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



These recommendations are directed at all components of the public health system from every level of government including town boards of health and legislatures, county officials, the state legislature, state officials and the federal government. They are also directed to key health care contributors such as physicians, hospitals, social service agencies, voluntary groups, employers, insurers and small businesses. These recommendations are advanced in the certain knowledge that public health today is a system of alliances, partnerships and coalitions all of whose goal is to protect the health of the whole community in order to assure the well being of each of its members.

A. General

The Public Health Infrastructure Work Group recommends that:

1. The Public Health Council appoint a standing Public Health Committee to oversee implementation of this report and to report on progress in achieving the actions recommended. In particular, this Committee should focus on implementing recommendations 2, 3 and 5 below.

2. The Public Health Council invite representatives of the NYS Department of Health and other members of the NYS public health system to update the Council at each meeting about the current challenges and issues facing public health at all levels of government and throughout the broader system of private and voluntary agencies.

3. The Federal Government, New York State and localities support a sustainable and flexible funding stream that assures that the State and localities can support the essential public health services and also emerging issues. Traditional essential programs should not have their resources depleted with the advent of new priorities.

The Work Group also recommends that the Public Health Council work with the NYS DOH to examine all funding sources that support local health departments and make recommendations for financing mechanisms that ensure effective public health service delivery. Improved mechanisms for management reporting and performance accountability linked to funding should be proposed.

B. Public Health Work Force

To address the findings related to work force, the Work Group recommends that:

4. A statewide public health training task force be convened including the schools of public health in New York State, representatives from the State and local health departments and other academic partners. This Task Force will consider issues of access, competency based training, leadership skills and public health career curricula at schools and colleges. It will develop specific initiatives that will:

  • Support the development of accessible, competency-based training and continuing education programs that meet the needs of the state and local public health work force;
  • Ensure that all state and local public health workers at all levels have an orientation to the key concepts of public health so that they have a basic understanding of the public health enterprise: its history, its focus on population health, its basis in legal authority, and the many disciplines involved;
  • Address the need for focused training for public health leaders on leadership, community partnerships and coalition building as well as risk communication and general communication approaches to an increasingly culturally diverse community;
  • Explore a public health leadership training scholarship program to facilitate participation by state and local leaders in the North East Public Health Leadership Institute or the National Public Health Leadership Institute;
  • Develop partnerships with academic, public health and medical institutions that keep the focus on training professionals for employment in state and local health departments and support core curriculum that trains graduates for governmental public health careers;
  • Promote attention to public health careers with public school systems and colleges/universities.

5. The Public Health Council review the NYS Sanitary Code to ensure that job titles and minimum qualifications are appropriate to today's public health needs and examine how the sanitary code qualifications and training requirements can be revised to support career ladders. Specifically the Council should:

  • Ensure that minimum qualifications are appropriate to today's public health needs and reflect current public health core functions and competencies;
  • Examine how the state sanitary code qualifications for specific job titles (e.g. sanitarians, public health nurses, public health educators) can be revised to support career ladders and career mobility while at the same time maintaining the standards needed for specific positions;
  • Examine how changes to the state sanitary code could facilitate training while not posing additional resource burdens on local health departments.

C. Public Health Organizational Systems and Relationships

To address the findings related to organizational systems and relationships, the Work Group recommends that:

6. The New York State Department of Health and local health departments examine regional, multi-county models for providing essential public health services in which specialty knowledge, expertise or other resources might be shared across regions. Such models represent one way to address the uneven distribution of work force specialists that currently exists in many areas of the state. This examination will need to address the legal barriers existing now that may constrain such a solution or make regional approaches more difficult to put in place.

7. The New York State Department of Health and its academic partners creatively use and make available to counties expert resources organized by and available in the disciplines of disease surveillance, epidemiological analysis, behavioral science, environmental health, social marketing, community organizing, and public health administration. This need is particularly acute for counties that lack the resources to purchase or leverage such services independently.

8. The state and local health departments together with academic institutions and other resources develop strong leadership training opportunities for public health professionals. The curriculum content should focus on team building, creating and sustaining coalitions, forging strong partnerships, communicating with diverse publics, inspiring a steady community engagement, fiscal and program management and overcoming competing agendas and conflicts.

9. The state and local health departments consider a campaign to improve public understanding about the public health system and its benefits. To begin, findings from research about what the public knows and understands should be used to support a campaign to educate the public about the benefits of the public health system and increase the public's involvement in this partnership.

D. Public Health Data and Information Systems

To address the findings related to data and information systems, the Work Group recommends that:

10. With assistance from the NYS Office for Technology (OFT), the NYS DOH, NYSACHO, and the New York State Association of Information Technology Directors develop a Comprehensive New York State Data and Information System Plan. The objective of this assessment and plan would be a comprehensive design and execution strategy for a system architecture capable of meeting today's public health infrastructure requirements for the State of New York.

Such a plan would:

  • Inventory and quantify the various systems currently in place;
  • Describe their functions;
  • Quantify the resulting data and information gaps;
  • Identify a set of system and user needs in order of priority.

11. The Federal and State governments standardize public health program indicators so that effectiveness can be measured, data and benefits communicated to a wide audience including researchers, and shifts in policy direction or service delivery appropriately made.

12. The NYS DOH and its academic partners collaborate to develop methods to teach public health evaluation methodologies to strengthen and increase the capacity at the State and LHD levels to undertake evaluations. Such evaluations are critical to understanding a program's effectiveness, to improving accountability and to communicating the value of public health to the public.