First Year Checkup: Strategies for a Stronger Public Health System

Report #194, January 2009
First Year Checkup: Strategies for a Stronger Public Health System

Full Report

Executive Summary

Press Release

FOR IMMEDIATE RELEASE
January 23, 2009

For Additional Information Contact:
Stuart Drown, Executive Director
(916) 445-2125

Commission Calls on State to Strengthen the New California Department of Public Health

The Little Hoover Commission on Thursday urged the governor and the Legislature to build on the progress achieved in California’s public health system by strengthening its leadership and capacity to meet the state’s health and safety needs.

In its report, First Year Checkup: Strategies for a Stronger Public Health Department, the Commission recommends bolstering the independence of the public health department by moving the department out of the Health and Human Services Agency so that the department director reports directly to the governor’s office. The department’s director should act as an advocate for the public on issues of public health and safety and be aided in this effort by the expert guidance of a permanent and independent public health board.

The Commission reiterated that the state must prioritize public health as one of the core components of public safety, equal to fire and police. The leadership of the new department must forcefully make the case for budget priorities that reflect the department’s public safety role.

The Commission’s interest in the department’s public safety role stems from its 2002 report on California’s emergency preparedness after the 9-11 terrorist attacks. In that report, Be Prepared: Getting Ready for New and Uncertain Dangers, the Commission found that public health represented the largest single weakness in the state’s emergency response network. The Commission followed that study with two public health reports, one in 2003 and another in 2005, citing the state’s lack of strong, independent leadership as well as the need to improve the ability to quickly detect and respond to disease outbreaks, natural or manmade.

In this study, the Commission found that the state has implemented some of the Commission’s earlier recommendations, including creating a new department of public health and a public health advisory committee to assist the state public health officer. It is close to piloting a web-based disease surveillance system to track the emergence of contagious illnesses, and it has conducted laboratory assessments to determine needs and potential solutions. The department, with the state’s help, performed a comprehensive assessment of state and local emergency preparedness and established guidelines for responding to a health care surge. The department also developed an emergency operations center within the public health department to coordinate with other emergency response partners.

In First Year Checkup: Strategies for a Stronger Public Health Department, the Commission acknowledged the strides made by the state in each of these areas, but emphasized that more work is needed to strengthen California’s public health system.

“The Commission is encouraged that the state’s response to its earlier recommendations will lead to further improvements and urges the governor and Legislature to continue transforming the public health department into a strong and effective public health leader,” Little Hoover Commission Chairman Daniel Hancock said.

In First Year Checkup: Strategies for a Stronger Public Health Department, the Commission’s recommendations include:

  • Make the California Department of Public Health an independent office, reporting directly to the governor, to act as a stronger advocate for Californians on public health and safety issues. The public health department must be led by a state surgeon general who reports directly to the governor and who acts as a stronger advocate for Californians on public health and public safety issues.
     
  • Transform the public health advisory committee into a state Board of Public Health to provide independent advice and guidance to the governor, Legislature and state public health officer. The new board should provide scientific expertise on the department’s public health programs and projects and examine ways to address problems and improve the health and safety of Californians. Until a new advisory committee is created, the state public health officer should bolster the stature of the existing advisory committee.
     
  • Broaden the efforts of the California Department of Public Health to grow and maintain the public health workforce. The public health department should partner with the state’s higher education systems to fill the pipeline for public health workers and educate students about employment opportunities in the state department of public health. The department also should regularly assess workforce needs and identify priority areas based on those needs, pipeline capacity and the future of public health practice. Public health workforce needs and solutions should be communicated to the governor and Legislature.
     
  • Develop the state’s laboratory capacity. To ensure a robust public health workforce is in place in the state’s public health labs, the public health department should facilitate consolidation of county laboratories into regional laboratory programs. The department also should assess its laboratory capacity priorities and seek leadership from the governor and Legislature to eliminate barriers to workforce development.
     
  • Create more flexible funding mechanisms to provide more efficient and effective services to the public. To provide more efficient and effective services to the public, the public health department should review its categorically-funded programs and determine which could be consolidated into block grants. The department also should continue to work with the federal government to streamline federal funds coming into California.
     

