Strengthening New York's Public Health System for the 21st Century



The Public Health Infrastructure Work Group began its work in February 2002 with a review of public health priorities established for New York State by the Public Health Council in 1996 through the Communities Working Together for a Healthier New York project. It reviewed the progress made to date on achieving these priorities and considered the challenges still remaining. It subsequently proceeded with a three-phase review process to develop ultimate findings and recommendations.

A. Phase I - A General Review

In Phase I the Work Group conducted a general review of state and local government public health systems in New York State with its particular reliance on local (county and NYC-based) systems for delivery of public health services. Work Group members reviewed background materials on the public health infrastructure including:

  • Federal and state public health programs;
  • NYS Public Health Law Article 6, the statutory authority for state aid for general public health work;
  • Public health work force position descriptions and qualifications as described in state Sanitary Code;
  • Information technology systems and specialized electronic health networks;
  • Emerging public health initiatives on emergency preparedness and bioterrorism; and
  • Nationally sponsored grant demonstration projects such as the Assessment Initiative funded by the Centers for Disease Control and Prevention (CDC) and the national Turning Point Initiative funded by the Robert Wood Johnson Foundation.

During Phase I, the Work Group also reviewed the findings of a number of studies that considered the public health system from multiple perspectives including:

  • The National Public Health Performance Standards Program/ New York, conducted by the Centers for Disease Control and Prevention (CDC Study);
  • The Department of Justice/CDC Public Health Performance Assessment of Emergency Preparedness: State-Wide Preliminary Results (DOJ Survey); Healthy People 2010, the national health objectives promulgated by US Department of Health and Human Services (2000);
  • The New York State Department of Health (NYSDOH) and New York State Association of County Health Officers (NYSACHO) Spring 2002 County Connectivity Survey;
  • Communities Working Together for a Healthier New York, September 1996.

Upon their publication in late 2002 and early 2003, the findings from two additional studies published by the Institute of Medicine were incorporated into the Work Group's general review of public health system infrastructure. These studies included:

  • The Future of the Public's Health in the 21st Century, Institute of Medicine of the National Academies, 2003; and
  • Who Will Keep the Public Healthy: Education of Public Health Professionals for the 21st Century, Institute of Medicine of the National Academies, 2002.

B. Phase II - Subcommittee Assessments

In Phase II, the Work Group appointed three subcommittees to address the three key elements of the public health infrastructure - work force, organizational systems and relationships, and data and information systems - more fully at the county level. The subcommittees invited fifteen local health departments (LHDs) to provide insight into current public health infrastructure strengths and gaps. The local health department participants represented a cross section of urban, suburban and rural counties. Each subcommittee selected specific assessment methods appropriate to their task. The Work Force Subcommittee employed a telephone survey, the Organizational Systems and Relationship Subcommittee used telephone interviews; and the Data and Information Systems Subcommittee convened a Focus Group using a discussion guide provided in advance and scripted questions. The participating local health departments had the opportunity to consider the content of their respective assessments in advance. Moreover they were encouraged to participate as teams in the discussions to insure a diversity of viewpoint and enrich the exchange.

New York State was enrolled in the initial trials of the National Public Health Performance Standards Program assessment conducted by the Centers for Disease Control and Prevention. In the course of their review of these trial findings, the Public Health Infrastructure Work Group used the New York performance data results to form a better understanding of the state's infrastructure needs. In particular, the Work Group was most interested in those essential services in which the state's aggregate performance fell below the New York State overall average. These performance findings framed the subcommittees' reviews of what factors constrain public health and what steps might be undertaken to strengthen infrastructure in New York State. (See Section VII of this report for the statewide data on the standards assessment). The three Subcommittee Reports are included in the Appendix accompanying this report.

C. Phase III - Development of Findings and Recommendations

In Phase III, the Work Group considered findings from their various reviews and developed a set of priority and long-term recommendations. These were presented as preliminary Findings and Recommendations to the Public Health Council at its May 16, 2003 meeting. This report provides a final discussion and documentation of the Work Group's assessment of New York State's public health system infrastructure with recommendations for further action.