2006 Results
Local
ocal Public Health PPMRS
Summary Report of Selected Performance Measures,
Expenditure and Staffing
Introduction
Each year, local health departments report their performance, expenditure and staffing to the MDH.
These reports are part of the Local Public Health Planning and Performance Measurement Reporting
System (LPH PPMRS). The reports are submitted at the end of each calendar year.
The following reports contain the results of selected 2006 performance measures, expenditure, and
staffing submitted by Minnesota’s local health departments – known collectively as the Community
Health Services (CHS) System. The local health department performance measures, expenditure and
staffing are organized into six areas of public health responsibility:
• Assure an Adequate Local Public Health Infrastructure (page 2)
• Promote Healthy Communities and Healthy Behaviors (page4)
• Prevent the Spread of Infectious Disease (page 7)
• Assure the Quality and Accessibility of Health Services (page 10)
• Protect Against Environmental Health Hazards (page 12)
• Prepare for and Respond to Disasters and Assist Communities in Recovery (page 15)
Performance Measures Overview
Percentages included in the performance measure reports are based on the actual number of local
health entities responding to the question. There were 75 local public health reporting entities
(referred to in this report as local health departments) for PPMRS. Community health boards (CHB)
determined how they wanted to report on the performance measures. Multi-county CHB could have
each county in the CHB report as individual counties or could report as one CHB. Of the 75 public
health departments: 28 are single-county CHBs, 9 are multi-county CHBs, 34 are single counties
within multiple-county CHBs, and 4 are city CHBs.
Expenditure and Staffing Overview
In 2006, the CHS System expended a total of $294 million dollars. Expenditure amounts presented in
the expenditure summaries represent portions of this total amount. The source of these funds
includes Local Tax Levy, Medicaid, and the LPH Act Funds.
Over 2800 full time employees (FTEs) were employed by the CHS System. Percentages included in
the staffing summaries are based on portions of this total number. These employees represent a
variety of job classifications including Public Health Nurses, Epidemiologists, and Health Planners.
Comprehensive statewide reports on each area of public health responsibility, financial, and staffing
can be found at www.health.state.mn.us/ppmrs.
www.health.state.mn.us/ppmrs
Prepared by the Office of Public Health Practice
September, 2007
1
Assure an Adequate Local Public Health Infrastructure
Overview
This area of public health responsibility describes aspects of the public health infrastructure that are essential
to a well-functioning public health system – including assessment, planning, and policy development. This
includes those components of the infrastructure that are required by law for community health boards. It also
includes activities that assure the diversity of public health services and prevents the deterioration of the
public health system.
Summary of Expenditure
Almost 10 percent of total expenditures were in the area of Infrastructure. Of the $28.6 million expended in
Infrastructure, most (72% or $20.6 million) was funded by the Local Tax Levy. Eight-three percent of local
health departments used Local Tax Levy to fund Infrastructure. The remaining funding sources included LPH
Act State Funds (19%) and Other Local Sources (5%). Sixty-six of the 75 local health departments (88%)
used LPH Act State Funds to support Infrastructure activities.
Summary of Staffing
Local health departments classified were 342 FTEs as working in the area of Infrastructure, which accounted
for 12% of all FTEs. Forty-one percent of FTE were Administrative Support with 16% being Health
Administrator and 15% being Administrative/Business Professional. Seven of the fourteen Epidemiologists
and a quarter of Health Planners are in Infrastructure.
Summary of Select Performance Measures
CHB Requirements
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All CHBs in Minnesota meet statutory requirements for MS 145A. This includes:
o The CHB meets composition requirements
o The CHB met at least twice during the reporting year
o The CHB has written procedures for business transaction
o The CHB as appointed an agent (typically the CHS Administrator)
o The CHB has a medical consultant (one exception)
Community Health Assessment, Action Plan, and Local Priorities
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The majority of local health departments have either updated or completed a community health
assessment between 1999 and 2006. A smaller portion had completed an action plan in that time period.
Of those completing an assessment in 2006, most used existing community groups and advisory
committees to solicit community input and engage special populations in the community.
Data, Communication, and Research
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Most (85%) proactively provided information to the public about local public health data and 81%
responded to requests from the public for local public health data. The remainder (19%) received no
requests.
Nearly all (97%) local health departments have trained and designated staff to provide risk
communication to the public about real or perceived public health concerns. Most have between 1 to 3
staff trained and a small number have up to 8 staff trained.
