To Protect and Prevent: Rebuilding California's Public Health System

Report #170, April 2003
To Protect and Prevent: Rebuilding California's Public Health System

Full Report

Executive Summary

Press Release

FOR IMMEDIATE RELEASE
April 10, 2003

For Additional Information Contact:
James P. Mayer, Executive Director
(916) 445-2125

California Surgeon General Needed To Protect Californians

The Little Hoover Commission on Thursday urged policy-makers to fortify California’s public health system so it can better detect and respond to a wide range of threats, from emerging diseases and hospital-acquired infections to bioterrorism.

The Commission recommended the State develop expert leadership, establish standards, increase training, improve communications and strengthen laboratory and other capacities essential to the public health infrastructure.

The comprehensive report – To Protect and Prevent: Rebuilding California’s Public Health System – was issued after 10 months of public meetings, interviews and deliberations, during which an array of experts identified specific weaknesses and practical improvements to a system that has gradually eroded over the last three decades.

The Commission initiated the project after the terrorist attacks of 2001 revealed that the traditional capacities of the public health system to detect and respond to epidemics and other disasters had been neglected as public attention focused on individual health care.  The Commission concluded that the improvements are needed to protect all California from a range of health risks. Experts said that a skilled and equipped public health system could save hundreds of lives in a bioterrorism attack – as well as reduce the 8,000 estimated deaths in California each year from infections that patients acquire while in hospitals.

"The complexity of today's public health threats requires a new commitment by government to defend the public," the Commission concluded. "Practices and procedures that block the swift ability to hire needed experts and employ life-saving technology are simply unacceptable in the face or risks so severe."

“If well-organized, well-equipped and well-staffed, lives will be saved,” the Commission stated.  “If nothing is done, we risk millions of preventable illnesses and deaths.”

The Commission recommended that the core public health functions – now fragmented and buried within large departments – be consolidated into a single state department with a surgeon general providing expert and focused leadership and reporting directly to the Governor.

The Commission also recommended that the State re-establish a volunteer public health board to provide expert involvement and public accountability to the government’s efforts.

This fortified state structure must build strong partnerships with local health and other agencies, hospitals and clinics, doctors and nurses.  The Commission found that these strategic players do not function as a well-honed system – with clearly defined responsibilities, quality assurances, and effective communications.

The State needs to strategically develop and employ technologies and trained professionals to make sure the system detects and assesses health threats, develops the most effective responses, and communicates with health care providers and the public.

Together, the reforms would redefine public health as the third component of California's public safety triad – police, fire and public health.

"An essential function of government is to protect the public’s safety, particularly from those threats that individuals cannot effectively deter themselves,” Chairman Michael Alpert said.  “Critical parts of this security function rest in the public health system, where skilled professionals are needed to prepare for, detect and respond to an array of hazards."

Experts testified to the Commission that these public health functions have been neglected over the years as attention and resources have turned to the important needs of residents without the ability to pay for personal health care.  At the same time the ability of hospitals and emergency rooms to respond to large public health crises have diminished because of efforts to reduce costs and attempts to serve uninsured patients.

A fortified public health system would reduce the risk to all Californians, ensuring capacities in times of emergency, and reducing demands on the overall health system.  The Commission concluded that a strong public health system – and in particular, focused, expert and public deliberation at the state level – could help policy-makers resolve the larger health care challenges.

While the federal and state government have taken steps since September 11, 2001 to repair the system, the fundamental and structural problems have not been adequately addressed in California.

"These challenges would be formidable in good economic times, but with discipline they are possible even now,” Alpert said. “Our recommendations for organizational changes can be made by better using existing personnel and other resources.  Many of the specific initiatives can be paid for with federal funds coming to California to improve homeland defense."

The Little Hoover Commission is a bipartisan and independent state agency charged with advising the Governor and the Legislature on ways to improve the efficiency and effectiveness of state programs.  The Commission’s report, along with written testimony from experts on this topic, is available on the Commission’s Web site: www.lhc.ca.gov.

Fact Sheet

Study Description

In reviewing California’s ability to respond to emergencies after the events of September 11, 2001, the Commission concluded that "the largest single weakness revealed by the terrorist attacks is the public health system." The Commission recommended that "the State needs to fashion immediate and long-term improvements to public health assets," and toward that end the Commission conducted this detailed review. 

For this study, the Commission examined California’s public health system and the most serious threats posed by the failing public health system. The Commission also reviewd strategies for improving, leveraging and potentially reorganizing public health functions to better safeguard the public. 


Previous Studies

Agenda

Overview

In this report, the Commission urges the State to fashion immediate and long-term improvements to public health assets. 

During its review of the State’s ability to respond to emergencies after the events of September 11, 2001, the Commission found the public health system as the weakest link in California’s homeland defense. The Commission found the State's public health leadership and organizational structure ill-prepared to fulfill the primary obligation of reducing injury and death from threats that individuals cannot control. Public health agencies lack equipment, training, procedures and standards necessary to perform in concert with traditional first responders.

The Commission recommends for the State to focus its public health functions into a single department with physician leadership and a public and expert advisory board. The Commission also recommends for the State to build a strong and responsive partnership with county health offices and private providers, and fortify its professional workforce and arm it with effective technologies. 

Print Agenda
  • November 18
    2002
    Public Health System
    9:30 a.m.
    Advisory Committee Meeting
    Agenda

    AGENDA

    Advisory Committee Meeting on Public Health System
    Monday, November 18, 2002, 9:30 a.m. – 2:30 p.m. 
    University of Southern California 
    Midtown Sacramento Campus 
    1800 I Street, Room E 
    Sacramento, CA


    Meeting Goals: Building on gleanings from two Little Hoover Commission public hearings and three advisory committee roundtable discussions, we will explore the status, best practices and opportunities for innovations in:

    1. The structure of public health governance, in California and nationally;
       
    2. Public health financing.
       

    Please come to the meeting prepared to think about and discuss:

    • Models to learn from in other states, the private sector, and other sectors of the economy;
       
    • Best practices to emulate; and
       
    • Successful public input models for public health prioritization, communication, policy-making, etc.


    Between presentations will be Q & A and roundtable discussion.

    9:30 – 9:35 a.m.  

    Meeting Goals
    (Commissioner Schockman)

    9:35 – 9:45 a.m.  

