin. 20.8
Local EPH Staff 28.3
State Partners 25.0
Avg. 25.2
*ES 7a Please list known barriers to linking services with all populations
Local PH Admin. Local EPH Staff State Partners
1. Unknown 1. Unknown 1. Funding
2. Distances 2. Language 2. Lack of training
3. No Public Knowledge 3. Distances 3. No political will
4. Lack of Funding 4. Public Education 4. No EPH in our mission
5. Part time hours 5. Funding 5. Lack of leadership
6. Language 6. Staff education 6. Little interest in EP
7. Service not available 7. City/County Reorg. 7. EH is excluded
8. High costs 8. Part time access 8. No EPH advocacy
9. Inadequate Staff 9. No PH coordination 9. Misunderstood Authority 10. Code education 10. Social Connection
11. Lack of awareness 11. Lack of awareness
*ES 8 To what level has Kansas succeeded in ensuring a competent EPH workforce?
Local PH Admin. 32.6
Local EPH Staff 32.0
State Partners 22.5
Avg. 29.4
Comments
“No education or credentialing requirements for employment.”
“No credential requirements for environmental health.”
“No post secondary education in KS offering Environmental Health.”
“Very limited CEU opportunities.”
“Occasional training from KSU, KDHE, CDC. Mostly from KEHA.”
*ES 8a Most common certifications among Environmental Health Staff
RS/REHS 42%
None 38%
Healthy Homes 6%
Lead 4%
CPFS – Food Safety 2%
Cert. Pool Insp. 2%
Haz-Woper 2%
Asbestos 2%
Public Waste Water 2%
0
10
20
30
40
50
60
70
80
HS Diploma Associates Bachelors Masters Doctorate
Pe
rce
nt
*ES 8b Levels of Education for Kansas EPH Staff
?
*ES 9 To what level has Kansas evaluated its effectiveness, accessibility and quality of its population
based environmental health services.
• Locals score 20
• Partners score 34
• Avg. score 22
*ES 9a Does this agency have an environmental health quality assurance – quality improvement plan?
Local PH Admin. Local EPH Staff State Partners
Yes 8% 15.8% 12.9%
No 64% 57.9% 59.6%
Don’t Know 28% 26.3% 27.4%
?
*ES 10 Have you or this agency completed research or best practices to help solve EPH problems and issues in Kansas.
Yes 21%
No 4%
Don’t know 73%
Examples
KELP projects
Air quality monitoring
EPH education survey
LEPP projects
WRAPS projects
?
Top 5 underserved environmental health services by response group
Local PH Admin Local EPH Staff State Partners
1. Lead 1. Lead 1. Air
2. Food Safety 2. Food Safety 2. Wells & water
3. Unsure 3. Wells & water 3. Food Safety
4. Healthy Homes 4. Healthy Homes 4. Solid Waste
5. Mold abatement 5. Schools 5. Watershed Protection
If the current Kansas Environmental
Public Health continues to decline, who
is next in line to fill the gap?
KDHE
Local Public Health
Privatization
Who provides the leadership?
No private cause for action No state initiative for action
Kansas Public Health System
YOU
Accreditation
Monitoring & Surveillance
Primary Care
Nursing
Education
Environmental Protection
Informatics
Life Styles
Existing State Public
And Environmental
Health Infrastructure
Existing Workforce
And Public Health
Knowledge Base
Kansas History and
Vision for Public
Health
Improvement
Existing Local
Public Health,
Environmental
Health and Personal
Health System
Establishment of
Formal
Planning Office
Convene Partners
As Workgroup
Alliance
10 Essential Public
Health &
Environmental Health
Assessments
CHA, Monitoring,
Surveillance and
Hazard Analysis
State
Improvement
Plan
Improved
Partnerships across
Multiple Sectors
Integrated Statewide
Quality Improvement
Plan
Local Public Health,
Environmental Health
Personal Health
Improvement Plans
Public Health System
that Provides the 10
Essential Services
Public Health
Education and
Science Based
Training
Improved 10
Essential Services
delivery
Improvement towards
Public Health System
Accreditation
Improved Core
Competencies are
meet
Integrated
Community,
Environmental,
Public and Personal
Health System.
Participation in
Accreditation
Improvements in
Determinants of
Health
Improved Public
Health,
Environmental Health
and Personal Health.
Improved Quality and
Quantity of Life
Inputs
Strategies Outputs Short-Term
Outcomes
Intermediate
Outcomes
Long-Term
Outcomes
Statewide Public Health Improvement Logic Model
How do we share a common understanding and vision of environmental public health in Kansas?
What is the future of environmental health in Kansas?
• What can you do?
• What can we do together?
On behalf of KEHA Thank you for your time. . . . Questions. . . . Comments
Jerry McNamar, Director Barber County Public Health & Environmental Health Department [email protected] 620 825-4986 office 620 886-2285 cell