The Iowa Governor's Public Health Conference

“While
the more radical among us would suggest that Iowa’s public health system
be completely re-engineered, it seems an unlikely undertaking. The
current approach is through legislation and incremental change…”

Most Iowans don’t think about much about public health. The truth is they wouldn’t think about it at all if there weren’t a pressing need. During the 2008 floods, we were glad that public health agencies were available to address tetanus and food safety. If public health is not involved in working through an epidemic like the H1N1 influenza, then who would be? For the rest of the time, most people would rather that public health remains unseen. This week, public health professionals gathered in Ames for their annual “Governor’s Conference on Public Health,” a two day affair with catered meals, plenary sessions and a venue for people across the state to network and learn about Iowa’s public health footprint.

Iowa Governor Chet Culver was absent from his own conference. According to Tom Newton, Director of the Iowa Department of Public Health, the reason Culver was unable to attend the conference this week is that because of the short legislative session, there were a lot of bills to consider, sign and perhaps line item veto. It was disappointing that after re-naming the conference for the governor more than a year ago, he developed a scheduling conflict: two separate signing ceremonies for the Teacher Diversity Bill at Moulton Elementary School in Des Moines and the Physician Assistants Bill at the Iowa Physician Assistants Society meeting in West Des Moines. Having heard Culver speak at the last Governor’s Barn Raising on Public Health in 2007, public health does not seem to be his milieu and he is probably smart to delegate his role at the conference to Newton. In any case, Lieutenant Governor Patty Judge is a more engaging speaker on public health and she was honored on Wednesday as the Iowa Public Health Association’s Iowa Public Health Official of the Year. In the end, the executive branch was well represented at the conference.

In his remarks, Newton covered the budgeting issue which looms large over public health employees. The state revenue gap for FY2010 was partly filled by $3 million in federal stimulus funds. This temporarily prevented the elimination of some public health jobs. The stimulus money along with another $2 million will need to be cut from the next year’s budget to deal with the revenue shortfall. The governor does not want to see the cuts and has publicly said so. Even with cuts, he does not want to substantially impact services. Tom Newton’s challenge is to devise a budget that can reduce local impact of a substantial revenue shortfall.

Newton said the group gathered should celebrate the successes of a progressive public health agenda. He pointed to the role Iowa public health officials played during the 2008 floods, activating to address the H1N1 influenza virus, the Public Health Modernization Act and the expansion of Hawk-I, and other state level health reform initiatives. This year, some preliminary data regarding the impacts of the $1.00 per pack cigarette tax and the Smoke Free Iowa Act were released and there has been a 50% decrease in the use of tobacco products in Iowa, with less than 15% of adults being smokers. The state has supported cessation efforts as the Iowa Quitline calls for people wanting to quit smoking have gone off the charts. All of the items Newton mentioned are good for Iowans.

While local boards of health in the 19th century used to disband after the spring “miasma,” they, and the public health departments they created, have now become an institutionalized part of our government. As such, they have become administrators of programs funded by others. Part of a public health department’s funding comes from county sources. A large portion of it comes from grants and from pass through of state and federal dollars for specific programs. Each county has a local board of health that is community based and intended to manage the health departments. The truth is that the myriad of programs, guidance, regulations and infrastructure reduce the number of policy decisions a local board of health needs to make to a very few, centered on issues that the permanent staff can’t resolve, or statutory directives. Public Health in Iowa has become a large bureaucracy.

While the more radical among us would suggest that Iowa’s public health system be completely re-engineered, it seems an unlikely undertaking. The current approach is through legislation and incremental change using the techniques of formal quality improvement processes. The author’s view is that to the extent we administer programs initiated at the federal and state level, that administration could be consolidated, instead of dispersed among our 99 counties. When there is an epidemic, like the H1N1 influenza, the Centers for Disease Control and the state take a dominating role anyway, so couldn’t other entities like hospitals, community health organizations and doctors’ offices be leveraged to ramp up and cover the needs dictated by state and federal authorities? While public health has had a lot of recent practice in emergency response, is there another way to formulate the emergency response plan to reduce the number of public health employees and achieve the same results?

On a sunny afternoon in Ames, as we dined, chatted and learned about each other, the idea of radical change was not on the menu. It seemed like the afternoon would continue forever, with good food, a schedule for the day, friends and sponsorship by a government that could perpetuate our roles unendingly. In this environment, it is difficult to think outside the box, which may be what public health in Iowa needs most.

~Paul
Deaton is a native Iowan living in rural Johnson County and weekend
editor of Blog for Iowa. He is also a member of the Johnson County, Iowa Board of Health. E-mail Paul
Deaton