    Introductions of Advisory Committee

    9:45 a.m.  

    Introduction of First Speaker 
    (Project Manager Hattie Rees Hanley)
     

    Session I:  Governance and Leadership Models

    9:45 a.m.

    Warner Hudson, MD, FACOEM, FAAFP, Member of Governor's State Strategic Committee on Terrorism and the Disaster Subcommittee of American College of Occupational and Environmental Medicine (PowerPoint Presentation)

    10:15 a.m.

    Richard J. Jackson, MD, MPH, Director, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention (PowerPoint Presentation)

    11:15 a.m.

    Don Sloma, MPH, Executive Director, Washington State Board of Health (PowerPoint Presentation)

    12:00 - 12:20 p.m. Break & select boxed lunch

    12:25 - 1:30 p.m.

    Joe Hafey, Public Health Institute – State models research & recommendations (Written Testimony, Attachment)

    Session II:  Finance

    1:30 p.m.

    Representative from California Health and Human Services Agency - Invited

  • October 29
    2002
    Public Health System
    9:30 a.m.
    Advisory Committee Meeting
    Agenda

    AGENDA

    Advisory Committee Meeting on Public Health System
    Tuesday, October 29, 2002, 9:30 a.m. – 2:30 p.m. 
    UC Davis Medical Center, Main Hospital ACSU Auditorium 
    2315 Stockton Boulevard 
    Sacramento, CA


    Meeting Goals: To discuss and gain a better understanding of priority capacity concerns in normal and surge conditions, including those that have been presented previously at hearings, specifically:

    • Hospital, trauma and emergency capacity
       
    • Workforce (including training and exercises)
       
    • Essential public health personnel
       
    • Public health laboratories
       
    • Rural shortages


    9:30 – 9:40 a.m.       

    Opening Remarks, Meeting Goals 
    (Executive Director Jim Mayer)

    9:40 – 9:55 a.m.       

    Introductions of Advisory Committee & Committee Process

    9:55 – 10:00 a.m.     

    Introduction of Speakers 
    (Project Manager Hattie Rees Hanley)

    10:00 a.m. – 2:30  p.m.    

    Capacity Distribution and Planning for Normal and Surge Conditions 
     

    Between the following presentations will be Q & A and roundtable discussion:

    1. Mike Boyd, UCDMC Associate Director – Welcome and remarks on academic medical center capacity
       
    2. Edward O’Neil, Ph.D., and Catherine Dower, J.D., Center for the Health Professions, UCSF – Workforce capacity, including public health workers (PowerPoint Presentation)
       

    12:00 – 12:30 p.m.    Lunch Break

    1. Kenneth Takata, Public Health Lab Director, Department of Health and Human Services, Sacramento County – Statewide lab capacity (PowerPoint Presentation)
       
    2. Carol Mordhorst, Public Health Director, Mendocino County Department of Public Health – Rural shortages


    Public Comments

  • October 24
    2002
    Public Health System
    9:00 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Public Health 
    Thursday, October 24, 2002, at 9:00 a.m.
    State Capitol, Room 437 
    Sacramento, CA


    Opening Remarks

    Public Health Leadership

    1. Lester Breslow, M.D., M.P.H., Member, Los Angeles County Public Health Commission; Professor Emeritus and Former Dean, UCLA School of Public Health; Former Director of Public Health, State of California  
    • Joint written testimony of Dr. Breslow and Philip R. Lee, M.D., Former Assistant Secretary for Health, U.S. Health and Human Services; Consulting Professor, Stanford University
       
    1. Robert Ross, M.D., President and CEO, California Endowment (Written Testimony)
       

    Strategic Partners

    1. C. Duane Dauner, President and CEO, California Healthcare Association (Written Testimony)
       
    2. Raymond J. Baxter, Ph.D., Senior Vice President, Community Benefit, Kaiser Permanente (Written Testimony)
       
    3. Loren Johnson, M.D., Immediate Past President, California Chapter of the American College of Emergency Physicians (CAL-ACEP) (Written Testimony)
       
    4. Stephen E. Hon, President, County Health Executives Association of California (Written Testimony)


    Government

    1. Richard Burton, M.D., M.P.H., Associate Director, California Department of Health Services (Written Testimony)
       
    2. Jeffrey L. Rubin, Chief, Disaster Medical Services Division, California Emergency Medical Services Authority (Written Testimony)
       

    Public Comments

  • September 9
    2002
    Public Health System
    9:30 a.m.
    Advisory Committee Meeting
    Agenda

    AGENDA

    Advisory Committee Meeting on Public Health System
    Monday, September 9, 2002, 9:30 a.m. – 2:30 p.m. 
    California Chamber of Commerce – California Room 
    1215 K Street, 14th Floor 
    Sacramento, CA


    Meeting Goals:

    1. Explore the range of public health threats facing California's population. 
       
    2. Explore the public health system’s preparedness for all hazards, including terrorism.


    9:30 – 9:35 a.m.       

    Opening Remarks 
    (Chairman Alpert)

    9:35 – 9:55 a.m.       

    Advisory Committee Process, Meeting Goals and Introductions 
    (Executive Director Jim Mayer)

    9:55 – 10:00 a.m.     

    Introduction of Speakers 
    (Project Manager Hattie Rees Hanley)

    10:00 a.m. – 2:30  p.m.    

    Potential Threats to California; and Public Health Preparedness, Including Surveillance, Analysis and Rapid Communication Capacity

    Between the following presentations will be Q & A and roundtable discussion:

    1. Alan Zelicoff, M.D., Senior Scientist, Center for Arms Control and National Security, Sandia National Laboratories (PowerPoint Presentation)
       
    2. Kenneth I. Shine, M.D., Director, RAND Center For Domestic and International Health Security; Immediate Past President, Institute of Medicine
       
    3. Arthur Reingold, M.D., Professor and Head of Epidemiology, U.C. Berkeley, School of Public Health (PowerPoint Presentation)
       

    12:00 – 12:30 p.m.    Lunch Break

    1. Steve Waterman, M.D., Senior Medical Epidemiologist, Centers for Disease Control, U.S. Mexico Border Infectious Disease Coordinator (PowerPoint Presentation)
       
    2. Colonel Cross and Major Weber, California National Guard (PowerPoint Presentation)
  • July 31
    2002
    Public Health System
    1:30 - 5:00 p.m., Library and Courts Building II, 900 N Street, Roo
    Advisory Committee Meeting
    Agenda

    AGENDA

    Advisory Committee Meeting on Public Health System
    Wednesday, July 31, 2002, 1:30 - 5:00 p.m. 
    Library and Courts Building II 
    900 N Street, Room 340 
    Sacramento, CA


    Meeting Goals:

    1. Review scope of study and issues to be discussed in upcoming meetings.
       
    2. Review core elements of a robust public health system:
    • Specify government duties within the public health system.
    • Benchmark California’s fulfillment of each of the government roles at the state and local levels.
    • Discuss approaches to measuring government’s capacity and preparedness for fulfilling each of its responsibilities in public health.
       