The Little Hoover Commission is a bipartisan and independent state agency charged with recommending ways to increase the efficiency and effectiveness of state programs. The Commission’s recommendations are sent to the governor and the Legislature. To obtain a copy of the report, First Year Checkup: Strategies for a Stronger Public Health Department, contact the Commission or visit its Web site: www.lhc.ca.gov.

Fact Sheet

Study Description

For this study, the Commission reviewed California’s public health system. In 2006, California policy-makers severed public health functions from the former Department of Health Services and established a separate Department of Public Health, a recommendation previously made by the Commission. The separation and establishment of the new Department of Public Health occurred on July 1, 2007. One year later, the Commission had the opportunity to assess the accomplishments of the new department as well as the challenges that remain and provide input and guidance as the new department takes root. 

Additionally in this review, the Commission had the opportunity to follow-up on the progress that had been made in implementing its other prior public health recommendations and to determine what additional actions are necessary. Specifically, the Commission assessed whether action had been taken in other key areas, such as its recommendations to install a real-time surveillance system to track the emergence of contagious disease, increase capacity of laboratory and other essential functions, improve communication and coordination among public-health and emergency-related agencies to ensure emergency-preparedness, and develop a plan for reducing illness and death resulting from hospital-acquired infections.

In this update, the Commission reviewed California’s public health system, continuing an assessment that began in 2002 with the Commission’s initial assessment of the state’s level of emergency preparedness in Be Prepared: Getting Ready for New and Uncertain Dangers. That report was followed by a more specific examination of public health in the Commission’s 2003 study, To Protect and Prevent: Rebuilding California’s Public Health System, and a follow-up report in 2005, Recommendations for Emergency Preparedness and Public Health, which refined and reiterated the recommendations made in 2003.


Previous Studies 

Agenda

Overview

In this report, the Commission recognizes the challenges in establishing a separate public health department, the California Department of Public Health, and advisory committee and calls for stronger and more independent public health leadership. 

During its review, the Commission found that the state had implemented some of the Commission’s earlier recommendations, including creating a new department of public health and a public health advisory committee to assist the state public health officer. The Commission also found that Californians need an independent public health leader with the authority to act first and foremost as an advocate for the health and well-being of the public.

The Commission recommends placing the public health department directly beneath the governor and empowering the public health board with more independence to provide oversight and guidance to health department leaders.

Print 
			Agenda
  • August 21
    2008
    Public Health
    10:30 a.m., 850 Marina Bay Parkway, Richmond, CA
    Site Visit
    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    August 7, 2008

    For Additional Information Contact:
    Stuart Drown, Executive Director
    (916) 445-2125

    Notice of Site Visit and Meeting

    The Public Health Subcommittee of the Little Hoover Commission will meet with officials at the California State Public Health Laboratory located at 850 Marina Bay Parkway in Richmond, California on Thursday, August 21, 2008, starting at 10:30 a.m., to tour the facility and discuss laboratory capacity.

    Following the laboratory tour, the subcommittee will meet from 2 to 4 p.m. in University Hall room 714C at the University of California, Berkeley, School of Public Health to discuss issues surrounding the state’s public health workforce, including challenges with recruitment and retention, the efforts to address these challenges and recommendations for improvement.

    Please RSVP by Thursday, August 14, 2008 if you plan on attending the laboratory tour or the subcommittee meeting.

    All public notices for meetings are on the Commission’s Web site, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Stuart Drown at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, August 14, 2008.

  • August 21
    2008
    Public Health
    2:00 - 4:00 p.m., University Hall, Room 714C, University of Califor
    Subcommittee Meeting
    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    August 7, 2008

    For Additional Information Contact:
    Stuart Drown, Executive Director
    (916) 445-2125

    Notice of Site Visit and Meeting

    The Public Health Subcommittee of the Little Hoover Commission will meet with officials at the California State Public Health Laboratory located at 850 Marina Bay Parkway in Richmond, California on Thursday, August 21, 2008, starting at 10:30 a.m., to tour the facility and discuss laboratory capacity.

