2009 LPH PPMRS Results
Summary Report of Expenditures, Staffing, Activities, and Performance Measures
Introduction
The following report summarizes the 2009 expenditures, staffing, and activities and performance measures
information for the Community Health Services (CHS) System, submitted by Minnesota’s local health
departments to the Minnesota Department of Health. The local health department’s expenditure, staffing, and
activities and performance measures are organized into six areas of public health responsibility:
•
•
•
•
•
•
Assure an Adequate Local Public Health Infrastructure (page 2)
Promote Healthy Communities and Healthy Behaviors (page 4)
Prevent the Spread of Infectious Disease (page 7)
Assure the Quality and Accessibility of Health Services (page 9)
Protect Against Environmental Health Hazards (page 10)
Prepare for and Respond to Disasters and Assist Communities in Recovery (page 12)
Overview
CHS System expenditures were $298 million ($56 per person) in 2009, representing a $19 million or 6% decrease
in expenditures from 2008. This decrease is heavy skewed by one local health department (LHD) which sustained
a $18.5 million cut. By removing this LHD, there is a minimal decrease ($733,584) in expenditures. Overall, most
(67%) LHDs had increases in total expenditures from 2008. Expenditure amounts presented in the expenditure
sections represent portions of this total amount. The source of these funds includes local tax levy, Medicaid, and
the LPH Act Funds (appendix A contains a complete list of funding sources and definitions).
The number of full-time equivalents (FTEs) employed by the CHS system was 2,939 full-time equivalents
(FTEs), a decrease of 76 FTEs (3%) from 2008. Two local health departments (LHDs) accounted for a significant
portion of this decrease with 52 less FTEs in 2009 than in 2008. Of the remaining 71 LHDs, 37 had a decrease
and 31 had an increase in the number of FTEs. Three LHDs had no changes. Percentages included in the staffing
sections are based on portions of this total number. These employees represent a variety of job classifications
including public health nurses, epidemiologists, and health planners (appendix B contains a complete list of job
classifications and definitions).
Percentages included in the activities and performance measure sections are based on the actual number of local
health entities responding to the question. There were 73 local public health reporting entities (referred to in this
report as local health departments (LHD)) in Minnesota. Minnesota’s local public health system consists of 53
Community Health Boards (CHBs). CHBs are allowed to decide the jurisdictional level at which they will report
their data. For example, a multi-county CHB could have each county in the CHB report as an individual county or
could choose to report collectively as one CHB. Of the 73 local health departments included in this report: 28 are
single-county CHBs, 10 are multi-county CHBs, 31 are single counties reporting separately within multi-county
CHBs, and 4 are city CHBs.
Comprehensive statewide reports on activities and performance measures, financial, and staffing can be found at
www.health.state.mn.us/ppmrs.
2009 LPH PPMRS Summary
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Assure an Adequate Local Public Health Infrastructure (infrastructure) describes aspects of the public health
infrastructure that are essential to a well-functioning public health system-including assessment, planning, and
policy development. This summary highlights the CHS System’s expenditures, staffing, and activities that assure
the diversity of public health services and prevent the deterioration of the public health system while addressing
infrastructure components required by law for community health boards.
Expenditures
Nine percent of total expenditures were in the area of infrastructure, a decrease of $1.3 million (5%) caused by
twenty-nine LHDs reducing spending in infrastructure. The median LHD spending was $133,000 with a range
from $1,000 to $3.7 million. Of the $25.4 million expended, most (68%) was funded by local tax levy. Eighty-six
percent of LHDs used local tax levy to fund infrastructure. The remaining funding sources included LPH Act state
general funds (19%) and other local sources (8%). Sixty-six of the 73 LHDs (90%) used LPH Act state funds for
infrastructure.
Staffing
Local health departments classified 275 FTEs as working in the area of infrastructure, which accounted for 9% of
all FTEs. This was a 15% decrease from 2008 caused by 48 LHDs reporting a decreased number of infrastructure
FTEs. Thirty-eight percent of FTEs were administrative support. Health administrators (19%) and
administrative/business professionals (17%) also accounted for a high percentage of FTEs.
Activities and Performance Measures
Community Health Board Statutory Requirements
All Community Health Boards in Minnesota met statutory requirements for MS 145A including:
• The CHB meets composition requirements
• The CHB met at least twice during the reporting year
• The CHB has written procedures for business transaction
• The CHB has appointed an authorized agent of the board (typically the CHS Administrator)
• The CHB has a medical consultant
Community Health Assessment, Action Plan, and Local Priorities
The majority of local health departments have either updated or completed a community health assessment
between 2005 and 2009. A smaller portion had completed an improvement plan in that time period. Of those
completing an assessment in 2009, most used community surveys, existing groups and advisory committees to
solicit community input and engage special populations in the community.
Data, Communication and Research
Almost 92% proactively provided information to the public about local public health data and also responded to
requests from the public for local health data. 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 4 staff trained.