    1. Review public health financing:
    • Review and map public health funding at the federal, state, and local levels.
    • Discuss levels of participation and discretion.
    • Discuss trends in per capita public health spending.
    • Discuss options for improvement and accountability.
       

    1:30 – 2:15 p.m.

    Opening Remarks and Introductions 
    (Subcommittee Chairman, H. Eric Schockman) 
     

    2:15 – 2:25 p.m.

    Advisory Committee Process and Meeting Goals 
    (Executive Director, James P. Mayer) 
     

    2:25 – 2:30 p.m.

    Review Scope of Study 
    (Project Manager, Hattie Rees Hanley) 
     

    2:30 – 3:40  p.m.

    Discussion of Core Elements of a Robust Public Health System
    (Dr. George Flores - presentation; group roundtable discussion) 
     

    3:40 – 3:50  p.m.  BREAK 
     

    3:50 – 5:00  p.m.

    Finance 
    (Dr. Richard Burton and Greg Franklin, Department of Health Services – overview; John Miller - tobacco funding and legislative perspective; group roundtable discussion)

    Public Comments

  • June 27
    2002
    Public Health System
    9:00 a.m., State Capitol, Room 113, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Public Health System
    Thursday, June 27, 2002, at 9:00 a.m.
    State Capitol, Room 113 
    Sacramento, CA
     

    Opening Remarks

    Overview of California’s Public Health System

    1. Jonathan E. Fielding, M.D., M.P.H., Director of Public Health and Health Officer, Los Angeles County, and Professor, Schools of Medicine and Public Health, University of California, Los Angeles (Written Testimony)
       
    2. Richard J. Burton, M.D., M.P.H., Associate Director, California Department of Health Services
       

    Legal Structure and Financing

    1. James B. Simpson, J.D., General Counsel, and Carmen R. Nevarez, M.D., M.P.H., Medical Director and Vice President of External Relations, Public Health Institute (Written Testimony)
       
    2. Poki Stewart Namkung, M.D., M.P.H., Director of Public Health and Health Officer, City of Berkeley and President, California Conference of Local Health Officers (Written Testimony)
       
    3. Assemblymember Keith S. Richman, M.D., M.P.H.


    Medical Facility and Labor Capacity Assessment, Risk Analysis and Planning

    1. David M. Carlisle, M.D., Ph.D., Director, State of California Office of Statewide Health Planning and Development (Written Testimony)
       
    2. Jack C. Lewin, M.D., Chief Executive Officer and Executive Vice President, California Medical Association (Written Testimony)
       
    3. George R. Flores, M.D., M.P.H., Former Director of Public Health and Health Officer, County of San Diego (Written Testimony)
       
    4. Roger C. On, M.D., Practicing Cardiologist and Assistant Clinical Professor of Medicine, UCLA School of Medicine (Written Testimony)


    Comments Submitted by Members of the Public

    • Lester Breslow, M.D., M.P.H., Professor and Dean Emeritus, UCLA School of Public Health, and Former Director, California State Department of Public Health (Written Comments)
November 18
2002
Public Health System
9:30 a.m. – 2:30 p.m., University of Southern California, Midtown Sacramento Campus,1800 I Street, Room E, Sacramento, CA
Advisory Committee Meeting
Agenda

AGENDA

Advisory Committee Meeting on Public Health System
Monday, November 18, 2002, 9:30 a.m. – 2:30 p.m. 
University of Southern California 
Midtown Sacramento Campus 
1800 I Street, Room E 
Sacramento, CA


Meeting Goals: Building on gleanings from two Little Hoover Commission public hearings and three advisory committee roundtable discussions, we will explore the status, best practices and opportunities for innovations in:

  1. The structure of public health governance, in California and nationally;
     
  2. Public health financing.
     

Please come to the meeting prepared to think about and discuss:

  • Models to learn from in other states, the private sector, and other sectors of the economy;
     
  • Best practices to emulate; and
     
  • Successful public input models for public health prioritization, communication, policy-making, etc.


Between presentations will be Q & A and roundtable discussion.

9:30 – 9:35 a.m.  

Meeting Goals
(Commissioner Schockman)

9:35 – 9:45 a.m.  

Introductions of Advisory Committee

9:45 a.m.  

Introduction of First Speaker 
(Project Manager Hattie Rees Hanley)
 

Session I:  Governance and Leadership Models

9:45 a.m.

Warner Hudson, MD, FACOEM, FAAFP, Member of Governor's State Strategic Committee on Terrorism and the Disaster Subcommittee of American College of Occupational and Environmental Medicine (PowerPoint Presentation)

10:15 a.m.

Richard J. Jackson, MD, MPH, Director, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention (PowerPoint Presentation)

11:15 a.m.

Don Sloma, MPH, Executive Director, Washington State Board of Health (PowerPoint Presentation)

12:00 - 12:20 p.m. Break & select boxed lunch

12:25 - 1:30 p.m.

Joe Hafey, Public Health Institute – State models research & recommendations (Written Testimony, Attachment)

Session II:  Finance

1:30 p.m.

Representative from California Health and Human Services Agency - Invited

October 29
2002
Public Health System
9:30 a.m. – 2:30 p.m., UC Davis Medical Center, Main Hospital ACSU Auditorium, 2315 Stockton Boulevard, Sacramento, CA
Advisory Committee Meeting
Agenda

AGENDA

Advisory Committee Meeting on Public Health System
Tuesday, October 29, 2002, 9:30 a.m. – 2:30 p.m. 
UC Davis Medical Center, Main Hospital ACSU Auditorium 
2315 Stockton Boulevard 
Sacramento, CA


Meeting Goals: To discuss and gain a better understanding of priority capacity concerns in normal and surge conditions, including those that have been presented previously at hearings, specifically:

  • Hospital, trauma and emergency capacity
     
  • Workforce (including training and exercises)
     
  • Essential public health personnel
     
  • Public health laboratories
     
  • Rural shortages


9:30 – 9:40 a.m.       

