Public Health in Kansas

Kansas Association of Local Health Departments 2015 Policy Statement

Public Health in Kansas The State of Kansas has a decentralized public health system consisting of the Kansas Department of Health and Environment and 100 local health departments. serving Kansas counties. Under Kansas law, local health departments report to the Board of Health, which in most cases is comprised of the local County Commission.

KALHD’s vision is a system of local health departments committed to helping all Kansans achieve optimal health by providing Foundational Public Health Services (FPHS).

FPHS are the suite of skills, programs, and activities that must be available in state and local health departments system-wide, and include the foundational capabilities and areas.

Foundational capabilities are cross-cutting skills that need to be present in state and local health departments everywhere for the health system to work anywhere. They are the essential skills and capacities needed to support the foundational areas, and other programs and activities, key to protecting the community’s health and achieving equitable health outcomes. Examples of these skills include organizational competencies such as leadership, governance, quality management, and health equity; all hazards preparedness and emergency response; assessment; and others. Foundational areas are those substantive areas of expertise or program-specific activities in all state and local health departments also essential to protect the community’s health. Examples of foundational areas include communicable disease control; chronic disease and injury prevention; and environmental public health inspections and monitoring, among others.1

Public health’s primary function is to protect and promote the population’s health through prevention, environmental protection, and public regulations and policies.2 Public Health focuses on prevention, which has led to the global eradication of smallpox, is close to doing the same with polio, and has greatly reduced the burden of other diseases such as measles, mumps, pertussis, and diphtheria.

Public health programs and services reduce chronic disease. According to the Institute of Medicine, over half of the US population has one or more chronic health conditions, and costs associated with preventable chronic diseases are estimated at over $1 trillion a year.”3 In the United States, 96% of Medicare costs, 83% of Medicaid costs, and 75% of all health care costs

1 Resolve-Public Health Leadership Forum. (2014, March). Defining and constituting foundational capabilities and areas (V1). Retrieved from http://www.resolv.org/site-healthleadershipforum/files/2014/03/Articulation-of- Foundational-Capabilities-and-Foundational-Areas-v1.pdf

2 CDC. (2012). PUBLIC HEALTH IN THE AGE OF HEALTH CARE REFORM. ATLANTA, GA: AUTHOR

3 Institute of Medicine. (2012). For the public’s health: Investing in a healthier future. Washington, DC: Author. are attributable to chronic disease.4Population-based prevention efforts improve the health of Kansans more efficiently than clinical care alone. According to the Centers for Disease Control and Prevention, “health care accounts for only 10% of health outcomes; the remaining 90% are influenced by a complex mix of determinants of health inclduing behaviors, socioeconomics, and physical environments.”5 A strong, well-funded public health system is essential to make progress in controlling the epidemic of chronic disease and associated costs.

Local public health departments focus on improving health outcomes by providing services such as immunizations, nutrition assistance, disease investigation and surveillance, emergency preparedness, home health, and enforcement of public health laws.

Public health departments engage community partners to monitor and assess the health of the community and to make data-based decisions to target scarce resources to address identified needs. These activities lead toward public health accreditation, which provides a means for departments to enhance management, measure performance, and demonstrate capacity to deliver quality services.

ISSUES State Support for Local Public Health: Despite the important role health departments play, theThe State of Kansas ranks near the bottom nationally for state support for local public health; a 20145 study conducted by Trust for America’s Health, ranks Kansas 446 for state support to public health.6 State “Aid to Local” funding has remained level since 1995; when calculated for the rate of inflation, this equates to approximately a 12% reduction.7 In the ensuing 201 years, both the costs and need for funding have grown. Recent events, such as the Kansas measles and pertussis outbreaks8 and the national response to the Ebola virus,

4 Centers for Disease Control and Prevention. (2009). The power to prevent, the call to control: At a glance 2009. Accessed at http://www.cdc.gov/chronicdisease/resources/publications/AAG/chronic.htm

5 CDC. (2012). PUBLIC HEALTH IN THE AGE OF HEALTH CARE REFORM. ATLANTA, GA: AUTHOR

6 Levi, J., Segal, L., & St. Laurent, R., & Gougelet, R.. (20145). Investing in America’s health: A state-by-state look at public health funding and key health facts. Trust for America’s Health. Retrieved from http://healthyamericans.org/assets/files/TFAH-2015-InvestInAmericaRpt- FINAL.pdfhttp://www.healthyamericans.org/assets/files/TFAH2013InvstgAmrcsHlth05%20FINAL.pdf

7 Kansas Center for Economic Growth. (2014). Who pays? The cost of Kansas’tax cuts for local communities. Retrieved from realprosperityks.com.

8 Marso, A. Measles, pertussis vex Kansas health workers as Ebola steals headlines. Topeka, KS: Kansas Health Institute News Service. Retrieved from http://www.khi.org/news/2014/oct/15/health-officials-report-some-

Kansas Association of Local Health Departments www.kalhd.org Page 2 underscore the necessity of maintaining a strong public health system. We urge the Governor and the Legislature to increase funding for local public health departments and remove Kansas from the bottom of states supporting public health.

Medicaid Expansion: We support expansion of the Kansas Medicaid program, which will complement counties’ efforts in public health by bringing federal dollars to Kansas, provide vital revenues to our local hospitals, and reduce the number of uninsured Kansans.

Immunizations: According to the Centers for Disease Control and Prevention (CDC), vaccinations are one of the ten great public health achievements of the 20th century. Vaccines have reduced or eliminated many diseases that once killed or seriously harmed infants, children, and adults. They provide protection not only to the individual receiving the immunization but also to others in the community who are unable to be fully immunized due to age or medical reasons. When immunization rates decrease, the risk of outbreak of preventable illness increases. Kansas statute provides exemptions to required vaccinations based upon the child’s health or family’s religious convictions. The current statutory exemptions are sufficient, and efforts to increase the allowable exemptions leading to decreased vaccination rates pose a significant risk to the health and well-being of Kansans.

Clean Air: The Kansas Clean Air Act is an effective public health strategy aimed at reducing the negative consequences of second-hand smoke exposure. Efforts to diminish the effectiveness of the law through exemptions provide no public benefit, and if implemented, would negatively impact the health of Kansans.

Expand Access to Dental Care: As a member of the Kansas Dental Project, we support passage of the Registered Dental Practioner legislation in order to increas access to quality, cost- effective dental care for Kansas families.

Community Fluoridation: We support preservation of community water fluoridation in Kansas. Community water fluoridation is proven to be a safe and effective way to reduce tooth decay.9

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The Kansas Association of Local Health Departments (KALHD) is a nonprofit association dedicated to strengthening local health departments for the purpose of improving and protecting the health of all Kansans. KALHD’s membership consists of 997 of the 100 local health departments in Kansas. pushback-quarantine/

9 CDC. Fluoridation basics. Retrieved from http://www.khi.org/news/2014/oct/15/health-officials-report-some- pushback-quarantine/

Kansas Association of Local Health Departments www.kalhd.org Page 3 For Additional Information, please contact:

Michelle Ponce

Executive Director [email protected]

785-271-8391

Kansas Association of Local Health Departments www.kalhd.org Page 4