A quarter (26%) of local health departments have either conducted their own or been involved with
research directed by a university or other research-type organization (this does not include program
evaluation). Some examples of this research includes:
o Emergency preparedness surveys on staff knowledge and willingness to respond
o Community and worksite smoking cessation
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Hypertension risk behaviors
Reproductive health
Pregnancy psychosocial risk
School-based FluMist administration
Environmental norms associated with alcohol, tobacco, other drugs, and gambling
Social Conditions and Cultural Competence
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Nearly two-thirds (65%) of local health departments described a collaboration that the local health
department and community organizations participated on that worked to improve social conditions that
affect health. Social conditions are conditions in the community that have an impact on population health.
Some examples of these collaborations include:
o Working with human services serving high-risk families in multiple programs.
o Partnering with other organizations to support healthy pregnancy in Latino families.
o Participating in diversity council/advisory committees focused on improving understanding
between diverse populations within the community.
o Addressing access to dental care in low income families and children.
o Supporting individuals/families to break out of the circle of poverty.
o Serving on teams to prevent homelessness.
o Assisting with the development of a free community clinic for the under and uninsured.
o Working to reduce drug/alcohol and tobacco use by children and youth.
o Establishing programs that produce lasting improvements in the health and well being of low
income, first time parents and their children.
o Partnering with agencies to address the health needs of migrant workers
o Participating on methamphetamine coalitions/task forces.
o Working with partners to address mental health issues in children and adults.
Seventy-five percent of administrators, directors and management staff have reviewed the Culturally and
Linguistically Appropriate Services (CLAS) standards.
A number of departments (32%) were successful in hiring staff who reflect the cultural and ethnic
communities served by the public health department. Methods used to hire these staff included:
o Using diversity internship program to recruit and hire staff.
o Working with community partners to recruit diverse staff.
o Providing priority status to bilingual/bicultural applicants.
o Recruiting peer counselors from successful program participants.
Most (88%) local health departments indicated that they have built cultural competence in their current
staff through education and training and working with cultural/racial groups to develop working
relationships and to gain more understanding of group.
Most (90%) local health departments to actions to make their services more culturally competent. These
included translating materials, increasing the use of interpreters, training staff, and providing support to
emergency and community health outreach (ECHO).
Policy Development
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Several (64%) local health department helped develop significant community and/or legislative policies.
These included ordinances and/or policies on:
o Smoke-free facilities (city/county building, city/county parks, restaurants
o Alcohol, tobacco and other drug use
o Methamphetamine clean-up
o School wellness
o Mental health services
o School emergency and crisis plan
o Tattoo and piercing
o Health reform
o Dental care
o Heat emergencies
o Exotic animals
o Truancy prevention
3
Promote Healthy Communities and Healthy Behaviors
Overview
This area of public health responsibility addresses the promotion of positive health behaviors and the
prevention of adverse health behaviors – in all populations across the lifespan. It also includes activities that
enhance the overall health of communities. This area of responsibility includes 20 broad-ranging topic areas.
For each topic area, public health departments indicated the level of service that best described their activities
to address each topic. A “program,” for reporting purposes, was defined as having objectives and a budget or
dedicated staff hours.
Summary of Expenditure
Almost $75 million (25 % of total expenditures) were expended in the area of Healthy Communities. Of the
$75 million, over one quarter ($21.1 million) came from Other Federal Funds. All but five local health
departments used Other Federal Funds to support these activities. Healthy Communities was funded by a
wide range of funding sources including Local Tax Levy (22%), LPH Act State Funds (11%), Other State
Funds (10%), Medicaid (9%), and Other Local Funds (7%). Nearly all health departments (96%) used some
LPH Act State Funds to support Healthy Communities.
Summary of Staffing
Almost a third of CHS workforce (881 FTEs) was reported as working in the area of Healthy Communities.
Public Health Nurses accounted for 42% of FTEs. Other job classification in Healthy Communities included
Administrative Support (12%), Public Health Nutritionist (9%), Health Educators (8%), and Other Nurses (8%).
Summary of Select Performance Measures
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Healthy Aging – 57% of local health departments have implemented programs, 43% provide general
health promotion activities, and 0% did not provide any services in this area. Example the implemented
programs included:
o Blood pressure and medication monitoring clinics at senior centers.
o Implemented walking programs for seniors.