Opening Remarks, Meeting Goals 
(Executive Director Jim Mayer)

9:40 – 9:55 a.m.       

Introductions of Advisory Committee & Committee Process

9:55 – 10:00 a.m.     

Introduction of Speakers 
(Project Manager Hattie Rees Hanley)

10:00 a.m. – 2:30  p.m.    

Capacity Distribution and Planning for Normal and Surge Conditions 
 

Between the following presentations will be Q & A and roundtable discussion:

  1. Mike Boyd, UCDMC Associate Director – Welcome and remarks on academic medical center capacity
     
  2. Edward O’Neil, Ph.D., and Catherine Dower, J.D., Center for the Health Professions, UCSF – Workforce capacity, including public health workers (PowerPoint Presentation)
     

12:00 – 12:30 p.m.    Lunch Break

  1. Kenneth Takata, Public Health Lab Director, Department of Health and Human Services, Sacramento County – Statewide lab capacity (PowerPoint Presentation)
     
  2. Carol Mordhorst, Public Health Director, Mendocino County Department of Public Health – Rural shortages


Public Comments

October 24
2002
Public Health System
9:00 a.m., State Capitol, Room 437, Sacramento, CA
Public Hearing
Agenda

AGENDA

Public Hearing on Public Health 
Thursday, October 24, 2002, at 9:00 a.m.
State Capitol, Room 437 
Sacramento, CA


Opening Remarks

Public Health Leadership

  1. Lester Breslow, M.D., M.P.H., Member, Los Angeles County Public Health Commission; Professor Emeritus and Former Dean, UCLA School of Public Health; Former Director of Public Health, State of California  
  • Joint written testimony of Dr. Breslow and Philip R. Lee, M.D., Former Assistant Secretary for Health, U.S. Health and Human Services; Consulting Professor, Stanford University
     
  1. Robert Ross, M.D., President and CEO, California Endowment (Written Testimony)
     

Strategic Partners

  1. C. Duane Dauner, President and CEO, California Healthcare Association (Written Testimony)
     
  2. Raymond J. Baxter, Ph.D., Senior Vice President, Community Benefit, Kaiser Permanente (Written Testimony)
     
  3. Loren Johnson, M.D., Immediate Past President, California Chapter of the American College of Emergency Physicians (CAL-ACEP) (Written Testimony)
     
  4. Stephen E. Hon, President, County Health Executives Association of California (Written Testimony)


Government

  1. Richard Burton, M.D., M.P.H., Associate Director, California Department of Health Services (Written Testimony)
     
  2. Jeffrey L. Rubin, Chief, Disaster Medical Services Division, California Emergency Medical Services Authority (Written Testimony)
     

Public Comments

September 9
2002
Public Health System
9:30 a.m. – 2:30 p.m., California Chamber of Commerce – California Room, 1215 K Street, 14th Floor, Sacramento, CA
Advisory Committee Meeting
Agenda

AGENDA

Advisory Committee Meeting on Public Health System
Monday, September 9, 2002, 9:30 a.m. – 2:30 p.m. 
California Chamber of Commerce – California Room 
1215 K Street, 14th Floor 
Sacramento, CA


Meeting Goals:

  1. Explore the range of public health threats facing California's population. 
     
  2. Explore the public health system’s preparedness for all hazards, including terrorism.


9:30 – 9:35 a.m.       

Opening Remarks 
(Chairman Alpert)

9:35 – 9:55 a.m.       

Advisory Committee Process, Meeting Goals and Introductions 
(Executive Director Jim Mayer)

9:55 – 10:00 a.m.     

Introduction of Speakers 
(Project Manager Hattie Rees Hanley)

10:00 a.m. – 2:30  p.m.    

Potential Threats to California; and Public Health Preparedness, Including Surveillance, Analysis and Rapid Communication Capacity

Between the following presentations will be Q & A and roundtable discussion:

  1. Alan Zelicoff, M.D., Senior Scientist, Center for Arms Control and National Security, Sandia National Laboratories (PowerPoint Presentation)
     
  2. Kenneth I. Shine, M.D., Director, RAND Center For Domestic and International Health Security; Immediate Past President, Institute of Medicine
     
  3. Arthur Reingold, M.D., Professor and Head of Epidemiology, U.C. Berkeley, School of Public Health (PowerPoint Presentation)
     

12:00 – 12:30 p.m.    Lunch Break

  1. Steve Waterman, M.D., Senior Medical Epidemiologist, Centers for Disease Control, U.S. Mexico Border Infectious Disease Coordinator (PowerPoint Presentation)
     
  2. Colonel Cross and Major Weber, California National Guard (PowerPoint Presentation)
July 31
2002
Public Health System
1:30 - 5:00 p.m., Library and Courts Building II, 900 N Street, Room 340, Sacramento, CA
Advisory Committee Meeting
Agenda

AGENDA

Advisory Committee Meeting on Public Health System
Wednesday, July 31, 2002, 1:30 - 5:00 p.m. 
Library and Courts Building II 
900 N Street, Room 340 
Sacramento, CA


Meeting Goals:

  1. Review scope of study and issues to be discussed in upcoming meetings.
     
  2. Review core elements of a robust public health system:
  • Specify government duties within the public health system.
  • Benchmark California’s fulfillment of each of the government roles at the state and local levels.
  • Discuss approaches to measuring government’s capacity and preparedness for fulfilling each of its responsibilities in public health.
     
  1. Review public health financing:
  • Review and map public health funding at the federal, state, and local levels.
  • Discuss levels of participation and discretion.
  • Discuss trends in per capita public health spending.
  • Discuss options for improvement and accountability.
     

1:30 – 2:15 p.m.

Opening Remarks and Introductions 
(Subcommittee Chairman, H. Eric Schockman) 
 

2:15 – 2:25 p.m.

Advisory Committee Process and Meeting Goals 
(Executive Director, James P. Mayer) 
 

2:25 – 2:30 p.m.