One quarter 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
topics of this research include:
• Obesity reduction curriculum in schools
• Emergency Preparedness
• Postpartum depression
• Understanding the burdens of diabetes, overweight, obesity, and asthma
2009 LPH PPMRS Summary
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Social Conditions and Cultural Competence
Ninety percent of local health departments described a collaboration that the local health department served on to
improve social conditions that affect health. Some examples of these collaborations and work include:
• Partner in the homeless collaborative and annual event that brings numerous service providers together in a
one stop service delivery model for homeless or at risk population Participating in senior health fairs to screen
seniors for depression and other health related concerns
• Our waiver nurses work on a team with social workers and are involved with employment and economic
assistance and housing for clients. The waiver staff also work with non-profit agencies to obtain housing
support, access to medical care, etc.
• Convened local SHIP coalitions and completed SHIP assessment and working on SHIP interventions.
Addressing access to dental care in low income families and children
• Public Health staff has been a member of a Housing committee, which works with, tenants, landlords, and
community regarding affordable housing, etc.
Most (96%) of administrators, directors and management staff have reviewed the Culturally and Linguistically
Appropriate Services (CLAS) standards. One third of LHDs 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:
• Using diversity internship program to recruit and hire staff
• Working with community partners to recruit diverse staff
• Providing priority status to bilingual/bicultural applicants
Eighty-nine percent of local health departments indicated that they have built cultural competence in their current
staff through education, training and working with cultural/racial groups to develop working relationships and to
gain more understanding of group. Ninety percent of local health departments took actions to make their services
more culturally competent. These included translating materials, increasing the use of interpreters, training staff,
and increasing interpreter usage.
Policy Development
Thirty-eight percent of local health departments helped develop significant community and/or legislative policies
around the areas of:
• Smoke-free facilities (city/count building, city/county parks, restaurants)
• Alcohol, tobacco and other drug use
• Side walks in new developments
• School wellness
• Violence prevention
• Tattoo and piercing
• Household hazardous wastes
• Dental care
Staffing Positions
Less than one third (30%) of the local health departments had staff positions that were vacant for more than 6
months with paraprofessional accounting for a majority of vacant positions. The primary reason for the difficulty
in filling these positions were budgetary restrictions.
Quality Improvement Initiatives
Eight-one percent of local health departments undertook quality improvement activities to improve their services
and processes. Examples of some efforts are in the areas of:
• Accurate medication administration and documentation at correctional facilities.
• SHIP leadership team.
• Immunization registry.
2009 LPH PPMRS Summary
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Promote Health Communities and Healthy Behaviors (healthy communities) addresses the promotion of
positive health behaviors and the prevention of adverse health behaviors- in all populations across the lifespan.
This summary highlights the CHS System’s expenditures, staffing, and activities that enhance the overall health
of communities including 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.
Expenditures
Almost $93 million (31% of total expenditures) were expended in the area of healthy communities, an increase of
$7.4 million dollars (9%) from 2008. Forty-nine LHDs had increases in healthy communities spending; these
increases are due in part to the State Health Improvement Program (SHIP). The median LHD spending was
$616,000 with a range from $76,000 to $14.3 million. Over one quarter of healthy communities expenditures ($25
million) were supported by other federal funds. Activities in healthy communities were funded by a wide range of
sources including local tax levy (23%), other state funds (11%), Medicaid (10%), LPH Act state funds (9%), and
TANF funds (8%). All or most health departments used some Federal Title V, Federal TANF, Other State, Other
Federal, and LPH Act state funds to support healthy communities.
Staffing
Healthy communities was staffed by 1007 FTEs, or 34% of the CHS workforce; a 3% (29 FTEs) increase from
2008. Although 41 LHDs had an increase in healthy communities FTEs, it is important to note that one LHD
accounted for a majority (22 FTEs) of the total increase. Public health nurses accounted for 37% of FTEs in this
area. Other staff in the area of healthy communities included administrative support (12%), public health program
specialists (9%), health educators (9%), and other nurses (7%).
Activities and Performance Measures
Topic Area
Healthy Aging
Percent of
LHDs that
provided
programs
60%
Percent of
LHDs that
provided
health
promotion and
educational
activities
34%
Percent of
LHDs that
did not
provide any
services
5%
Examples of
Programs and Activities
•
•
•
Alcohol
55%
30%
15%
•
•
Arthritis
5%
38%
56%
•
Fall prevention outreach program.
Healthy living seminar series for seniors
provides education on healthy heart and
healthy bones.
Worked with law enforcement to conduct
alcohol compliance checks and alcohol
retailer training.
Alcohol and drug abuse education
programs in schools.
Arthritis screening and case management
through diet, exercise and medication.
Implemented community-based efforts to
improve the health status and quality of life
for persons who have arthritis.
