Lehigh Valley Board of Health

Presentation to theHealth Commission

October 17, 2011

Members of the Board of Health

David K. Bausch Robert B. Black, M.S. Eric J. Gertner, M.D., M.P.H. Carol A. Kuplen, R.N., M.S.N. David T. Lyon, M.D., M.P.H. Ilene S. Prokup, M.S., R.N., PHCNS, BC John F. Reinhart, M.Ed. Halyna I. Stegura, R.N., M.S.N. Vicky Kistler, M.Ed., Ex-Officio Judith K. Maloney, J.D., M.P.H., Ex-Officio

Public health problems …

EVERYDAYVicky Kistler, M.Ed.,

Director, Allentown Health Bureau

The Lehigh Valley is NOT healthy.

County Health Rankings

• Lehigh County — 37/67 Pennsylvania Counties

• Northampton County — 60/67 Pennsylvania Counties

Low birth-weight babies

• Northampton County — 62/67 Pennsylvania Counties

Obesity

• Lehigh County — 26% of adults• Northampton County — 30% of adults

Physical environment — Air quality

• Lehigh County — 54/67 Pennsylvania Counties

• Northampton County — 57/67 Pennsylvania Counties

The Lehigh Valley is NOT healthy …

And we deserve better.

More than 2/3 of the Lehigh Valley’s citizens have inadequate access

to public health services

The public wants regional

public health

Community Survey

• Muhlenberg College Institute of Public Opinion — Dr. Christopher Borick

• Spring 2011 Quality of Life Survey• Demographically representative of the residents of the Lehigh Valley

• 68% of respondents supported the establishment of a regional health department

48 community organizations have

committed their support to the establishment of

a regional health department …

AIDSNET American Red Cross of the Greater Lehigh ValleyArea Health Education Center (AHEC)Cancer Support Community of the Greater Lehigh Valley (formerly the Wellness Community)

Casa GuadalupeCenter for Humanistic ChangeChildren's Coalition of the Lehigh ValleyCJW and AssociatesCommunity Action Committee of the Lehigh Valley (CACLV)Community Services for ChildrenConnections for WomenDiscover Lehigh Valley

(formerly Lehigh Valley Convention and Visitors Bureau)

Dorothy Rider Pool Health Care TrustEaston Weed & Seed Health CommitteeFamily Connection of EastonGreater Lehigh Valley Chamber of CommerceLeague of Women Voters of Lehigh CountyLeague of Women Voters of Northampton CountyLehigh Carbon Community CollegeLehigh County Conference of ChurchesLehigh County Medical SocietyLehigh County Senior CenterLehigh Valley Academy of Family PhysiciansLehigh Valley Association of Independent Colleges

(Cedar Crest College, DeSales University, Lafayette College,

Lehigh University, Moravian College, Muhlenberg College)

Lehigh Valley Community FoundationLehigh Valley Economic Development CorporationLehigh Valley Nurse Practitioners' AssociationLehigh Valley PartnershipMethodist Services for Children & FamiliesNational Association of County and City Health Officials (NACCHO)Neighborhood Health Centers of the Lehigh ValleyNew Directions Treatment ServicesNorthampton Community CollegeNorthampton County Medical SocietyPartnership for a Tobacco-Free Northeast PennsylvaniaPennsylvania Association of School Nurses and Practitioners

Pennsylvania Public Health AssociationPlanned Parenthood of Northeast PennsylvaniaThe Public Health Faculty of East Stroudsburg UniversitySlate Belt Communities that CareSlate Belt Chamber of CommerceSlater Family NetworkTwo Rivers Health and Wellness FoundationUnited Way of the Greater Lehigh ValleyUniversity of Pittsburgh, Center for Rural Health PracticeUniversity of Pittsburgh School of Public HealthWeller Center

What will the Lehigh Valley Department of

Healthlook like?

Lehigh Valley Health Department Clinical Sites

Allentown

Bethlehem

Slatington Easton

Bangor

Personal Health Services

July 2012–July 2013

Chronic Disease Prevention Programs

Expected number of people served: 31,000

• Cancer prevention• Heart disease prevention• Osteoporosis prevention• Tobacco cessation and prevention• Nutrition education

Maternal and Child Health Promotion Programs

Expected number of people served: 7,100

• Child/adolescent advocacy, home visitation• Childhood lead poisoning and prevention• Dental health• Teen pregnancy prevention• Child death review• Healthy woman program

Communicable Disease Control

Expected number of people served: 59,100

• Communicable disease investigations5,100

• Community immunizations33,000

• TB/STD/HIV/AIDS21,000Total Personal Health

Services Staff60

Environmental Health Services

July 2012–July 2013

Food Protection ProgramExpected inspections: 7,500

• Establishment inspection/licensing– Food service establishments

• Temporary• Mobile• Retail

– Vending machines

• Food-borne disease surveillance and investigation

• Food safety training and public awareness

Environmental ControlExpected inspections: 9,200

• Housing hygiene and sanitation• Lead source reduction• Vector control• Noise control• Indoor air quality• On-lot sewage disposal• Pollution incident response• Public health nuisances

Health Bureau Staffing Summary

Personal Health Services60

Environmental Health Services32

Health Bureau Physician Director,Management, Quality Assurance and Support 12

Total staff 104

Institutional SanitationExpected inspections: 1,500

• Child-care facility inspection• Public bathing place sanitation• School sanitation• Long-term care facility inspection

Total Environmental Health Services Staff

32

Financial Plan

Lehigh Valley Health Department

Major Budget Assumptions• Bethlehem and Allentown opt-in to new bi-county health department

• Start date — July 1, 2012• Current Allentown and Bethlehem staffs will be retained in comparable positions and with comparable benefits

• The counties will approve the Health Department budget and service levels annually through the Health Commission

Major Budget Assumptions

• Salaries will be increased at 2% per annum for budget purposes

• Needs assessment will start immediately and regional “satellite” offices will be established

• The Health Department will continue to receive in-kind services from health care providers, in the form of lab tests, x-rays, materials, clinical personnel, etc.