    Following the laboratory tour, the subcommittee will meet from 2 to 4 p.m. in University Hall room 714C at the University of California, Berkeley, School of Public Health to discuss issues surrounding the state’s public health workforce, including challenges with recruitment and retention, the efforts to address these challenges and recommendations for improvement.

    Please RSVP by Thursday, August 14, 2008 if you plan on attending the laboratory tour or the subcommittee meeting.

    All public notices for meetings are on the Commission’s Web site, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Stuart Drown at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, August 14, 2008.

  • August 28
    2008
    Public Health
    9:00 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Public Health 
    Thursday, August 28, 2008, at 9:00 a.m. 
    State Capitol, Room 437 
    Sacramento, CA


    Opening Remarks

    Local Government Perspectives

    1. Ann Lindsay, President, California Conference of Local Health Officers; Health Officer, Humboldt County Department of Health and Human Services (Written Testimony)
       
    2. David Souleles, President, County Health Executives Association of California (Written Testimony)
       

    Statewide Views 

    1. Giorgio Piccagli, President, California Public Health Association - North (Written Testimony)
       
    2. Mary Pittman, President, Public Health Institute (Written Testimony)
       
    3. Betsy Imholz, Director of Special Projects, Consumers Union (Written Testimony)
       

    Public Health Workforce Capacity 

    1. Mimi Lachica, Long Beach Health Laboratory Director; President, California Association of Public Health Laboratory Directors (Written Testimony)


    California Department of Public Health 

    1. Mark B. Horton, Director and Public Health Officer, California Department of Public Health (Written Testimony)
      ​​​​​​​

    Comments Submitted by Members of the Public

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    August 14, 2008

    For Additional Information Contact:
    Stuart Drown, Executive Director
    (916) 445-2125

    Notice of Meetings

    On Thursday, August 28, 2008, the Little Hoover Commission will conduct a public hearing on public health. The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

    The purpose of this hearing is to provide the Commission with an update on the status of California’s public health system following the Commission’s report, To Protect and Prevent: Rebuilding California’s Public Health System (April, 2003), and follow-up review in 2005 that prioritized specific recommendations from the 2003 report. The Commission will assess the progress that has been made in recent years and the impact of the new California Department of Public Health (CDPH) since it was established on July 1, 2007. The Commission will hear testimony from the CDPH director and state public health officer, local health officers and public health associations.

    There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. A business meeting will follow the hearing.

    An advisory group to the Data and Technology Subcommittee of the Little Hoover Commission will meet on Wednesday, August 27, 2008, from 2 to 4 p.m. in the Legislative Counsel’s Conference Room located on the lower level of 925 L Street, Sacramento, CA. The group will discuss opportunities and challenges to implementing a statewide performance measurement system.

    In addition, the California’s Water Boards Subcommittee of the Little Hoover Commission will meet on Thursday, August, 28, 2008, from 2:30 to 4:30 p.m. in the Legislative Counsel’s Conference Room located on the lower level of 925 L Street, Sacramento, CA. The subcommittee will discuss potential reforms to the state and regional water boards system.

    All public notices for meetings are on the Commission’s Web site, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Stuart Drown at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, August 21, 2008.

Print 
		Agenda
  • August 21
    2008
    Public Health
    10:30 a.m., 850 Marina Bay Parkway, Richmond, CA
    Site Visit
    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    August 7, 2008

    For Additional Information Contact:
    Stuart Drown, Executive Director
    (916) 445-2125

    Notice of Site Visit and Meeting

    The Public Health Subcommittee of the Little Hoover Commission will meet with officials at the California State Public Health Laboratory located at 850 Marina Bay Parkway in Richmond, California on Thursday, August 21, 2008, starting at 10:30 a.m., to tour the facility and discuss laboratory capacity.

    Following the laboratory tour, the subcommittee will meet from 2 to 4 p.m. in University Hall room 714C at the University of California, Berkeley, School of Public Health to discuss issues surrounding the state’s public health workforce, including challenges with recruitment and retention, the efforts to address these challenges and recommendations for improvement.

    Please RSVP by Thursday, August 14, 2008 if you plan on attending the laboratory tour or the subcommittee meeting.

    All public notices for meetings are on the Commission’s Web site, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Stuart Drown at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, August 14, 2008.