2009 LPH PPMRS Summary
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Topic Area
Percent of
LHDs that
provided
programs
Percent of
LHDs that
provided
health
promotion and
educational
activities
Percent of
LHDs that
did not
provide any
services
Examples of
Programs and Activities
•
Asthma
29%
34%
37%
•
•
Cancer
14%
60%
26%
•
•
Cardiovascular
Disease and
Stroke
33%
58%
10%
•
•
Diabetes
27%
49%
23%
•
•
HIV/AIDS
23%
42%
34%
•
•
Infant, Child,
and
Adolescent
Growth and
Development
96%
4%
0%
•
•
Injury
71%
23%
5%
•
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.
Implemented effective home prevention
strategies.
Provided information on cancer prevention
and screening to minority populations at
worksites.
Work with community partners to educate
women about prevention, screening and
early intervention of breast cancer.
Community programs focusing on healthy
lifestyles -physical activity, health
nutrition, and decreased tobacco use and
exposure.
Public access defibrillator program –
improve awareness and access to AEDs.
Diabetes education and free blood sugar
checks at local clinics, health fairs and
worksites.
Diabetes support group to provide
education, sharing of ideas and networking.
HIV counseling, education and testing
services to high school students.
HIV prevention education at outpatient
chemical dependency treatment programs.
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.
Follow Along program- to detect
developmental delays and socio-emotional
concerns early in school children.
Car seat safety education and distribution
programs in collaboration with community
partners.
Home safety assessment for seniors and
new parents.
2009 LPH PPMRS Summary
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Topic Area
Percent of
LHDs that
provided
programs
Percent of
LHDs that
provided
health
promotion and
educational
activities
Percent of
LHDs that
did not
provide any
services
Examples of
Programs and Activities
•
Mental Health
42%
37%
21%
•
•
Nutrition
63%
36%
1%
63%
26%
11%
•
•
Oral/Dental
Health
Other Drug
Use
•
•
47%
29%
25%
•
•
Physical
Activity
63%
27%
10%
•
•
Pregnancy and
Birth
95%
5%
0%
•
•
STDs/STIs
41%
41%
18%
•
Comprehensive, school program to prevent
bullying, improve the social climate of
classrooms and reduce related antisocial
behaviors such as vandalism and truancy.
Screening of prenatal/postnatal women and
senior citizens for depression.
Support to schools for improved nutrition
and physical activity polices and programs.
Communitywide fitness and wellness
programs, encouraging proper nutrition and
exercise.
Dental screenings and fluoride varnishing
in WIC and MCH programs.
Oral/Dental education in the schools.
Involvement in community
methamphetamine coalitions, use reduction
activities and development of ordinances.
Partner to reduce adolescent substance use
and create conditions that make marijuana
and other drug use less desirable and
accessible.
Support community and worksite physical
activity programs through “walkable”
communities and activity challenges.
Fit WIC program targeting pre-school
children to encourage play time sessions.
Information and support for high risk, low
income, pregnant teens and women for
healthy lifestyle choices, preterm birth
prevention, and connection to necessary
resources.
Childbirth and breastfeeding education
classes for teens and special needs clients.
STD/STI information, testing and initial
treatment given to teens and adults at
counseling centers.
Outreach and education on safe sex to high
risk individuals in jail, group homes and
alternative learning programs in
mainstream public schools.
2009 LPH PPMRS Summary
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Topic Area
Percent of
LHDs that
provided
programs
Percent of
LHDs that
provided
health
promotion and
educational
activities
Percent of
LHDs that
did not
provide any
services
Examples of
Programs and Activities
•
Tobacco Use
66%
27%
7%
•
•
Unintended
Pregnancies
63%
27%
10%
•
•
Violence
36%
47%
18%
•
Raise the awareness of the health hazards
of secondhand smoke and to raise the
number of restaurant establishments that
are smoke free.
Participate in tobacco diversion classes for
under age youth found with tobacco.
Work with schools to offer education on
unintended pregnancy, STIs, adoption
option, and young parenting issues.
Information to postpartum clients on
contraception options and access to
services.
Public campaign on coaching boys into
men to educate them about how they relate
to women in order to counteract negative
messages they may learn from elsewhere.
Bullying prevention project includes
classroom instruction and school discipline
practices.
Prevent the Spread of Infectious Disease (infectious disease) focuses on infectious diseases that are spread
person to person. This does not include diseases that are initially transmitted through the environment, such as
food, water, vectors and/or animals. This summary highlights the CHS System’s expenditures, staffing, and
activities that detect acute and communicable diseases, assure the reporting of communicable diseases, prevent the
transmission of diseases (including immunizations), and implement control measures during communicable
disease outbreaks.
Expenditures
Six percent ($17.4 million) of total expenditures were in the area infectious disease, a slight decrease of 2% from
2008. The median LHD spending was $60,000 with a range from $2,270 to $7.7 million. Other federal funds
supported 43% ($7.5 million) of infectious disease spending. Other funding sources included local tax levy
(28%), LPH Act state funds (11%), and client fees (7%). It is important to note that two LHDs accounted for 55%
of infectious disease spending and accounted for 93% of the other federal funds in infectious disease.