Alcohol – 53% of local health departments have implemented programs, 41% provide general health
promotion activities, and 6% did not provide any services in this area. Example the implemented
programs included:
o Coalitions to reduce incidence of drinking and driving.
o Alcohol and drug resistance education programs in schools.
Arthritis – 4% of local health departments have implemented programs, 64% provide general health
promotion activities, and 32% did not provide any services in this area. Example the implemented
programs included:
o Arthritis disease management through diet, exercise and medication.
o Implement community-based efforts to improve the health status and quality of life for persons
who have arthritis.
Asthma – 13% of local health departments have implemented programs, 69% provide general health
promotion activities, and 18% did not provide any services in this area. Example the implemented
programs included:
o Research environmental triggers of asthma and implement effective home prevention strategies.
o Education of parents, staff and students to reduce incidence of asthma attacks in school age
children, management if attack occurs, education of physiology and symptoms associated with
asthma and tips to mitigate the attack.
Cancer – 18% of local health departments have implemented programs, 73% provide general health
promotion activities, and 10% did not provide any services in this area. Example the implemented
programs included:
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Work with community partners to educate women about prevention and early intervention of
breast cancer.
o Screen for breast and cervical cancer during weekly family planning clinics.
Cardiovascular Disease and Stroke– 30% of local health departments have implemented programs,
64% provide general health promotion activities, and 5% did not provide any services in this area.
Example the implemented programs included:
o Community programs focusing on healthy lifestyles including physical activity, healthy nutrition,
and decreased tobacco use and exposure.
o Public access defibrillator program to improve awareness and access to AEDs (automated
external defibrillators).
Diabetes – 19% of local health departments have implemented programs, 68% provide general health
promotion activities, and 9% did not provide any services in this area. Example the implemented
programs included:
o Diabetes education and free blood glucose checks at local clinics, health fairs and special events.
o Community-wide health promotion and disease prevention programs to increase selfempowerment of diabetes management.
HIV/AIDS – 19% of local health departments have implemented programs, 62% provide general health
promotion activities, and 19% did not provide any services in this area. Example the implemented
programs included:
o HIV counseling and testing services.
o HIV prevention education at outpatient chemical dependency treatment programs.
Infant, Child and Adolescent Growth and Development – 84% of local health departments have
implemented programs, 16% provide general health promotion activities, and 0% did not provide any
services in this area. Example the implemented programs included:
o Home visits to new parents to provide information on growth and development, promote
breastfeeding, connect families to resources, promote maternal and infant mental health, and
promote medical homes.
o Provide nutrition and physical activity based education to change adult behaviors, thus
influencing children's behaviors by offering opportunities in the community.
Injury – 64% of local health departments have implemented programs, 33% provide general health
promotion activities, and 2% did not provide any services in this area. Example the implemented
programs included:
o Car seat safety education programs in collaboration with community partners.
o Home safety assessment for seniors and new parents.
Mental Health – 42% of local health departments have implemented programs, 53% provide general
health promotion activities, and 5% did not provide any services in this area. Example the implemented
programs included:
o Comprehensive, school program to prevent bullying, improve the social climate of classrooms
and reduce related antisocial behaviors such as vandalism and truancy.
o Screening of prenatal/postnatal women and senior citizens for depression.
Nutrition – 46% of local health departments have implemented programs, 50% provide general health
promotion activities, and 4% did not provide any services in this area. Example the implemented
programs included:
o Support to schools for improved nutrition and physical activity policy and programs.
o Community-wide fitness and wellness programs, encouraging proper nutrition and exercise.
Oral/Dental Health – 47% of local health departments have implemented programs, 44% provide general
health promotion activities, and 9% did not provide any services in this area. Example the implemented
programs included:
o Dental screenings and fluoride varnishing in WIC and MCH programs.
o Oral/dental education in the schools.
Other Drug Use – 47% of local health departments have implemented programs, 42% provide general
health promotion activities, and 11% did not provide any services in this area. Example the implemented
programs included:
o Involvement in community methamphetamine coalitions, use reduction activities and development
of ordinances.
o Partner to reduce adolescent substance use and create conditions that make marijuana and other
drug use less desirable and accessible.
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Physical Activity – 55% of local health departments have implemented programs, 39% provide general
health promotion activities, and 4% did not provide any services in this area. Example the implemented
programs included:
o Support community and worksite physical activity programs through “walkable” communities and
activity challenges.
o Nutrition education and physical activity support to school age children during the summer.
