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Department of Health House Health and Human Services Finance House Health and Human Services Reform Edward P Ehlinger MD MSPH Commissioner of Health January 13 2015 Prevention first cure if you must capacity to do in both directions ID: 772144

care health services public health care public services spending disease state mdh department access water free million program people

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Department of Health House Health and Human Services Finance House Health and Human Services Reform Edward P. Ehlinger , MD, MSPH Commissioner of Health January 13, 2015

“ Prevention first, cure if you must; capacity to do in both directions .” Charles Nathaniel Hewitt Secretary, MN State Board of Health 1872-1897

“Public Health is what we, as a society, do collectively to assure the conditions in which people can be healthy. Institute of Medicine

Determinants of Health Model based on frameworks developed by: Tarlov AR. Ann N Y Acad Sci 1999; 896: 281-93; and Kindig D, Asada Y, Booske B . JAMA 2008; 299(17): 2081-2083.

Necessary conditions for health (WHO) Peace Shelter Education Food Income Stable eco-system Sustainable resourcesHealth CareEquity World Health Organization. Ottawa charter for health promotion. International Conference on Health Promotion: The Move Towards a New Public Health, November 17-21, 1986 Ottawa, Ontario, Canada, 1986. Accessed July 12, 2002 at <http://www.who.int/hpr/archive/docs/ottawa.html>.

Public health = longer lives Life Expectancy at Birth, United States, 1900 - 1996 25 of the 30 years of life gained in the 20 th Century resulted from public health accomplishments

95 5 Our investments in health

Minnesota’s Health Care Spending Source: Minnesota Health Care Spending and Projections, 2012, Feb. 2014 Minnesota 48 th nationally in per capita public health spending

Healthy Healthcare System Balances Treatment and Prevention

Deaths Prevented And Change In Health Care Costs Plus Program Spending, Three Intervention Scenarios, At Year 10 And Year 25. Milstein B et al. Health Aff 2011;30:823-832

Deaths Prevented And Change In Health Care Costs Plus Program Spending, Three Intervention Scenarios, At Year 10 And Year 25. Milstein B et al. Health Aff 2011;30:823-832 ©2011 by Project HOPE - The People-to-People Health Foundation, Inc.

Cost Benefits of Treatment and Prevention Milstein B et al. Health Aff 2011;30:823-832

MDH Mission To protect, maintain and improve the health of all Minnesotans One of first 5 State Health Departments to be Accredited

MDH District Offices

State and Local Public Health Partnership

Infectious Disease Around-the-clock monitoring of infectious diseases, like Ebola Investigation into novel illnesses through close work with partners A swift, effective response to disease outbreaks and public health emergencies (MPR photo/Mark Steil )

Environmental Health Assurance that the water you drink is clean and the food you eat is safe Advice about reducing risks

Emergency Preparedness Statewide preparations for responding to public health emergencies, including a possible pandemic Planning with hospitals and health care systems to rapidly care for large numbers of injured or ill victims

Office of Medical Cannabis 2014 law creates a new process to allow 5,000 seriously-ill Minnesotans to acquire and use medical cannabis to treat certain specified conditions Registered two manufacturers by 12/1 Development of a patient registryPublished review of medical Cannabis studiesAdopted administrative rules

Rural Health, Workforce, & Vulnerable Adults Planning to help ensure rural Minnesotans have access to care Assuring adequate health/health care workforce Assurance that abuse or neglect in nursing homes, hospitals and other care facilities will be corrected

Health Economics Trends in health care costs and economic indicators Health care cost is MN privately insured spending on health care services per person, and does not include enrollee out of pocket spending for deductibles, copayments/coinsurance, and services not covered by insurance. Sources: Health care cost data from Minnesota Department of Health, Health Economics Program; per capita personal income from U.S. Department of Commerce, Bureau of Economic Analysis; inflation data from U.S. Bureau of Labor Statistics (consumer price index); workers ’ wages from MN Department of Employment and Economic Development

Health Care Homes & State Innovation Model Health reforms to: Reward value, not volume of services (Health Care Homes) Care coordination Quality incentive payments Create transparency of quality and cost (State Innovation Model)Quality measurement and reportingAll Payer Claims Database

Health Promotion and Chronic Disease Alcohol Diet/Physical Activity Microbial Agents Toxic Agents Firearms Attributable Causes of Death

Statewide Health Improvement Program (SHIP) Locally-controlled, research-based strategies include: • “Farm to School” - kids get healthy produce while benefiting local farmers • Support employers with comprehensive workplace wellness (ROI up to 6:1)• “Complete Streets” - sidewalks and crosswalks for to physical activity• Healthier eating and physical activity in childcare settings• Colleges and apartment buildings going tobacco-free

SHIP – Washington County Improving Water Access in Forest Lake Schools 3,100 Forest Lake-area students will have access to water bottle filling stations in schools.Water access based on Alliance for a Healthier Generation’s assessment and planning toolIncreasing student access to water proved to be an early and quick strategic success for the District.

SHIP – Goodhue County Safe Biking in Zumbrota Zumbrota Bikeabout used a 90-minute ride to determine safety & improvement needs in the community Discussion of findings at 11/14 Park Board will be used for Zumbrota Master Bicycle Plan

SHIP – Olmsted County Tobacco-free housing County spent 2+ years developing Smoke-Free Multi-Housing policy and passed a smoke-free grounds policyImproves quality of life for seniors, children, minority community and those in poverty300 affordable housing units will now smoke free effective May 1, 2015

Community & Family Health An immunization program for preventable diseases WIC Services providing access to nutritious food. Pneumococcal Vaccine Licensed

Source: mncompass.org Advancing Health Equity 50 years of growing diversity

The Center for Health Equity A focus on Health Equity

Vital Records and Mortuary Science Birth and death certificates Assurance that the dead are disposed of safely

MDH Budget

How the General Fund Budget is Spent

Staffing Base FY 2016-17 MDH Staffing Levels Total FTEs: 1,309General Fund FTEs: 128 (9.8%)

Largest Sources of Federal Funding2016-17 Federal Agency Amount US Department of Agriculture (WIC) $240 million Centers for Disease Control (CDC) $119 million Centers for Medicare and Medicaid Services (CMS) $41 million Health Resources and Services Administration (HRSA) $38 million Department of Health and Human Services (other)$34 millionEnvironmental Protection Agency (EPA)$20 million

MDH Sections Most Reliant on Federal Funds Section % of Funding from Federal Sources Office of Emergency Preparedness 98% Infectious Disease Epidemiology Prevention and Control 85% Community and Family Health 81% Health Promotion and Chronic Disease 63%

“ Public health is what we, as a society, do collectively to assure the conditions in which (all) people can be healthy.” -Institute of Medicine (1988),   Future of Public Health Edward P. Ehlinger, MD, MSPH Commissioner, MDH P.O. Box 64975 St. Paul, MN 55164-0975 Ed.ehlinger@state.mn.us