Staffing
In the CHS System, 140 FTEs (5% for all FTEs) were reported as working in the area of infectious disease, an
increase of one FTE from 2008. Nurses, including public health and other nurses, accounted for 51% of the staff
in the area of infectious disease. Other professions included administrative support (17%), health planner (5%),
and paraprofessional (5%). It is important to note that two LHDs accounted for 28% of FTEs in the area of
infectious disease and another two LHDs had no FTEs in this area.
2009 LPH PPMRS Summary
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Activities and Performance Measures
Infectious Disease Trends and Gaps
A majority (79%) of the local health departments monitored and analyzed infectious disease risk identifying
trends and reporting gaps for their communities. Reasons for not identifying trends and practice gaps included
activity performed by another entity and not having staff capacity.
Immunization Trends and Gaps
Overall, ninety percent of the local health departments monitored and analyzed immunization data and practices
to identify trends and practice gaps. The reasons for not performing this activity were another entity performing
this activity, not having staff capacity and not having jurisdiction specific data. Local health departments
identified a number of disease trends, reporting gaps, and related activities including:
• Issues with training and educating staff on immunization practices
• Variances in provider vaccine administration practices
• Issues with MIIC system.
• Increase in the number of missed opportunities for immunizations by providers
• Problems in medical clinics with inappropriate vaccine storage
• Increased efforts to target low immunization rates by sending reminders and making follow-up calls.
• Working to increase timely reporting, assess vaccine shortages, storage and handling concerns and school
vaccinations
Almost all local health departments provided infectious disease and immunization information to local providers
(97%) and the public (99%) and 97% provided immunizations to children and to adults. The primary reason
among those that did not provide this service was that immunizations were offered by another clinic in the
jurisdiction.
Correctional Health Services
Six-three percent of the LHDs provided some level of correctional health services. Of those that provided that
service, the most commonly seen infectious disease was common cold followed by Chlamydia. They also
reported significant number of cases of Hepatitis C and tuberculosis (including latent TB).
Contacting Disease Reporting Entities
Local public health departments had 137 hospitals within their jurisdictions and contacted 96% of the hospitals to
provide information on infectious disease reporting, either in person or by phone. Other methods (newsletters or
emails) were also used to contact 83% of hospitals. Of the 111 freestanding urgent care clinics in LHD’s
jurisdictions, 55% were contacted either in person or by phone with 78% contacted by other methods such as
newsletters or e-mails to provide education on infectious disease reporting. LHDs identified 782 primary care
clinics were within their jurisdictions, 77% were contacted in person/by phone and 98% were contacted using
other methods.
Tuberculosis activities
Eighty-two of percent of local health departments provided directly observed therapy (DOT) for tuberculosis. The
most frequently identified reason for those not performing this service were another entity performed this activity
or TB clients or physicians refused DOT. Eighty-eight percent 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 had infectious disease cases or this function was performed by another
entity. Two-thirds of local health departments monitored individuals for latent tuberculosis infection (LTBI), for a
total of 1925 individuals monitored.
Innovative programs
Local health departments provided a number of innovative programs to prevent the spread of infectious diseases.
In 2009 many of the activities were around H1N1 including school base vaccination clinics and extensive
communication campaign around covering your cough and handwashing.
2009 LPH PPMRS Summary
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Responded to Infectious Diseases
Throughout the year, local health departments provided a number of infectious diseases response activities
(excluding those of vector-borne, food-borne, and/or water borne). This included:
• Responded to H1N1
• Conducted TB contact investigations
• Conducted pertussis investigations
• Conducted perinatal hepatitis B investigations
Assure the Quality and Accessibility of Health Services (assure health services) involves assessing health care
capacity and access to health care. This summary highlights the CHS System’s expenditures, staffing, and
activities to identify and reduce barriers to health services, fill health care gaps, and link people to needed
services.
Expenditures
Expenditures in the area of health services were by far the largest, totaling $110.6 million, $22.6 million less than
in 2008, a decrease of 17%. Forty-five LHDs had decreases in assure health services, with one LHD accounting
for a $22.6 million decrease. The median LHD spending was $177,000 with a range from $79,000 to $27.6
million. Assure health services expenditures were supported by local tax levy (27%) and Medicaid (26%). A
significant part of assure health services includes providing services through home health care, hospice,
correctional health, and emergency medical services programs. These services accounted for 46% of assure health
services and 17% of all expenditures. Eighteen percent ($24.3 million) of spending was on home health care and
hospice services. It is important to note that two LHDs expended $38.3 million dollars in assure health services,
accounting for 35% of overall expenditures, 62% of all local tax levy dollars, and 29% of the Medicaid dollars
spent in the area of assure health services.
Staffing
The area of assure health services employed 1,205 FTEs, a decrease of 6% from 2008. Nurses, including public
health and other nurses, accounted for 48% of FTEs in this area. Other staff included paraprofessionals (15%),
medical and public social worker (12%), and administrative support (10%). A significant part of assure health
services includes providing direct services through home health care, hospice, correctional health, and emergency
medical services programs. These direct service FTEs accounted for 379 FTEs, 31% of all assure health services
FTEs and 13% of all FTEs. Home health care programs accounted for 22% of all assure health services FTEs and
9% of all FTEs.