Review Scope of Study 
(Project Manager, Hattie Rees Hanley) 
 

2:30 – 3:40  p.m.

Discussion of Core Elements of a Robust Public Health System
(Dr. George Flores - presentation; group roundtable discussion) 
 

3:40 – 3:50  p.m.  BREAK 
 

3:50 – 5:00  p.m.

Finance 
(Dr. Richard Burton and Greg Franklin, Department of Health Services – overview; John Miller - tobacco funding and legislative perspective; group roundtable discussion)

Public Comments

June 27
2002
Public Health System
9:00 a.m., State Capitol, Room 113, Sacramento, CA
Public Hearing
Agenda

AGENDA

Public Hearing on Public Health System
Thursday, June 27, 2002, at 9:00 a.m.
State Capitol, Room 113 
Sacramento, CA
 

Opening Remarks

Overview of California’s Public Health System

  1. Jonathan E. Fielding, M.D., M.P.H., Director of Public Health and Health Officer, Los Angeles County, and Professor, Schools of Medicine and Public Health, University of California, Los Angeles (Written Testimony)
     
  2. Richard J. Burton, M.D., M.P.H., Associate Director, California Department of Health Services
     

Legal Structure and Financing

  1. James B. Simpson, J.D., General Counsel, and Carmen R. Nevarez, M.D., M.P.H., Medical Director and Vice President of External Relations, Public Health Institute (Written Testimony)
     
  2. Poki Stewart Namkung, M.D., M.P.H., Director of Public Health and Health Officer, City of Berkeley and President, California Conference of Local Health Officers (Written Testimony)
     
  3. Assemblymember Keith S. Richman, M.D., M.P.H.


Medical Facility and Labor Capacity Assessment, Risk Analysis and Planning

  1. David M. Carlisle, M.D., Ph.D., Director, State of California Office of Statewide Health Planning and Development (Written Testimony)
     
  2. Jack C. Lewin, M.D., Chief Executive Officer and Executive Vice President, California Medical Association (Written Testimony)
     
  3. George R. Flores, M.D., M.P.H., Former Director of Public Health and Health Officer, County of San Diego (Written Testimony)
     
  4. Roger C. On, M.D., Practicing Cardiologist and Assistant Clinical Professor of Medicine, UCLA School of Medicine (Written Testimony)


Comments Submitted by Members of the Public

  • Lester Breslow, M.D., M.P.H., Professor and Dean Emeritus, UCLA School of Public Health, and Former Director, California State Department of Public Health (Written Comments)
Print Agenda
  • November 18
    2002
    Public Health System
    9:30 a.m.
    Advisory Committee Meeting
    Agenda

    AGENDA

    Advisory Committee Meeting on Public Health System
    Monday, November 18, 2002, 9:30 a.m. – 2:30 p.m. 
    University of Southern California 
    Midtown Sacramento Campus 
    1800 I Street, Room E 
    Sacramento, CA


    Meeting Goals: Building on gleanings from two Little Hoover Commission public hearings and three advisory committee roundtable discussions, we will explore the status, best practices and opportunities for innovations in:

    1. The structure of public health governance, in California and nationally;
       
    2. Public health financing.
       

    Please come to the meeting prepared to think about and discuss:

    • Models to learn from in other states, the private sector, and other sectors of the economy;
       
    • Best practices to emulate; and
       
    • Successful public input models for public health prioritization, communication, policy-making, etc.


    Between presentations will be Q & A and roundtable discussion.

    9:30 – 9:35 a.m.  

    Meeting Goals
    (Commissioner Schockman)

    9:35 – 9:45 a.m.  

    Introductions of Advisory Committee

    9:45 a.m.  

    Introduction of First Speaker 
    (Project Manager Hattie Rees Hanley)
     

    Session I:  Governance and Leadership Models

    9:45 a.m.

    Warner Hudson, MD, FACOEM, FAAFP, Member of Governor's State Strategic Committee on Terrorism and the Disaster Subcommittee of American College of Occupational and Environmental Medicine (PowerPoint Presentation)

    10:15 a.m.

    Richard J. Jackson, MD, MPH, Director, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention (PowerPoint Presentation)

    11:15 a.m.

    Don Sloma, MPH, Executive Director, Washington State Board of Health (PowerPoint Presentation)

    12:00 - 12:20 p.m. Break & select boxed lunch

    12:25 - 1:30 p.m.

    Joe Hafey, Public Health Institute – State models research & recommendations (Written Testimony, Attachment)

    Session II:  Finance

    1:30 p.m.

    Representative from California Health and Human Services Agency - Invited

  • October 29
    2002
    Public Health System
    9:30 a.m.
    Advisory Committee Meeting
    Agenda

    AGENDA

    Advisory Committee Meeting on Public Health System
    Tuesday, October 29, 2002, 9:30 a.m. – 2:30 p.m. 
    UC Davis Medical Center, Main Hospital ACSU Auditorium 
    2315 Stockton Boulevard 
    Sacramento, CA


    Meeting Goals: To discuss and gain a better understanding of priority capacity concerns in normal and surge conditions, including those that have been presented previously at hearings, specifically:

    • Hospital, trauma and emergency capacity
       
    • Workforce (including training and exercises)
       
    • Essential public health personnel
       
    • Public health laboratories
       
    • Rural shortages


    9:30 – 9:40 a.m.       

    Opening Remarks, Meeting Goals 
    (Executive Director Jim Mayer)

    9:40 – 9:55 a.m.       

    Introductions of Advisory Committee & Committee Process

    9:55 – 10:00 a.m.     

    Introduction of Speakers 
    (Project Manager Hattie Rees Hanley)

    10:00 a.m. – 2:30  p.m.    

