Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-5528

Title:

AN ACT CONCERNING ESSENTIAL PUBLIC HEALTH SERVICES.

Vote Date:

3/27/2014

Vote Action:

Joint Favorable Substitute

PH Date:

3/17/2014

File No.:

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

This bill would require local health departments and districts to provide a basic health program as a prerequisite to receiving funding from the Department of Public Health (DPH). The basic health program includes (1) monitoring the community health status to identify and solve problems; (2) investigating and diagnosing health problems and hazards in the community; (3) informing and educating people in the community regarding health issues; (4) mobilizing community partnerships and action to solve health problems for people in the community; (5) developing policies that support individual and community health; (6) enforcing laws and regulations to ensure safety and health; (7) connecting people to health care when appropriate; (8) assuring a competent public health and personal care workforce; (9) evaluating effectiveness, accessibility, and quality of personal and population-based health services; and (10) researching to find innovative solutions to health problems.

RESPONSE FROM ADMINISTRATION/AGENCY:

Senator Toni Boucher: The statues authorize the Department of Public Health to provide state funding to a local health department, provided that the department is responsible for a population of at least 50,000 or serves three or more municipalities. This bill would further mandate that a local health department provide essential public health services in order to qualify for certain funds. HB 5528 would require local health departments to provide more comprehensive and higher quality health services. This is a laudable goal and one that will enhance the health of the general public.

In Section 3 subsection (8) of this bill, local health departments would have to assure “the existence of a competent workforce to health care professionals.” The term “health care professional” as it is currently used in statue is associated with a wide variety of professions licensed by the state and includes MDs, RNs, LPNs, chiropractors, dentists, APRNs, acupuncturists, and massage therapists among many others. If the term “health care professionals” could be changed to “public health professionals” it would make the requirements of this bill more manageable for local health departments while still holding them to a higher standard.

NATURE AND SOURCES OF SUPPORT:

Andrea L. Boissevain, Director of Health, Town of Stratford: Provided testimony in support of HB 5528.

The list of reasons includes:

● Connecticut's eight existing public health mandates in the state statues are outdated and no longer apply to local health departments and districts.

● Nationally, local health departments embrace the 10 essential public health services as the standard for services.

● Every Connecticut resident should be assured provision of the 10 essential public health services.

● Stratford's Path to Quality Public Health Services and Community Health Improvement.

Charles Brown, Executive Director, Connecticut Association of Directors of Health (CADH): The eight mandated public health services listed in the Public Health Code are outdated and do not accurately represent the function and practice of local public health service provision within our communities. Local health departments have the responsibility for protecting the health of populations within their jurisdictions. The ten essential public health services outlined in HB 5528 encompass the functions local public health departments and districts currently perform and would clarify public health's position within the health system. Moving to the ten essential public health services would also eliminate current mandates, such as providing emergency medical services and planning for genetic disease control, that most departments in Connecticut cannot and do not fulfill.

Aligning the work of local public health departments and districts with the national standard will both position Connecticut to readily access federal funding and assist our public health agencies to become accredited through the voluntary public health accreditation process. This nationally recognized accreditation process is based upon the ten essential public health services and by framing local public health services in Connecticut in the same way we would provide our departments and districts with a strong foundation as they seek this recognition of their programs.

In the bill, Essential Service #8 has been changed to “assuring the existence of a competent workforce of health care professionals” instead of “assure a competent public health and personal care workforce”. Local public health departments and districts do not have oversight for the health care professionals within their jurisdictions, so it is not possible for them to be accountable for the existence of this vital workforce. Local Directors of Health work diligently to ensure that their workforce, comprised of public health professionals such as sanitarians and public health nurses, is prepared for the challenges they face today and in the future. Asking local health departments to accept responsibility for the entire health care workforce is beyond the capacity of their agencies.

Jennifer Kertanis, Director of Health, Farmington Valley Health District: Provided testimony in support of HB 5528 on behalf of the Farmington Valley Health District, which includes 110,000 people in the towns of Avon, Canton, Barkhamsted, Colebrook, Simsbury, Farmington, Hartland, New Hartford, Granby, and East Granby. This bill is necessary to replace the existing antiquated language regarding local public health and to more accurately reflect what every resident should expect of their local health department while aligning these expectations with the national standard.

Local health departments are responsible for preventing disease outbreaks, promoting policies that support good health, and protecting residents from public health emergencies. The ten essential services reflect the activities, skills, and capabilities required to effectively and efficiently accomplish this mission. Local health departments routinely monitor the health status of their communities. They then diagnose and investigate health problems, a critical component in swiftly preventing disease outbreaks and public health emergencies.

The failure to modernize public health law means that we continue to operate under a set of antiquated expectations that most local health departments cannot do or fulfill. The failure to reference the nationally recognized framework may impede local health departments who seek to achieve voluntary accreditation.

Carolyn Wysocki, Chair, Connecticut Association of Boards of Health (CABOH) Leadership Council: Provided testimony in support of HB 5528 on behalf of the Connecticut Association of Boards of Health (CABOH), which serves the purpose of establishing a statewide network of effective Boards of Health and public health partners that actively plan and support the provision of essential public health services in their jurisdictions.

The bill expands Connecticut's Public Health System with opportunities for new and additional programs and services while at the same time inclusive of those that were in the current statues. The recent Annual Report of the Central Connecticut Health District is an excellent example of how the current programs and services are already integrated within the 10 Essential Services.

The Connecticut Hospital Association (CHA): CHA and its member hospitals are working in partnership with the Connecticut Association of Directors of Health, local health directors, and other stakeholders within the state, to assess community health needs and identify ways to work together in the promotion of health and achievement of health improvement goals for Connecticut's communities. This bill promotes the modernization of Connecticut public health law to reflect the ten essential services that are nationally recognized as a framework to guide the work of public health agencies. The proposed framework clarifies the role of public health within the larger healthcare system, increases the ease of application for national public health department accreditation, positions agencies for access to federal grant funding, and provides flexibility to towns to promote public health in a way that best meets the needs of the local population served.

Kathryn Dube, Connecticut Council of Small Towns: This bill would seek to modernize Connecticut's public health law to include the nationally recognized framework of ten essential services of public health. Local Health departments throughout the state are currently operating under outdated regulations. By updating these critical guidelines, local health departments are better positioned to ensure a safe and healthy community. In addition to updating the current public health laws, the new framework would provide for greater access to federal funding.

The new framework would:

● Explain what public health is

● Clarify the role of public health within the larger health care system

● Provide accountability by linking public health performance to health outcomes

Others Providing Similar Testimony in Support of HB 5528:

Maura Esposito, Director of Health, Killingworth Health Department

Elaine O'Keefe, Executive Director, Office of Public Health Practice

NATURE AND SOURCES OF OPPOSITION:

None

Reported by: Francesco Sandillo

Date: 4/2/14