Pregnancy and Birth – 89% of local health departments have implemented programs, 11% provide
general health promotion activities, and 0% did not provide any services in this area. Example the
implemented programs included:
o Information and support for high risk, low income, pregnant teens and women for healthy lifestyle
choices, preterm birth prevention, and connection to necessary resources.
o Childbirth and breastfeeding education classes for teens and special needs clients.
STD/STI – 36% of local health departments have implemented programs, 56% provide general health
promotion activities, and 8% did not provide any services in this area. Example the implemented
programs included:
o Outreach and education on safe sex to high risk individuals in jail, group homes and alternative
learning programs and mainstream public schools.
o Target prevention programs for men who have sex with men, high risk women, and high risk
teens.
Tobacco Use – 67% of local health departments have implemented programs, 23% provide general
health promotion activities, and 1% did not provide any services in this area. Example the implemented
programs included:
o Raise the awareness of the health hazards of secondhand smoke and to raise the number of
restaurant establishments that are smoke free.
o Participate in tobacco diversion classes for under age youth found with tobacco.
Unintended Pregnancies – 64% of local health departments have implemented programs, 34% provide
general health promotion activities, and 3% did not provide any services in this area. Example the
implemented programs included:
o Work with schools to offer education on unintended pregnancy, STI's, adoption option, and young
parenting issues.
o Information to postpartum clients on contraception options and access to services.
Violence – 32% of local health departments have implemented programs, 55% provide general health
promotion activities, and 12% did not provide any services in this area. Example the implemented
programs included:
o Address health needs of women and children in shelter due to domestic violence.
o Collaborate on vulnerable adult team to assure protection and reporting of violence against
vulnerable adults.
6
Prevent the Spread of Infectious Disease
Overview
This area of responsibility focuses on infectious diseases that are spread person to person, not diseases that
are initially transmitted through the environment, such as food, water, vectors and/or animals. This highlights
local health department activities to detect acute and communicable diseases, assure the reporting of
communicable diseases, prevent the transmission of disease (including immunizations), and implement
control measures during communicable disease outbreaks.
Summary of Expenditure
Nearly 5% of total expenditures were in Infectious Disease. Of the $13.7 expended, Other Federal Funds
supported 40% ($5.4 million) of Infectious Disease spending. Other funding sources included Local Tax Levy
(22%), LPH Act State Funds (12%), and Client Fees (8%). It is important to note that one public health
department accounted for 40% of Infectious Disease spending and expended 93% of the Other Federal
Funds in Infectious Disease.
Summary of Staffing
One hundred and twenty-six FTEs were reported as working in the area of Infectious Disease. Nurses,
including registered public health nurses and others, accounted 56% of the staff in Infectious Disease. Other
professions included support staff, health planner, and public health educator. One public health department
accounted for 12% of FTEs in the area of Infectious Disease.
Summary of Select Performance Measures
Infectious Disease Trends and Gaps
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Over half (56%) of local health departments monitored and analyzed infectious disease risk to identify
disease trends and reporting gaps for their communities.
Of those responding no, the majority (72%) indicated that another entity performed this activity for their
jurisdiction. A smaller number (13%) indicated that they did not have the staff capacity to perform this
function.
Local health departments identified a number of disease trends and reporting gaps. Examples included:
o Gaps in clinic reporting of disease
o Gap in timely access to disease data from MDH
o Under reporting of STDs
o Increase in tuberculosis cases (including latent tuberculosis)
o Increase in salmonella
o Increase in STDs, especially Chlamydia
o Increase in Pertussis
o Increase in activities related to polio (refugees, Amish community)
o Increase in West Nile and Lyme disease
o Increase in Giardiasis in new refugees
Immunization Trends and Gaps
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The majority (77%) of local health departments monitored and analyzed immunization data and practices
to identify trends and practice gaps.
Of those responding no, the reasons for not performing this activity were equal among: not having staff
capacity, another entity performing this activity, and no CoCasa being done in 2006.