Activities and Performance Measures
Identifying Gaps in Health care Services
Local health departments identified health care service gaps or barriers during their most recent community
assessment. The four most frequently identified gaps or barriers were lack of insurance (85%), transportation
(85%), lack of mental health providers (85%), and lack of dental services (82%).
Addressing Gaps in Health care Services
Local health departments undertook efforts to address gaps and barriers in health care. The two most frequently
addressed issues were lack of dental services (75%) and lack of insurance (73%). Other issues addressed by more
than 50% of local health departments included transportation and dental providers. Local health departments
addressed gaps and barriers many ways including:
•
•
•
•
•
•
Working with human services to address the mental health service gaps
Established dental clinic and dental vans
Worked with volunteer organizations to provide transportation
Participated in local coalitions to address dental services
Enhanced telemedicine services
Screened for insurance and medical assistance eligibility
2009 LPH PPMRS Summary
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•
•
Worked with local partners and providers to provide medical and dental services to the under and uninsured
Implementation of low cost family planning services.
Improving Accessibility of Health Services
Most (85%) of local health departments took actions to improve the accessibility of health services including:
•
•
•
•
•
•
•
•
•
•
•
Worked with home care providers to assure home care service coverage in remote rural areas.
Expanded and varied clinic hours and locations
Maintained flexible hours for home visiting and other programs
Increased nursing hours in jail
Increased number of nurses available for programs
Expanded public health services available during WIC clinics
Expanded use of telehealth services
Coordinated with social services on intensive rehabilitation services for high risk mental health population
Use of bus tokens to improve transportation
Increased number of staff trained to do dental varnishing
Increased use of bilingual staff
Almost all (99%) local health departments provide or assure Child and Teen Checkup outreach and screening.
Other services provided or assure by more than 80% of local health departments included, early intervention
services, WIC clinics, immunization clinics, family home visiting, Follow Along Program, long term care
consultations, and personal care assistance assessments. Of those that provided the above mentioned services,
most of them indicated that their health department staff routinely assessed clients for health insurance status.
More than 60% of the local health departments indicated that they were able to report health insurance status data
on their clients in the following areas: WIC clinics, immunization clinics, family home visiting, C&TC outreach
and long term care consultations.
Protect Against Environmental Health Hazards (environmental health) 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 summary highlights the CHS System’s expenditures, staffing, and activities that identify and
mitigate environmental risks, including foodborne, waterborne, and vectorborne diseases and public health
nuisances.
Expenditures
Environmental health expenditures decreased by 11% ($4.7 million) from 2008 to$38.7 million in 2009. Forty
LHDs had decreases in environmental health funding while 20 LHDs had spending less than $5000 of which 9
had no spending. The median LHD spending was $22,000 with a range from $0 to $20.6 million. Other fees
supported 60% ($23.1 million) of the environmental health expenditures. Other funding sources included local tax
levy (25%), other state funds (6%), and other local funds (3%). It is important to note that two LHDs represented
75% of spending in this area, accounting for 81% of the other fees expended almost 70% of local tax levy
expended.
Staffing
Environmental health was staffed by 179 FTEs, or 7% of the CHS workforce. This was a 12% decrease (24
FTEs) from 2008 due primarily to a single LHD ending its environmental health program. Over half (52%) of the
environmental health FTEs were environmental scientists and specialists. The remaining occupations represented
included licensure/inspection/ regulatory specialist (7%) and health educator (6%). It is important to note that
three local health departments accounted for 52% of all FTEs in this area and eleven LHDs had no FTEs in this
area.
2009 LPH PPMRS Summary
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Activities and Performance Measures
Emerging Environmental Health Issues
The emerging environmental health issues most frequently identified in 2009 include:
• Mold
• Declining and Substandard Rental
Property
• Garbage/Junk Houses
• Lead
• Source Water Contamination
• Improper sewage disposal
Public Health Nuisances
Most (86%) of local public health departments have written policies and procedures for implementing the removal
and abatement of public health nuisances specified in Minnesota statute. Local public departments reported a total
of 912 public health nuisance inspections in 2009 as compared to 979 in 2008. Almost two-thirds were confirmed
public health nuisances confirmed. The top three most frequently reported public health nuisances complaints
were mold, garbage/junk houses; and accumulation of rubbish or junk.
Drinking Water
Thirty-seven percent of the local health departments assesses the status of drinking water quality as part of its
community health assessment. Of these, most of them 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 food-borne illness
risk factors per establishment for its jurisdiction, and if they were able to report on that data. Twenty-six LHDs
collected and 20 are able to report on the average number of foodborne illness risk factors per establishment. The
top two risk factors identified included improper holding temperatures and contaminated equipment.
