PHIP Sustaining the Vision of the Public Health Improvement Plan
Bobbie Berkowitz
Mimi FieldsIt has been said that progress is the art of maintaining order amidst change, and change amidst order. Washington State has experienced many changes in its health system reform efforts consequent to major legal and financing shifts. Still, progress has continued toward improving and maintaining access to health care for the uninsured through the Basic Health Plan, Medicaid, and insurance reforms. We are working toward improving the health of the entire population through health promotion, protection, and prevention initiatives, but we face challenges posed by unacceptable trends for certain diseases, injuries, and environmental threats.
A Sound Beginning
The state public health system and its multiple partners produced the first Public Health Improvement Plan in November 1994. This document reflected our state's commitment to the vision of a healthier people in healthy communities, and the need to ensure access to health care for all citizens, plus pressures to improve our efficiency and effectiveness. This first plan attracted attention because it focused on community-based decision making, data-based public policy, effective health regulation, and population-based prevention and health promotion programs. It addressed the core functions of public health -- assessment, policy development, administration, prevention, and quality and access -- and set standards for carrying out those functions. The plan set goals for Washington State for the year 2000, following the lead of the national Healthy People 2000. It recommended changes to public health system financing and governance mechanisms and prompted new public health legislation backed by an infusion of new funds.We have made progress in our efforts to train the public health work force in the core functions, and we collaborated with numerous partners in the medical care community about access, quality, and outcomes. We have developed a national presence and, as leaders in this work, have shared our experiences with other states.
A Look at the Future
How to implement this vision embodied in the 1994 plan, establish the capacities required, and maintain the accountability demanded by policy makers was the challenge for the 1996 Public Health Improvement Plan. Its recommendations for action during 1997 to 1999 will become the work plan for public health and its many partners as we approach the twenty-first century, and the framework for preparation of the 1998 plan. The following partial list of recommendations addresses three major goals:To improve information-based decision making:
To improve collaboration:
- Develop a core set of health indicators, a broader set of selected indicators, and quantitative state health objectives.
- Coordinate the Board of Health's State Public Health Report and the Department of Health's Health of Washington State so the two publications reinforce each other.
To improve accountability:
- Designate a portion of 1997-99 state funds for partnerships that build and sustain local core function capacity.
- Analyze the American Indian Health Commission's proposed definition of "tribal health jurisdiction."
- Promote a dialogue statewide to share information about collaborations among local public health jurisdictions, their communities, managed care plans/providers, and other elements of the health system.
Recommended Reading
- Provide additional state funding to enable continued development of state and local core function capacity and to allow local action on public health issues identified through community assessment processes.
- Explore flexibility of federal funding to maximize its use in building core function capacity in the public health system.
- Develop new or revised Washington Administrative Code regulations that include the core public health functions to guide the performance of local health jurisdictions continue to develop new performance measures.
Public Health Improvement Plan
Olympia: Washington State Department of Health, November 1994; revised November 1996.Healthy People 2000.
DHHS Publication No. (PHS) 91-50212 Washington, DC: U.S. Public Health Service, 1990.Washington State Public Health Report.
Olympia: Washington State Board of Health, January 1996.The Health of Washington State: A Statewide Assessment of Health Status, Health Risks, and Health Systems. Olympia: Washington State Department of Health, September 1996.
Authors
Bobbie Berkowitz, Ph.D., R.N. is director, Turning Point National Program Office, and a senior lecturer in the Department of Health Services at the UW School of Public Health and Community Medicine.
Mimi Fields, M.D., MPH., is health officer and deputy secretary, Washington State Department of Health, and assistant dean for public health practice at the UW School of Public Health and Community Medicine.
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Created: 3/4/98 Updated: 7/15/99