Local health departments identified a number of immunization trends and practice gaps. Examples
included:
o Increase in working with WIC and HeadStart to monitor immunizations
o Increased compliance with HIB
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o Poor compliance with 4th dose of Prevnar
o Increase in Hep A to infants
o Increase in varicella cases
o Inadequate reporting or low immunization rates in daycare centers
o Improvement in immunization levels in 24-35 month population
o Problems in medical clinics with appropriate vaccine spacing
o Issues with MIIC data entry and coding errors by users
o Working to increase medical clinic/provider reporting (and timely reporting) in MIIC
o Increase in missed 4th dose DTaP
o Missed opportunities for immunizations by providers
Almost all (96%) local health departments provide immunizations to children. That same percentage gives
immunizations to adults.
All local health departments provided infectious disease and immunization information to local providers
and the public.
Correctional Health Services
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Two thirds of local health departments provide some level of correctional health services. Of those that
provide that service, hepatitis C was the most commonly seen infectious disease. They also reported
significant amounts of the common cold, hepatitis B, Chlamydia, and tuberculosis (include latent TB).
Contacting Disease Reporting Entities
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Local health departments reported a total of 138 hospitals in their jurisdictions.
o They contacted 75% of these hospitals either in person on by phone to provide education on
infectious disease reporting. The majority (86%) of public health departments contacted all of the
hospitals in their jurisdiction.
o They contacted 86% of these hospitals by other methods such as newsletters or e-mails to
provide education on infectious disease reporting. The majority (87%) contacted all of the
hospitals in their jurisdiction.
Local health departments reported a total of 65 freestanding urgent care clinics in their jurisdictions.
o They contacted 31% of these urgent care clinics either in person on by phone to provide
education on infectious disease reporting. A small number (19%) contacted all of the urgent care
clinics in their jurisdiction.
o They contacted 55% of these urgent care clinics by other methods such as newsletters or e-mails
to provide education on infectious disease reporting. Thirty percent contacted all of the urgent
care clinics in their jurisdiction.
Local health departments reported a total of 816 primary care clinics in their jurisdictions.
o They contacted 80% of these primary care clinics either in person on by phone to provide
education on infectious disease reporting. Two thirds (66%) contacted all of the primary care
clinics in their jurisdiction.
o They contacted 92% of these primary care clinics by other methods such as newsletters or emails to provide education on infectious disease reporting. Most (84%) contacted all of the
primary care clinics in their jurisdiction.
Tuberculosis Activities
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Just over half (52%) of local health departments indicated that they provided directly observed therapy
(DOT) for tuberculosis. Of those responding no, the most frequently identified reason was that they had
not TB cases or that another entity performed this activity.
Over half (56%) of local health departments indicated a capacity to identify, locate, evaluate, and monitor
contacts of infectious TB cases based on MDH/CDC standards. The remainder indicated that they had
not infectious TB cases (32%) or this function was performed by another entity.
Local health departments indicated that they monitored 2965 clients for latent tuberculosis infection
(LTBI). These clients were monitored by 75% of the public health departments. The remaining public
health departments did not identify or monitor any LTBI clients.
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Innovative Programs
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Local health departments were asked to provide examples of innovative or effective programs to prevent
the spread of infectious diseases. Examples presented included:
o An “Infectious Disease Boot Camp" for public health and school nurses
o STD/STI prevention programs to schools
o “Cover Your Cough” campaigns in schools and health care facilities
o Community-wide “Do It In Your Sleeve” presentation
o “Lunch and Learn” presentations for county employees
o Work with local medical centers to sponsor flu clinics
o Hand-washing study in schools
o Home visits with the Amish Community
o Training of day care center staff
o FluMist application in schools
o Local radio programs on infectious diseases and prevention
Response Activities
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Throughout the year, local health departments responded to a number of infectious diseases. This
included responding to or addressing questions regarding:
o Pertussis
o Norovirus
o Mumps
o Chlamydia
o Tuberculosis/LTBI
o Bovine TB
o Bacterial and viral meningitis
o Herpes Gladitorium
o MRSA
o Rabies
o Polio
o Salmonella
o Hepatitis A and B
o Legionella
o Tetanus vaccinations (following
o Chicken pox
tornado)
9
Assure the Quality and Accessibility of Health Services
Overview
This area of responsibility assesses health care capacity and access to health care. It also addresses
identification and reduction of barriers to health services. It describes public health activities to fill health care
gaps, reduce barriers and link people to needed services.
Summary of Expenditure
Spending in the area of Health Services was by far the largest with $123.0 million. Health Services was
supported by Local Tax Levy funds (35%) and Medicaid (24%). Eighteen percent of spending was on home
health services. It is important to note that one public health department expended over $50 million dollars in
Health Services, accounting for 43% of overall expenditures and 43% of the Medicaid dollars spent in the
area of Health Services.