Environmental Health Innovation
Local health departments provided examples of an innovative or effective program in environmental health
including:
• Updated public health nuisance ordinances
• Mandatory training of new food workers
• Radon activities, including education, home radon detection kits and tracking
• Lead screening at WIC, C&TC and MCH visits
• Septic system inspection and education programs
• ‘Cooking safely for a Crowd’ educational presentation to those who cater to large crowds
• Collection and recycling of hazardous electronic wastes from households
• Food safety education
Environmental Health Response Activities
Local public health departments provided examples of vectorborne, foodborne, and/or water borne disease
response activities including:
• E-coli and Salmonella outbreak investigation/monitoring
• Unsafe community water system
• Bed bugs infestation
• Public pool complaints
Prepare for and Respond to Disasters and Assist Communities in Recovery (emergency preparedness)
addresses activities that prepare public health to respond to disasters and assist communities in responding to and
recovering from disasters. This summary highlights the CHS System’s expenditures, staffing, and activities to
plan and prepare for and respond to disasters.
2009 LPH PPMRS Summary
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Expenditures
Emergency preparedness expenditures were the least of the six areas of public health responsibility, with $12.9
million or 4% of total expenditures. Emergency preparedness expenditures increased by 11% from 2008 to 2009
due to in part to the H1N1 response. The median LHD spending was $79,000 with a range from $17,000 to $1.6
million. Almost 80% ($10.2 million) of the emergency preparedness funding was from other federal funds.
Federal preparedness and pandemic flu planning dollars comprise the majority of other federal funds. The
remaining funding came from other local tax levy and LPH Act state funds.
Staffing
Emergency preparedness accounted for 5% of all FTEs (134 FTEs), an increase of 30% from 2008. This increase
is due in part to the ongoing H1N1 response which led to 57 LHDs reporting an increase in emergency
preparedness FTEs. Twenty-eight percent of emergency preparedness FTEs were public health nurses. Other
professions in this area were administrative support (13%), health planner (11%), health administrator (11%), and
public health educator (9%).
Activities and Performance Measures
Contact Information
All local public health departments kept their primary contact information updated with MDH and in the local
jurisdiction’s Emergency Operations Plan (EOP).
Planning
Almost all (99%) local health departments reviewed or updated their department’s emergency response plan.
Eighty- one percent 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) and have a system to notify and deploy those staff during an emergency. Ninetynine percent have tested the system.
Communication
All local health departments tested their Health Alert Network system at least once during the year and have an
emergency response plan that includes how the public health department will communicate with the media and
public.
Response
Seventy-two public health departments indicated that they participated in a real public health response to a
potential or actual emergency. Examples of responses include:
• Response to food borne illnesses and outbreaks
• Implementation of emergency risk and communications plan during pertussis outbreak
• Response to E. coli outbreak
• Response to floods ( assuring food, water, heat, medications, and transportation to shelter)
• Actively responded to H1N1
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Appendix A
Funding Definitions
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Funding Definitions
Client Fees
Report expenditures that had as their source revenue received as a client fee (i.e. sliding fees for a health care or MCH
service).
Local Tax
Report expenditures that had as their source revenue from local tax levies.
Medicaid
(Title XIX of the Social Security Act) Report expenditures that had revenue from Medicaid reimbursements as their
source. This includes Prepaid Medical Assistance Plans (PMAPs), community based purchasing and community
alternative care (CAC), community alternatives for disabled individuals (CADI), development disabled (DD) (formerly
known as mental retardation or related conditions (MR/RC)), elderly (EW), and traumatic brain injury (TBI) waivers.
This does not include alternative care (AC) which is reported in Other State Funds.
Medicare
(Title XVIII of the Social Security Act) Report expenditures that had Medicare reimbursements as their source. Also
include revenue from Minnesota Health Senior Options (MSHO).
Other Federal Funds
Report expenditures that had as their source of revenue as the Federal Government other than those specified elsewhere
in the glossary (i.e. Medicaid, Medicare, TANF, and Title V). This includes dollars that come directly and as pass thru
funds. Any funds with a Catalog of Federal Domestic Assistance (CFDA) number are federal funds. Examples include
WIC, Veteran's Administration, Pandemic Flu Supplemental Funding, and Public Health Preparedness. This does NOT
include Medicaid, Medicare, Medicaid waivers, Title V, and TANF funds. If a grant is funded by both state and federal
sources (e.g., 30% state funds and 70% federal funds) divide the amount appropriately between Other State Funds and
Other Federal Funds.
Other Fees (non-client)
Report expenditures that had as their source revenue received as a fee for service, or for a license or permit. Usually the
charge has been set by statute, charter, ordinance, or board resolution.
Other Local Funds
Report expenditures that had their source from other local funds (not pass thru from state or federal government)
including in-kind and contracts, grants or gifts from local agencies such as schools, social service agencies, community
action agencies, hospitals, regional groups, non profits, corporations or foundations. Please confirm that these funds do
not originate from a federal or state source.
