RESOLVE

What are the “Foundational Capabilities” of a Functioning Public Health System?

February 3, 2015

What are the “foundational capabilities” of a functioning public health system and how are they defined? Do variations exist in these definitions among public health practitioners? The de Beaumont Foundation and RESOLVE recently teamed up to conduct research and publish two articles further examining how practitioners in governmental public health are conceptualizing, defining, and funding foundational capabilities and foundational areas (From Patchwork to Package: Implementing Foundational Capabilities for State and Local Health Departments and Practitioner Perspectives on Foundational Capabilities).

The findings in these reports build on a recommendation issued by the Institute of Medicine (IOM) in an April 2012 report calling for the description of, cost estimation for, and the sustained funding of a foundational set of public health services:

“The committee believes that it is a critical step to develop a detailed description of a basic set of public health services that must be made available in all jurisdictions. The basic set must be specifically defined in a manner that allows cost estimation to be used as a basis for an accounting and management framework and compared among revenues, activities, and outcomes. The committee developed the concept of a minimum package of public health services, which includes the foundational capabilities and an array of basic programs no health department can be without.”

In short, we need to have a clear understanding of what public health departments must do and provide everywhere for the health system to work anywhere. Many health departments at the state and local levels, including in Ohio, Colorado, Texas, and Washington have been working to do that.

In partnership with the de Beaumont Foundation, RESOLVE sought to further understand whether and how practitioners were thinking of this issue. The project team conducted 50 interviews with leaders representing state and local health departments in order to better understand their knowledge and beliefs about the foundational capabilities of governmental health departments. The team sought to gather perspectives from a diverse range of health departments across the country, conducting interviews with health department representatives based on geography and jurisdictional characteristics, including population size, governance structure (i.e., centralized or de-centralized), and level of poverty.

Researchers asked specifically about familiarity with the term “foundational capabilities,” and included discussion of public health’s role in communicable disease prevention and health promotion, policy development and support, workforce development, environmental health, assessment and surveillance, among other topics.

While only half of the interviewees had heard of the term “foundational capabilities,” most were familiar with, and affirmed the concept, citing examples in their particular context. When interviewees did relate to these concepts, they used different phrases to describe them, such as “cross-cutting capacities,” “core competencies,” “basic support services” and others. This data reveals that while the term “foundational capabilities” may not exist in the everyday language of a practitioner, the notion of a need to define and acknowledge a “foundation” for governmental public health clearly resonated with many interviewees.

Questions probed on (1) the extent to which their health departments possessed foundational capabilities, (2) how (if at all) these activities were funded, and (3) how they went about prioritizing these activities within their health department. Most respondents interviewed indicated their respective department currently possessed these capabilities, though to what degree was not investigated. Notably, many current public health department leaders said that while they were funding some amount of foundational capabilities with existing funds, they were doing so by piecing together a patchwork of support from state, local, and/or federal funds.

Health departments play a critical role in protecting and improving health in all communities across the country, and yet the funding and infrastructure is fragmented – hampering efforts to maximize public health’s role in providing all people the robust health system everyone should have regardless of their zip code. This study is the first of its kind to assess practitioner perspectives on foundational capabilities of public health and highlight the importance of being able to define, first, what public health is doing, and second, use those definitions to seek funding to support public health’s foundation.

For more reading:

Engaging the Community and Health Care Providers to Help Prioritize the Allocation of Scarce Medical Resources

March 31, 2014

The H1N1 pandemic of 2009-2010 has resurfaced in the news lately. A recent article in The Lancet Respiratory Medicine finds that adult patients treated with drugs such as Tamiflu or Relenza (or similar) were half as likely to die compared to those who went untreated[1]. These findings are indeed exciting, and assuming availability of the drugs, promising.

But what happens when lifesaving therapies or devices are in short supply? How do we make decisions to allocate scarce resources in a pandemic or other public health emergency? What kinds of ethical frameworks should be used to do so?

In partnership with the Johns Hopkins Berman Institute and University School of Medicine, and the Health System’s Office of Emergency Management, as well as the UPMC Center for Health Security, RESOLVE has managed a series of public engagement sessions to answer these complex questions. By engaging “lay” community members and health care providers, alike, this project seeks to collectively consider decision-making criteria for allocating ventilators in a pandemic flu. These discussions use a deliberative democracy model to probe views on different principles for allocating scarce medical resources.

The project’s principle investigator, Dr. Lee Daugherty Biddison, discusses the project in this Hopkins Medicine Magazine article by David Green

***Update 6/23/14*** Since the initial posting of this blog entry, the project was published in Annals of the American Thoracic Society. For more information, please see this abstract.

-Rachel Nelson & Chrissie Juliano


[1] Stella G Muthuri PhD, S. V.-B.-B. (2014). Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. The Lancet Respiratory Medicine.

As Food Safety Moves to the National Forefront, RESOLVE Launches Second Phase of Forum

January 28, 2013

With the release of proposed rules on January 4, the FDA took a major step toward implementing the Food Safety Modernization Act (FSMA), a 2010 law that overhauls how the agency governs food, moving to a more risk-based food safety system. RESOLVE has been very active on this issue. The Pew Charitable Trusts and the Robert Wood Johnson Foundation jointly fund our Collaborative Food Safety Forum (CFSF). The progress on FSMA was front page news in both the New York Times and the Washington Post, and featured quotes from Mike Taylor, Deputy Commissioner for Foods at FDA and our program officer at Pew, Sandra Eskin.

We convened a series of CFSF discussions to engage key stakeholders in rigorous, collaborative, and creative problem-solving and consensus building dialogue to think through ideas for efficient and effective implementation of the law. Phase II of this work is underway with meetings timed to coincide with the roll out of these rules, providing stakeholders an opportunity for collaborative analyses.

The website for the Collaborative Food Safety Forum provides information on the meetings held during Phase One, and will have information as Phase Two unfolds.

RESOLVE also was involved in the design and facilitation of the Pew funded Produce Safety Project, convened by Georgetown University. This project  included a series of five regional meetings that engaged stakeholders, particularly food growers and producers, in discussions on the current science underpinning considerations for improving food safety, particularly the “4 W’s” – water quality, waste management (including use of compost), wildlife, and worker hygiene.  Input from these sessions provided context for the now released proposed rule for produce safety.

- Abby Dilley