Summary of Staffing
Health Services employed 1122 FTEs, which is 40% of all FTEs in the CHS System. Over 400 FTEs (36%)
worked in home health services. Nurses, public health and other nurses, accounted for 49% of FTEs. Other
professions include Support Staff and Paraprofessionals. Forty-two percent of all Public Health Nurses and
62% of all Other Nurses worked in the area of Health Services.
Summary of Select Performance Measures
Identifying Gaps in Health Care Services
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Local health departments were asked which health care service gaps or barriers they identified in their
most recent community assessment. The two most frequently identified gaps/barriers were lack of mental
health services (88%) and lack of mental health providers (85%). Other gaps or barriers identified by
more than 80% of public health departments included transportation, lack of insurance, and lack of dental
providers and services.
Addressing Gaps in Health Care Services
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Local health departments undertook efforts to address gaps and barriers in health care. The two most
frequently addressed issues were dental services (76%) and lack of insurance (68%). Other issues
addressed by more than 50% of local health departments included transportation, basic life needs and
dental providers.
Local health departments were asked to describe progress they made in addressing gaps and barriers.
Examples included the following:
o Contracted or partnered with culturally diverse providers
o Identified insurance status of incarcerated
o Participated in local coalitions to address dental services
o Provided Medicaid Part D education
o Enhanced telemedicine services
o Screened for insurance and medical assistance eligibility
o Worked with local partners to provide medical services to the under and uninsured
o Enhanced access to transportation services
o Incorporated new services into existing programs (i.e. WIC and C&TC) to increase access
o Expanded home visiting services to homeless pregnant woman and families
o Worked with local partners to address medical provider shortage issues (including mental health
and chemical dependency providers)
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Improving Accessibility of Health Services
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Local health departments took actions to improve the accessibility of their health services. Some
examples included:
o Expanded and varied clinic hours and locations
o Maintained flexible hours for home visiting and other programs
o Increased nursing hours and jail
o Increased number of nurses available for programs
o Expanded public health services available during WIC clinics
o Expended use of telehealth services
o Increased care coordination for managed care
o Maintained 24/7 on call nurse
o Increased use of bilingual staff
o Increased the availability of “walk-in” slots for clinics
To obtain an overall picture of the services provided by local health departments, they were asked to
identify those services they provided (or contracted for) to fill a gap or to link people to needed services.
Almost all (96%) local health departments provide Child and Teen Checkup outreach and screening.
Others services provided by more than 80% of local health departments included Alternative Care,
Community Alternatives for Disabled Individuals, MN Senior Health Options, Elderly Waiver, Long Term
Care Consultation, and PCA Assessments.
Insurance Status
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Over half (59%) of local health departments assess the insurance status of clients in all programs. The
remained assesses clients in all programs except Correctional Health and a smaller number did not
access clients in WIC. Very few (3%) did not ever assess clients’ insurance status.
All local health departments routinely refer clients without insurance to appropriate resources.
Most (80%) local health departments were able to report the insurance status of it clients. Of those that
could report insurance status, most indicated that they could report on clients in MCH home visiting
programs and outreach, case management programs, and outreach and screening programs.
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Protect Against Environmental Health Hazards
Overview
This area of responsibility addresses aspects of the environment that pose risks to human health (broadly
defined as any risk emerging from the environment), but does not include injuries. This area also summarizes
activities that identify and mitigate environmental risks, including foodborne and waterborne diseases and
public health nuisances.
This area of responsibility includes 31 broad-ranging topic areas with the following categories: Air Quality,
Built Environment/Housing, Selected Public Health Nuisances, Food Protection, Solid and Hazardous Waste
Management, Recreational Water, Drinking Water and Other. Public health departments indicated if there
were ordinances or written policies to address each topic and if they had trained staff to address each topic.
They were also asked to identify the services they provided related to the topic and to identify who provided
the services if the public health department did not.
Summary of Expenditure
Almost 14% of total expenditures went toward Environmental Health. Other Local Funds supported 40% ($16
million).Other funding sources included Local Tax Levy (26 percent), Other Fees (19%), and Other State
Funds (6%). It is important to note that one local health department represented 45% of spending in this area,
accounting for 90% of the Other Local Funds. Another local health department represented 18% of spending,
accounting for almost 50% of Local Tax Levy.