Other State Funds
Report expenditures of dollars spent from other state funds other than those specified including grants and contracts from
the Minnesota Department of Health and other state agencies that are not "pass thru" dollars from the federal
government. Funding with a CFDA number are federal dollars. Examples of other state funding include alternative care
and family planning special project. Please confirm that these funds do not originate from a federal source. If a grant is
funded by both state and federal sources (e.g., 30% state funds and 70% federal funds) divide the amount appropriately
between Other State Funds and Other Federal Funds.
Private Insurance
Report expenditures that had reimbursements received from private insurance companies as their source.
State General Funds
Report expenditures of dollars that had the state general funds portion of the Local Public Health Act as their source.
State general funds are to be used for the operations of community health boards.
TANF
Report the total of invoices sent to MDH for reimbursement for the period of January 1st to December 31tst that had
Federal TANF as their funding source.
Title V
Report expenditures of dollars that had the federal Title V (MCH) portion of the Local Public Health Act as their source.
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Appendix B
Job Classifications
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JOB CLASSIFICATIONS
This Glossary includes brief definitions and decision guidelines for the titles in the expanded Bureau of Health Professions
listing developed by Columbia University School of Nursing Center for Health Policy. These definitions have been slightly
modified to fit with Minnesota’s public health workforce; modifications have been noted. For the complete report go to:
www.nursing.columbia.edu/chphsr/pdf/enum2000.pdf
Health Administrator
This single category encompasses all positions identified as leading a public health agency, program or major
sub-unit. This includes occupations in which employees set broad policies, exercise overall responsibility for
execution of these policies, of direct individual departments or special phases of the agency’s operations, or
provide specialized consultation on a regional, district or area basis. Examples of occupations include
department heads, bureau chiefs, division chiefs, directors, deputy directors, CHS administrator, public
health nursing director, and environmental health director. This does NOT include managers, supervisors, or
team leaders.
Administrative/Business Professional
Performs work in business, finance, auditing, management and accounting. Individuals trained at a
professional level in their field of expertise prior to entry into public health. Examples of occupations include
office manager and accountants.
Administrative Support (Including Clerical and Sales)
Occupations in which workers are responsible for internal and external communication, recording and
retrieval of data and/or information and other paperwork required in an office. Examples of occupations
includes bookkeepers, messengers, clerk-typists, stenographers, court transcribers, hearing reporters,
statistical clerks, dispatchers, license distributors, payroll clerks, office machine and computer operators,
telephone operators, legal assistants, secretaries, clerical support, WIC clerks, and receptionist.
Environmental Scientist and Specialist
Applies biological, chemical, and public health principles to control, eliminate, ameliorate, and/or prevent
environmental health hazards. Examples of occupations include environmental researcher, environmental
health specialist, food scientist, soil and plant scientist, air pollution specialist, hazardous materials
specialist, toxicologist, water/waste water/solid waste specialist, sanitarian, and entomologist.
Epidemiologist
Investigates, describes and analyzes the distribution and determinants of disease, disability, and other health
outcomes, and develops the means for their prevention and control; investigates, describes and analyzes the
efficacy of programs and interventions. Includes individuals specifically trained as epidemiologists, and those
trained in another discipline (e.g., medicine, nursing, environmental health) working as epidemiologists under
job titles such as nurse epidemiologist.
Health Planner/Researcher/Analyst
Analyzes needs and plans for the development of public health and other health programs, facilities and
resources, and/or analyzes and evaluates the implications of alternative policies relating to public health and
health care. Includes a number of job titles without reference to the specific training that the individual might
have (e.g. health analyst, community planner, research scientist).
Interpreter
Individuals who translate information in one language to another language for public health purposes. (This is
not an official EEO-4/CHP/BHPr+ definition.)
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Licensure/Inspection/ Regulatory Specialist
Audits, inspects and surveys programs, institutions, equipment, products and personnel, using approved
standards for design or performance. Includes those who perform regular inspections of a specified class of
sites or facilities, such as restaurants, nursing homes, and hospitals where personnel and materials present
constant and predictable threats to the public, without specification of educational preparation. This
classification probably includes a number of individuals with preparation in environmental health, nursing
and other health fields.
Medical & Public Health Social Worker
Identifies, plans, develops, implements and evaluates social work interventions on the basis of social and
interpersonal needs of total populations or populations-at-risk in order to improve the health of a community
and promote and protect the health of individuals and families. This job classification includes titles
specifically referring to social worker. (This category has been modified from the original occupational title
and includes “Mental Health/Substance Abuse Social Worker.”)
Mental Health Counselor
Emphasizes prevention and works with individuals and groups to promote optimum mental health. This
occupation may help individuals deal with addictions and substance abuse; family, parenting, and marital
problems; suicidal tendencies; stress management; problems with self-esteem; and issues associated with
aging, and mental and emotional health. It can also provide services for persons having mental, emotional, or
substance abuse problems and may provide such services as individual and group therapy, crisis intervention,
and social rehabilitation. May also arrange for supportive services to ease patients, return to the community. It
includes such titles as community health worker and crisis team worker. This category excludes psychiatrists,
psychologists, social workers, marriage and family therapists, and substance abuse counselors.