Lehigh Valley Health Department

Expense budget for first full year — 2013

• Salaries and Benefits $7,469,549• Operations $2,131,615• Total Expense $9,601,164• 5% less than previous budget proposal• Incremental budget increase of $4,344,242

over combined Allentown and Bethlehem 2010 budgets

• 104 full-time employees (FTEs) — an increase of 40 FTEs over Allentown/Bethlehem 2010 levels

Lehigh Valley Health Department Funding sources

• PA Act 315 @ 4.11 per capita (of 6.00 p.c.available)

• PA Act 12 and Act 537 (Sewage Facilities Act)• Cities (ABE) contributions @ 3.75 per capita• Community contributions• In-kind services from local health providers• Categorical grants• Fees• County contributions — fixed at $450,000 each

through FY2016

Lehigh Valley Health Department Comparisons with 3rd-Class

Pennsylvania Counties

Alberto Cardelle, MPH, Ph.D., East Stroudsburg

UniversityGrant from Two Rivers Health and Wellness

Foundation

Are communities served by public

health departments healthier than

those which are not?

YES

53 Pa. Counties Without Health Departments have significantly lower

health rankings than 322 U.S.

“Peer” Counties With Health Departments

Counties with local health departments . . .

64th percentile in Pa. Health Outcome Rankings

Peer Counties without local health departments . . .

37th percentile in Pa. Health Outcome Rankings

New Study by Mays and Smith Shows Increased Public Health Spending

can Save Lives

• Infant deaths per 1,000 live births -6.85%

• Heart disease deaths per 100,000 population-3.22%

• Diabetes deaths per 100,000 population-1.44%

• Cancer deaths per 100,000 population-1.13%

Mortality ratesPercent change per

10% increase in spending

Asthma Impact is Significant

• Annual cost to U.S. — $20 billion• Average annual cost to asthma sufferers — $3,300 each

• Pa. asthma patients have over 10,000 hospitalizations per year

• 60% of children and 35% of adults with asthma miss school or work on the average of 12 days a year

• Conservative estimate: $27 million in annual loss of income to Lehigh Valley asthma sufferers

Public Health Education Interventions will Help

• Examples: medications, asthma triggers, self management/monitoring techniques

• Example of successful intervention: Gallefross, 2011– $122 cost per adult to administer– 71% reduction in loss of work days

• Targeted intervention administered to 5,000 LV adults:– Cost: $600 thousand– Savings: $3.7 million (in lost work days @ 25%

percentile income level)

– ROI: 478%

Cardiovascular Disease (CVD)

• Accounts for 1 of every 2.9 deaths in the U.S. — one death every 39 seconds

• Total costs in U.S. estimated at over $500 billion per year

• Heart disease leading cause of death in PA — over 26% and over 40,000 deaths a year

• In LV, over 120,000 adults suffer from hypertension and 60,000 from CVD — 15,000 are hospitalized per year

• LV sufferers miss over 400,000 workdays each year at a cost of over $15 million

Public Health Prevention Programs will Help

• Education-based programs to alter knowledge and attitudes

• Teach skills to make behavioral changes for a healthier lifestyle

• Conservative example: Farquhar Program – 1990– Cost to administer: about $20/adult– Result: 16% reduction in prevalence of CVD

and associated lost work days

• Prevention program administered to 10,000 LV adults– Cost: $200,000– Savings: $1.1 million (in reduced lost work days only)– ROI: 480%

Numerous Studies have Shown

That Every Dollar Spent on Prevention Yields As Much As $20 in Reduced Health

Care Costs

East Stroudsburg UniversityEconomic Impact Analysis

• Net Additional Spending $4,344,242• Net Additional Employees (FTEs) 40• Total Economic Impact $7,895,225• Total New Jobs Created 85

Using multipliers established by the U.S. Department of Commerce, Bureau of Economic

Analysis

A bi-county health department will . . .

• Create a healthier Lehigh Valley and improved quality of life

• Be the first ever in Pennsylvania

• Extend public health services to over 450,000 Lehigh Valley citizens (over 2/3 of the population)

• Provide over $9.6 million in services annually by leveraging $450,000 in County contributions, a small fraction of both county budgets

A bi-county health department will . . .

• Provide a strong return on invested public dollars through effective disease prevention/health promotion programs

• Insure that all local restaurants are inspected at least annually

• Provide a comprehensive, coordinated response to a communicable disease outbreak, natural disaster, or other public health emergency

• Inject nearly $8 million into the LV economy and create 85 new jobs