Summary of Staffing
Environmental Health was staffed by 191 FTEs, 7% of all staff. Almost 60% of Environmental Health FTEs
are Environmental Scientists and Specialists. The remaining professions include
Licensure/Inspection/Regulatory Specialists and Health Educators. It is important to note that two local health
departments accounted for 35% of FTEs in Environmental Health.
Summary of Select Performance Measures
Ordinances and Policies
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For six of the 30 topic areas (excluding “Other”), over 50% of local health departments indicated that they
did have written ordinances and/or policies to address the topic. These topics included:
o Animals/Pests/Vectors
o Clandestine Drug Labs
o Garbage/Junk House
o Household Hazardous Waste
o Solid Waste
o Individual Sewage Treatment
For 24 of the 30 topic areas (excluding “Other”), over 50% of local health departments indicated that they
did not have written ordinances and/or policies to address the topic. These topics included:
o Outdoor Air
o Recreational Camps and Youth
o Indoor Air
Camps
o Radon
o Food Service
o Environmental Tobacco Smoke
o Grocery and Convenience Stores
o Asbestos
o Daycare Establishments
o Lead
o Non Household Hazardous Waste
o Licensed Lodging Facilities
o Public Pools and Spas
o Manufactured Home Parks
o Lakes and Swimming Beaches
o Mold
o Water Well Construction and
o Rental Property Inspection
Sealing
o Private Well Testing
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Non-Community Water Supplies
Sources Water Protection
Consumer Food Safety
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Body Art (includes piercing and
tattooing)
Tanning Beds
Trained Staff
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For eight of the 30 topic areas (excluding “Other”), over 50% of local health departments indicated that
they did have staff trained in the topic. These topics included:
o Radon
o Animals/Pests/Vectors
o Environmental Tobacco Smoke
o Clandestine Drug Labs
o Lead
o Garbage/Junk House
o Mold
o Private Well Testing
For 22 of the 30 topic areas (excluding “Other”), over 50% of local health departments indicated that they
did not have staff trained in the topic. These topics included:
o Outdoor Air
o Solid Waste
o Indoor Air
o Individual Sewage Treatment
o Asbestos
o Public Pools and Spas
o Licensed Lodging Facilities
o Lakes and Swimming Beaches
o Manufactured Home Parks
o Water Well Construction and
o Rental Property Inspection
Sealing
o Recreational Camps and Youth
o Non-Community Water Supplies
Camps
o Sources Water Protection
o Food Service
o Consumer Food Safety
o Grocery and Convenience Stores
o Body Art (includes piercing and
o Daycare Establishments
tattooing)
o Household Hazardous Waste
o Tanning Beds
o Non Household Hazardous Waste
Services Provided
•
•
•
•
•
In all but one topic area (Recreational Camps and Youth Camps) local health departments indicated that
the service they provided most frequently was education.
In 22 of the 30 topic areas (excluding “Other”) the next most frequently identified service was
consultation/technical assistance.
In half of the topic areas the “Referral to another county/city department” or “No activities/services
provided by the city/county” was the most frequently selected response. These topic areas included:
o Outdoor Air
o Solid Waste
o Asbestos
o Individual Sewage Treatment
o Manufactured Home Parks
o Lakes and Swimming Beaches
o Rental Property Inspection
o Water Well Construction and
o Recreational Camps and Youth
Sealing
Camps
o Sources Water Protection
o Grocery and Convenience Stores
o Body Art (includes piercing and
o Household Hazardous Waste
tattooing)
o Non Household Hazardous Waste
o Tanning Beds
When specifying a department within the county/city department to which the local health department
referred these services, the most frequently identified city/county department was the Environmental
Health or Environmental Services Department.
When indicating that the city/county did not provide these services, the most frequently identified
responsible entity was the Minnesota Department of Health or the Minnesota Pollution Control Agency.
Emerging Environmental Health Issues
•
Local health departments were asked to identify emerging environmental health issues in their
communities that were identified during the past year. The most frequently identified issues included:
o Mold
o Clandestine Drug Labs
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o
o
o
o
Environmental Tobacco Smoke
Radon
Garbage/Junk Houses
Declining and Substandard Rental Property
Public Health Nuisances
•
•
•
Most (80%) of local health departments have written policies and procedures for implementing the
removal and abatement of public health nuisances specified in Minn. Stat. 145A.04 Subd. 8 and 145A.03
Subd. 17.