    Capacity Distribution and Planning for Normal and Surge Conditions 
     

    Between the following presentations will be Q & A and roundtable discussion:

    1. Mike Boyd, UCDMC Associate Director – Welcome and remarks on academic medical center capacity
       
    2. Edward O’Neil, Ph.D., and Catherine Dower, J.D., Center for the Health Professions, UCSF – Workforce capacity, including public health workers (PowerPoint Presentation)
       

    12:00 – 12:30 p.m.    Lunch Break

    1. Kenneth Takata, Public Health Lab Director, Department of Health and Human Services, Sacramento County – Statewide lab capacity (PowerPoint Presentation)
       
    2. Carol Mordhorst, Public Health Director, Mendocino County Department of Public Health – Rural shortages


    Public Comments

  • October 24
    2002
    Public Health System
    9:00 a.m., State Capitol, Room 437, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Public Health 
    Thursday, October 24, 2002, at 9:00 a.m.
    State Capitol, Room 437 
    Sacramento, CA


    Opening Remarks

    Public Health Leadership

    1. Lester Breslow, M.D., M.P.H., Member, Los Angeles County Public Health Commission; Professor Emeritus and Former Dean, UCLA School of Public Health; Former Director of Public Health, State of California  
    • Joint written testimony of Dr. Breslow and Philip R. Lee, M.D., Former Assistant Secretary for Health, U.S. Health and Human Services; Consulting Professor, Stanford University
       
    1. Robert Ross, M.D., President and CEO, California Endowment (Written Testimony)
       

    Strategic Partners

    1. C. Duane Dauner, President and CEO, California Healthcare Association (Written Testimony)
       
    2. Raymond J. Baxter, Ph.D., Senior Vice President, Community Benefit, Kaiser Permanente (Written Testimony)
       
    3. Loren Johnson, M.D., Immediate Past President, California Chapter of the American College of Emergency Physicians (CAL-ACEP) (Written Testimony)
       
    4. Stephen E. Hon, President, County Health Executives Association of California (Written Testimony)


    Government

    1. Richard Burton, M.D., M.P.H., Associate Director, California Department of Health Services (Written Testimony)
       
    2. Jeffrey L. Rubin, Chief, Disaster Medical Services Division, California Emergency Medical Services Authority (Written Testimony)
       

    Public Comments

  • September 9
    2002
    Public Health System
    9:30 a.m.
    Advisory Committee Meeting
    Agenda

    AGENDA

    Advisory Committee Meeting on Public Health System
    Monday, September 9, 2002, 9:30 a.m. – 2:30 p.m. 
    California Chamber of Commerce – California Room 
    1215 K Street, 14th Floor 
    Sacramento, CA


    Meeting Goals:

    1. Explore the range of public health threats facing California's population. 
       
    2. Explore the public health system’s preparedness for all hazards, including terrorism.


    9:30 – 9:35 a.m.       

    Opening Remarks 
    (Chairman Alpert)

    9:35 – 9:55 a.m.       

    Advisory Committee Process, Meeting Goals and Introductions 
    (Executive Director Jim Mayer)

    9:55 – 10:00 a.m.     

    Introduction of Speakers 
    (Project Manager Hattie Rees Hanley)

    10:00 a.m. – 2:30  p.m.    

    Potential Threats to California; and Public Health Preparedness, Including Surveillance, Analysis and Rapid Communication Capacity

    Between the following presentations will be Q & A and roundtable discussion:

    1. Alan Zelicoff, M.D., Senior Scientist, Center for Arms Control and National Security, Sandia National Laboratories (PowerPoint Presentation)
       
    2. Kenneth I. Shine, M.D., Director, RAND Center For Domestic and International Health Security; Immediate Past President, Institute of Medicine
       
    3. Arthur Reingold, M.D., Professor and Head of Epidemiology, U.C. Berkeley, School of Public Health (PowerPoint Presentation)
       

    12:00 – 12:30 p.m.    Lunch Break

    1. Steve Waterman, M.D., Senior Medical Epidemiologist, Centers for Disease Control, U.S. Mexico Border Infectious Disease Coordinator (PowerPoint Presentation)
       
    2. Colonel Cross and Major Weber, California National Guard (PowerPoint Presentation)
  • July 31
    2002
    Public Health System
    1:30 - 5:00 p.m., Library and Courts Building II, 900 N Street, Roo
    Advisory Committee Meeting
    Agenda

    AGENDA

    Advisory Committee Meeting on Public Health System
    Wednesday, July 31, 2002, 1:30 - 5:00 p.m. 
    Library and Courts Building II 
    900 N Street, Room 340 
    Sacramento, CA


    Meeting Goals:

    1. Review scope of study and issues to be discussed in upcoming meetings.
       
    2. Review core elements of a robust public health system:
    • Specify government duties within the public health system.
    • Benchmark California’s fulfillment of each of the government roles at the state and local levels.
    • Discuss approaches to measuring government’s capacity and preparedness for fulfilling each of its responsibilities in public health.
       
    1. Review public health financing:
    • Review and map public health funding at the federal, state, and local levels.
    • Discuss levels of participation and discretion.
    • Discuss trends in per capita public health spending.
    • Discuss options for improvement and accountability.
       

    1:30 – 2:15 p.m.

    Opening Remarks and Introductions 
    (Subcommittee Chairman, H. Eric Schockman) 
     

    2:15 – 2:25 p.m.

    Advisory Committee Process and Meeting Goals 
    (Executive Director, James P. Mayer) 
     

    2:25 – 2:30 p.m.

    Review Scope of Study 
    (Project Manager, Hattie Rees Hanley) 
     

    2:30 – 3:40  p.m.

    Discussion of Core Elements of a Robust Public Health System
    (Dr. George Flores - presentation; group roundtable discussion) 
     

    3:40 – 3:50  p.m.  BREAK 
     

    3:50 – 5:00  p.m.

    Finance 
    (Dr. Richard Burton and Greg Franklin, Department of Health Services – overview; John Miller - tobacco funding and legislative perspective; group roundtable discussion)

    Public Comments

  • June 27
    2002
    Public Health System
    9:00 a.m., State Capitol, Room 113, Sacramento, CA
    Public Hearing
    Agenda

    AGENDA

    Public Hearing on Public Health System
    Thursday, June 27, 2002, at 9:00 a.m.
    State Capitol, Room 113 
    Sacramento, CA
     

    Opening Remarks

    Overview of California’s Public Health System

    1. Jonathan E. Fielding, M.D., M.P.H., Director of Public Health and Health Officer, Los Angeles County, and Professor, Schools of Medicine and Public Health, University of California, Los Angeles (Written Testimony)
       
    2. Richard J. Burton, M.D., M.P.H., Associate Director, California Department of Health Services
       

    Legal Structure and Financing

    1. James B. Simpson, J.D., General Counsel, and Carmen R. Nevarez, M.D., M.P.H., Medical Director and Vice President of External Relations, Public Health Institute (Written Testimony)
       