  • August 21
    2008
    Public Health
    2:00 - 4:00 p.m., University Hall, Room 714C, University of Califor
    Subcommittee Meeting
    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    August 7, 2008

    For Additional Information Contact:
    Stuart Drown, Executive Director
    (916) 445-2125

    Notice of Site Visit and Meeting

    The Public Health Subcommittee of the Little Hoover Commission will meet with officials at the California State Public Health Laboratory located at 850 Marina Bay Parkway in Richmond, California on Thursday, August 21, 2008, starting at 10:30 a.m., to tour the facility and discuss laboratory capacity.

    Following the laboratory tour, the subcommittee will meet from 2 to 4 p.m. in University Hall room 714C at the University of California, Berkeley, School of Public Health to discuss issues surrounding the state’s public health workforce, including challenges with recruitment and retention, the efforts to address these challenges and recommendations for improvement.

    Please RSVP by Thursday, August 14, 2008 if you plan on attending the laboratory tour or the subcommittee meeting.

    All public notices for meetings are on the Commission’s Web site, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Stuart Drown at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, August 14, 2008.

  • August 28
    2008
    Public Health
    9:00 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Public Health 
    Thursday, August 28, 2008, at 9:00 a.m. 
    State Capitol, Room 437 
    Sacramento, CA


    Opening Remarks

    Local Government Perspectives

    1. Ann Lindsay, President, California Conference of Local Health Officers; Health Officer, Humboldt County Department of Health and Human Services (Written Testimony)
       
    2. David Souleles, President, County Health Executives Association of California (Written Testimony)
       

    Statewide Views 

    1. Giorgio Piccagli, President, California Public Health Association - North (Written Testimony)
       
    2. Mary Pittman, President, Public Health Institute (Written Testimony)
       
    3. Betsy Imholz, Director of Special Projects, Consumers Union (Written Testimony)
       

    Public Health Workforce Capacity 

    1. Mimi Lachica, Long Beach Health Laboratory Director; President, California Association of Public Health Laboratory Directors (Written Testimony)


    California Department of Public Health 

    1. Mark B. Horton, Director and Public Health Officer, California Department of Public Health (Written Testimony)
      ​​​​​​​

    Comments Submitted by Members of the Public

    Public Notice

    PUBLIC NOTICE

    FOR IMMEDIATE RELEASE
    August 14, 2008

    For Additional Information Contact:
    Stuart Drown, Executive Director
    (916) 445-2125

    Notice of Meetings

    On Thursday, August 28, 2008, the Little Hoover Commission will conduct a public hearing on public health. The hearing will begin at 9 a.m. in Room 437 of the State Capitol in Sacramento.

    The purpose of this hearing is to provide the Commission with an update on the status of California’s public health system following the Commission’s report, To Protect and Prevent: Rebuilding California’s Public Health System (April, 2003), and follow-up review in 2005 that prioritized specific recommendations from the 2003 report. The Commission will assess the progress that has been made in recent years and the impact of the new California Department of Public Health (CDPH) since it was established on July 1, 2007. The Commission will hear testimony from the CDPH director and state public health officer, local health officers and public health associations.

    There will be an opportunity for public comment at the end of the hearing. The Commission also encourages written comments. A business meeting will follow the hearing.

    An advisory group to the Data and Technology Subcommittee of the Little Hoover Commission will meet on Wednesday, August 27, 2008, from 2 to 4 p.m. in the Legislative Counsel’s Conference Room located on the lower level of 925 L Street, Sacramento, CA. The group will discuss opportunities and challenges to implementing a statewide performance measurement system.

    In addition, the California’s Water Boards Subcommittee of the Little Hoover Commission will meet on Thursday, August, 28, 2008, from 2:30 to 4:30 p.m. in the Legislative Counsel’s Conference Room located on the lower level of 925 L Street, Sacramento, CA. The subcommittee will discuss potential reforms to the state and regional water boards system.

    All public notices for meetings are on the Commission’s Web site, www.lhc.ca.gov. If you need reasonable accommodation due to a disability, please contact Stuart Drown at (916) 445-2125 or littlehoover@lhc.ca.gov by Thursday, August 21, 2008.