Occupation Safety & Health Specialist
Reviews, evaluates, and analyzes workplace environments and exposures and designs programs and
procedures to control, eliminate, ameliorate, and/or prevent disease and injury caused by chemical, physical,
biological, and ergonomic risks to workers. Occupations include industrial hygienist, occupational therapist,
occupational medicine specialist and safety specialist. It also includes a physician or nurse specifically
identified as an occupational health specialist.
Other Nurse
Helps plan, develop, implement and evaluate nursing and public health interventions for individuals, families
and populations at risk of illness or disability. Other nurses include nurses with the following titles: RN, NP,
and LPN. A nurse that has a baccalaureate or higher degree with a major in nursing and meets the
requirements stated in Minnesota Rules Chapter 6316 should be classified as a “Public Health Nurse.” (This
is not an official EEO-4/CHP/BHPr+ definition.)
Other Public Health Professional
This includes positions in a public health setting occupied by professionals (preparation at the baccalaureate
level or above) that do not fall under the specific professional categories. (This category has been slightly
modified from the original occupational title.). Examples of occupations include physician assistant,
laboratory professional, EMS professional, intern, speech therapist, and public relations/media specialist.
Paraprofessionals
Occupations in which workers perform some of the duties of a professional or technician in a supportive role,
which usually require less formal training and/or experience normally required for professional or technical
status. This includes research assistants, medical aides, child support workers, home health aides, library
assistants and clerks, ambulance drivers and attendants, home maker, case aide, community outreach/field
worker, and advocate.
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Public Health Dental Worker
Plans, develops, implements and evaluates dental health programs to promote and maintain optimum oral
health of the public; public health dentists may provide comprehensive dental care; the dental hygienist may
provide limited dental services under professional supervision. This category is specific in its inclusion of
only employees trained in dentistry or dental health, but abnormally broad in that it neglects the
professional/technician distinction and includes the entire range of qualifications, from dental surgeon to
dental hygienist.
Public Health Educator
Designs, organizes, implements, communicates, provides advice on and evaluates the effect of educational
programs and strategies designed to support and modify health-related behaviors of individuals, families,
organizations, and communities. This title includes all job titles that include health educator, unless specified
to another specific category, such as dental health educator or occupational health educator.
Public Health Nurse
Plans, develops, implements and evaluates nursing and public health interventions for individuals, families
and populations at risk of illness or disability. This title only includes public health nurses who meet the
requirements stated in Minnesota Rules Chapter 6316. Public health nurses must have a baccalaureate or
higher degree with a major in nursing. (This category has been modified from the original occupational title.)
Public Health Nutritionist
Plans, develops, implements and evaluates programs or scientific studies to promote and maintain optimum
health through improved nutrition; collaborates with programs that have nutrition components; may involve
clinical practice as a dietitian. Examples include community nutritionist, community dietitian, nutrition
scientist, and registered dietician.
Public Health Physical Therapist
Assesses, plans, organizes, and participates in rehabilitative programs that improve mobility, relieve pain,
increase strength, and decrease or prevent deformity of individuals, populations and groups suffering from
disease or injury.
Public Health Physician
Identifies persons or groups at risk of illness or disability, and develops, implements and evaluates programs
or interventions designed to prevent, treat or ameliorate such risks; may provide direct medical services
within the context of such programs. Examples include MD and DO generalists and specialists, some of
whom have training in public health or preventive medicine. This job classification does not include
physicians working in administrative positions (health administrator or official) and some in specialty areas
(epidemiology, occupational health).
Public Health Program Specialist
Plans, develops, implements and evaluates programs or interventions designed to identify persons at risk of
specified health problems, and to prevent, treat or ameliorate such problems. This job classification includes
public health workers reported as public health program specialist without specification of the program, as
well as some reported as specialists working on a specific program (e.g. AIDS Awareness Program Specialist,
immunization program specialist.) Includes individuals with a wide range of educational preparation, and may
include individuals who have preparation in a specific profession (e.g., dental health, environmental health,
medicine, and nursing).
Service-Maintenance
Occupations in which workers perform duties which result in or contribute to the comfort, convenience,
hygiene or safety of the general public or which contribute to the upkeep and care of buildings, facilities or
grounds of public property. Workers in this group may operate machinery. This includes chauffeurs, laundry
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and dry cleaning operatives, truck drivers, bus drivers, garage laborers, custodial employees, grounds
keepers, drivers, transportation, and housekeeper.
Technicians
This classification includes occupations which require a combination of basic scientific or technical
knowledge and manual skill which can be obtained through specialized post-secondary school education or
through equivalent on-the-job training. Examples include computer programmers, drafters, survey and
mapping technicians, photographers, technical illustrators, technicians (medical, dental, electronic, physical
sciences), inspectors, environmental health technician, nutritional technician, detox technician, EMS
technician, hearing and vision technician, laboratory technician, and computer specialist.
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