    2. Poki Stewart Namkung, M.D., M.P.H., Director of Public Health and Health Officer, City of Berkeley and President, California Conference of Local Health Officers (Written Testimony)
       
    3. Assemblymember Keith S. Richman, M.D., M.P.H.


    Medical Facility and Labor Capacity Assessment, Risk Analysis and Planning

    1. David M. Carlisle, M.D., Ph.D., Director, State of California Office of Statewide Health Planning and Development (Written Testimony)
       
    2. Jack C. Lewin, M.D., Chief Executive Officer and Executive Vice President, California Medical Association (Written Testimony)
       
    3. George R. Flores, M.D., M.P.H., Former Director of Public Health and Health Officer, County of San Diego (Written Testimony)
       
    4. Roger C. On, M.D., Practicing Cardiologist and Assistant Clinical Professor of Medicine, UCLA School of Medicine (Written Testimony)


    Comments Submitted by Members of the Public

    • Lester Breslow, M.D., M.P.H., Professor and Dean Emeritus, UCLA School of Public Health, and Former Director, California State Department of Public Health (Written Comments)
November 18
2002
Public Health System
9:30 a.m. – 2:30 p.m., University of Southern California, Midtown Sacramento Campus,1800 I Street, Room E, Sacramento, CA
Advisory Committee Meeting
Agenda

AGENDA

Advisory Committee Meeting on Public Health System
Monday, November 18, 2002, 9:30 a.m. – 2:30 p.m. 
University of Southern California 
Midtown Sacramento Campus 
1800 I Street, Room E 
Sacramento, CA


Meeting Goals: Building on gleanings from two Little Hoover Commission public hearings and three advisory committee roundtable discussions, we will explore the status, best practices and opportunities for innovations in:

  1. The structure of public health governance, in California and nationally;
     
  2. Public health financing.
     

Please come to the meeting prepared to think about and discuss:

  • Models to learn from in other states, the private sector, and other sectors of the economy;
     
  • Best practices to emulate; and
     
  • Successful public input models for public health prioritization, communication, policy-making, etc.


Between presentations will be Q & A and roundtable discussion.

9:30 – 9:35 a.m.  

Meeting Goals
(Commissioner Schockman)

9:35 – 9:45 a.m.  

Introductions of Advisory Committee

9:45 a.m.  

Introduction of First Speaker 
(Project Manager Hattie Rees Hanley)
 

Session I:  Governance and Leadership Models

9:45 a.m.

Warner Hudson, MD, FACOEM, FAAFP, Member of Governor's State Strategic Committee on Terrorism and the Disaster Subcommittee of American College of Occupational and Environmental Medicine (PowerPoint Presentation)

10:15 a.m.

Richard J. Jackson, MD, MPH, Director, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention (PowerPoint Presentation)

11:15 a.m.

Don Sloma, MPH, Executive Director, Washington State Board of Health (PowerPoint Presentation)

12:00 - 12:20 p.m. Break & select boxed lunch

12:25 - 1:30 p.m.

Joe Hafey, Public Health Institute – State models research & recommendations (Written Testimony, Attachment)

Session II:  Finance

1:30 p.m.

Representative from California Health and Human Services Agency - Invited

October 29
2002
Public Health System
9:30 a.m. – 2:30 p.m., UC Davis Medical Center, Main Hospital ACSU Auditorium, 2315 Stockton Boulevard, Sacramento, CA
Advisory Committee Meeting
Agenda

AGENDA

Advisory Committee Meeting on Public Health System
Tuesday, October 29, 2002, 9:30 a.m. – 2:30 p.m. 
UC Davis Medical Center, Main Hospital ACSU Auditorium 
2315 Stockton Boulevard 
Sacramento, CA


Meeting Goals: To discuss and gain a better understanding of priority capacity concerns in normal and surge conditions, including those that have been presented previously at hearings, specifically:

  • Hospital, trauma and emergency capacity
     
  • Workforce (including training and exercises)
     
  • Essential public health personnel
     
  • Public health laboratories
     
  • Rural shortages


9:30 – 9:40 a.m.       

Opening Remarks, Meeting Goals 
(Executive Director Jim Mayer)

9:40 – 9:55 a.m.       

Introductions of Advisory Committee & Committee Process

9:55 – 10:00 a.m.     

Introduction of Speakers 
(Project Manager Hattie Rees Hanley)

10:00 a.m. – 2:30  p.m.    

Capacity Distribution and Planning for Normal and Surge Conditions 
 

Between the following presentations will be Q & A and roundtable discussion:

  1. Mike Boyd, UCDMC Associate Director – Welcome and remarks on academic medical center capacity
     
  2. Edward O’Neil, Ph.D., and Catherine Dower, J.D., Center for the Health Professions, UCSF – Workforce capacity, including public health workers (PowerPoint Presentation)
     

12:00 – 12:30 p.m.    Lunch Break

  1. Kenneth Takata, Public Health Lab Director, Department of Health and Human Services, Sacramento County – Statewide lab capacity (PowerPoint Presentation)
     
  2. Carol Mordhorst, Public Health Director, Mendocino County Department of Public Health – Rural shortages


Public Comments

October 24
2002
Public Health System
9:00 a.m., State Capitol, Room 437, Sacramento, CA
Public Hearing
Agenda

AGENDA

Public Hearing on Public Health 
Thursday, October 24, 2002, at 9:00 a.m.
State Capitol, Room 437 
Sacramento, CA


Opening Remarks

Public Health Leadership

  1. Lester Breslow, M.D., M.P.H., Member, Los Angeles County Public Health Commission; Professor Emeritus and Former Dean, UCLA School of Public Health; Former Director of Public Health, State of California  
  • Joint written testimony of Dr. Breslow and Philip R. Lee, M.D., Former Assistant Secretary for Health, U.S. Health and Human Services; Consulting Professor, Stanford University
     
  1. Robert Ross, M.D., President and CEO, California Endowment (Written Testimony)
     

Strategic Partners

  1. C. Duane Dauner, President and CEO, California Healthcare Association (Written Testimony)
     
  2. Raymond J. Baxter, Ph.D., Senior Vice President, Community Benefit, Kaiser Permanente (Written Testimony)
     
  3. Loren Johnson, M.D., Immediate Past President, California Chapter of the American College of Emergency Physicians (CAL-ACEP) (Written Testimony)
     