Local health departments reported a total of 2702 public health nuisance inspections in 2006. Of these
84% were public health nuisances confirmed in 2006.
The most frequently reported public health nuisances complaints were Garbage/Junk houses (ranked in
the top three by 43 public health departments). “Accumulations of rubbish or junk as to become
dangerous or injurious” and “Failure to keep waste, refuse, or garbage in an enclosed building or properly
contained” also ranked fairly high.
Drinking Water
•
To assess the quality of drinking water in their communities, nearly half (43%) of local health departments
reviewed test results on public non-community water supplies.
Foodborne Illness
•
Local health departments were asked if they were able to collect data on the average number of
foodborne illness risk factors per establishment for its jurisdiction, and if they were able report on that
data.
o Over half (53%) do not do food, beverage and lodging licensing so were not able to report data.
o Of those able to report the data (23%), the top two risk factors identified included improper
temperatures and cross contamination. They indicated an average of 3.25 risk factors per
inspection.
Environmental Health Innovation
•
Local health departments were asked to provide an example of an innovative or effective program in
environmental health. Examples included:
o Updated public health nuisance ordinances
o Radon activities, including education, screening, and tracking
o Environmental tobacco smoke ordinances and advocacy
o Septic system inspection and education programs
o Junkyard abatement
o Water quality on public beaches
o Food safety education
o Clandestine drug lab ordinance
Environmental Health Response Activities
•
Local health departments provided examples of vectorborne, foodborne, and/or water borne disease
response activities in which they participated. Examples included:
o E-coli outbreak
o Cockroach infestations in apartment buildings
o Norovirus outbreak
o Investigation and mitigation of rat infested home
o Unsafe community water system
o Salmonella outbreak
o Garbage house mitigation (including dead chickens)
o Enforcement of unsafe food disposal
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Prepare for and Respond to Disasters and Assist
Communities in Recovery
Overview
This area of responsibility addresses activities that prepare public health to respond to disasters and assist
communities in responding to and recovering from disasters.
Summary of Expenditure
Disaster Preparedness received the least amount of funding at $13.6 million, less than 5% of total
expenditures. Almost 60% ($8 million) of funding was from Other Federal Funds. Federal preparedness and
pandemic flu planning dollars comprise the majority of Other Federal Funds. Other funding came from Other
State Funds (14%), Local Tax Levy (12%), and Other Fees (11%).
Summary of Staffing
Disaster Preparedness FTEs accounted for 5% of total FTEs (140 FTEs). Twenty-one percent of Disaster
Preparedness FTEs were public health nurses, with Environmental Scientists and Specialists accounting for
14%.
Summary of Select Performance Measures
Contact Information
•
•
Almost all (99%) of local health departments kept their primary contact information updated with the MDH.
Almost as many (97%) kept their contact information updated in the local jurisdictions Emergency
Operations Plan (EOP).
Planning
•
•
Almost all (95%) local health departments reviewed or updated their department’s emergency response
plan.
Most (85%) reviewed the health and medical annex of the local jurisdictions’ EOP with the emergency
manager.
Workforce
•
•
All local health departments indicated that they have trained appropriate staff in the National Incident
Management System (NIMS).
Almost all (99%) have a system to notify and deploy those staff during an emergency and most (87%)
have tested the system.
Communication
•
•
Almost all local health departments tested their local Health Alert Network at least once during the year.
Most (91%) have an emergency response plan that includes how the public health department will
communicate with the media and public during an emergency.
Response
•
Twenty percent of local health departments indicated that they had participated in a real public health
response to a potential or actual emergency in their local jurisdiction. Examples of response activities
included:
o Potential polio exposure in new refugees
15
o
o
o
o
o
o
o
o
o
o
High levels of total coliform in county building water system
Health response to wild fires (evacuation, congregate care, air quality)
Strep A meningitis
Norovirus outbreaks (including 100 children at a summer camp)
Extreme heat response with activation of cooling plan
Health response to tornado (injury tracking, volunteer management, tetanus clinic, animal debris
and carcass removal)
E-coli contamination of community water supply
Health response to industrial fire
Health response to ice storms (food, water, shelter, heat, medications, transportation to shelter)
Support of special populations following natural gas shutdown
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