  4. Stephen E. Hon, President, County Health Executives Association of California (Written Testimony)


Government

  1. Richard Burton, M.D., M.P.H., Associate Director, California Department of Health Services (Written Testimony)
     
  2. Jeffrey L. Rubin, Chief, Disaster Medical Services Division, California Emergency Medical Services Authority (Written Testimony)
     

Public Comments

September 9
2002
Public Health System
9:30 a.m. – 2:30 p.m., California Chamber of Commerce – California Room, 1215 K Street, 14th Floor, Sacramento, CA
Advisory Committee Meeting
Agenda

AGENDA

Advisory Committee Meeting on Public Health System
Monday, September 9, 2002, 9:30 a.m. – 2:30 p.m. 
California Chamber of Commerce – California Room 
1215 K Street, 14th Floor 
Sacramento, CA


Meeting Goals:

  1. Explore the range of public health threats facing California's population. 
     
  2. Explore the public health system’s preparedness for all hazards, including terrorism.


9:30 – 9:35 a.m.       

Opening Remarks 
(Chairman Alpert)

9:35 – 9:55 a.m.       

Advisory Committee Process, Meeting Goals and Introductions 
(Executive Director Jim Mayer)

9:55 – 10:00 a.m.     

Introduction of Speakers 
(Project Manager Hattie Rees Hanley)

10:00 a.m. – 2:30  p.m.    

Potential Threats to California; and Public Health Preparedness, Including Surveillance, Analysis and Rapid Communication Capacity

Between the following presentations will be Q & A and roundtable discussion:

  1. Alan Zelicoff, M.D., Senior Scientist, Center for Arms Control and National Security, Sandia National Laboratories (PowerPoint Presentation)
     
  2. Kenneth I. Shine, M.D., Director, RAND Center For Domestic and International Health Security; Immediate Past President, Institute of Medicine
     
  3. Arthur Reingold, M.D., Professor and Head of Epidemiology, U.C. Berkeley, School of Public Health (PowerPoint Presentation)
     

12:00 – 12:30 p.m.    Lunch Break

  1. Steve Waterman, M.D., Senior Medical Epidemiologist, Centers for Disease Control, U.S. Mexico Border Infectious Disease Coordinator (PowerPoint Presentation)
     
  2. Colonel Cross and Major Weber, California National Guard (PowerPoint Presentation)
July 31
2002
Public Health System
1:30 - 5:00 p.m., Library and Courts Building II, 900 N Street, Room 340, Sacramento, CA
Advisory Committee Meeting
Agenda

AGENDA

Advisory Committee Meeting on Public Health System
Wednesday, July 31, 2002, 1:30 - 5:00 p.m. 
Library and Courts Building II 
900 N Street, Room 340 
Sacramento, CA


Meeting Goals:

  1. Review scope of study and issues to be discussed in upcoming meetings.
     
  2. Review core elements of a robust public health system:
  • Specify government duties within the public health system.
  • Benchmark California’s fulfillment of each of the government roles at the state and local levels.
  • Discuss approaches to measuring government’s capacity and preparedness for fulfilling each of its responsibilities in public health.
     
  1. Review public health financing:
  • Review and map public health funding at the federal, state, and local levels.
  • Discuss levels of participation and discretion.
  • Discuss trends in per capita public health spending.
  • Discuss options for improvement and accountability.
     

1:30 – 2:15 p.m.

Opening Remarks and Introductions 
(Subcommittee Chairman, H. Eric Schockman) 
 

2:15 – 2:25 p.m.

Advisory Committee Process and Meeting Goals 
(Executive Director, James P. Mayer) 
 

2:25 – 2:30 p.m.

Review Scope of Study 
(Project Manager, Hattie Rees Hanley) 
 

2:30 – 3:40  p.m.

Discussion of Core Elements of a Robust Public Health System
(Dr. George Flores - presentation; group roundtable discussion) 
 

3:40 – 3:50  p.m.  BREAK 
 

3:50 – 5:00  p.m.

Finance 
(Dr. Richard Burton and Greg Franklin, Department of Health Services – overview; John Miller - tobacco funding and legislative perspective; group roundtable discussion)

Public Comments

June 27
2002
Public Health System
9:00 a.m., State Capitol, Room 113, Sacramento, CA
Public Hearing
Agenda

AGENDA

Public Hearing on Public Health System
Thursday, June 27, 2002, at 9:00 a.m.
State Capitol, Room 113 
Sacramento, CA
 

Opening Remarks

Overview of California’s Public Health System

  1. Jonathan E. Fielding, M.D., M.P.H., Director of Public Health and Health Officer, Los Angeles County, and Professor, Schools of Medicine and Public Health, University of California, Los Angeles (Written Testimony)
     
  2. Richard J. Burton, M.D., M.P.H., Associate Director, California Department of Health Services
     

Legal Structure and Financing

  1. James B. Simpson, J.D., General Counsel, and Carmen R. Nevarez, M.D., M.P.H., Medical Director and Vice President of External Relations, Public Health Institute (Written Testimony)
     
  2. Poki Stewart Namkung, M.D., M.P.H., Director of Public Health and Health Officer, City of Berkeley and President, California Conference of Local Health Officers (Written Testimony)
     
  3. Assemblymember Keith S. Richman, M.D., M.P.H.


Medical Facility and Labor Capacity Assessment, Risk Analysis and Planning

  1. David M. Carlisle, M.D., Ph.D., Director, State of California Office of Statewide Health Planning and Development (Written Testimony)
     
  2. Jack C. Lewin, M.D., Chief Executive Officer and Executive Vice President, California Medical Association (Written Testimony)
     
  3. George R. Flores, M.D., M.P.H., Former Director of Public Health and Health Officer, County of San Diego (Written Testimony)
     
  4. Roger C. On, M.D., Practicing Cardiologist and Assistant Clinical Professor of Medicine, UCLA School of Medicine (Written Testimony)


Comments Submitted by Members of the Public

  • Lester Breslow, M.D., M.P.H., Professor and Dean Emeritus, UCLA School of Public Health, and Former Director, California State Department of Public Health (Written Comments)