Local Health Departments Key to Stopping Spread of COVID-19
This Medical Care Blog post was written by Associate Professor Jie Chen, Lecturer Priscilla Novak and doctoral students Ivy Benjenk and Deanna Barath in the Department of Health Policy and Management. It will be published on Thursday, March 26.
The rapid emergence of COVID-19 reminds us of the importance of the public health system and the central role of local health departments (LHDs) in preparedness and response. Effective epidemic response rests on the performance of the essential public health activities—assessment, policy development, and assurance—by LHDs.
Evidence suggests that LHDs are effective in improving population health, reducing substance use-related and suicide-related emergency department utilization, avoidable hospital admissions, readmissions, costs, and preventable deaths. Our publication (Chen et al. 2018, Medical Care) demonstrated that LHDs are particularly critical to coordinate and provide tailored care and promote health equity. However, the funding to finance LHDs constitutes only about 3% of total healthcare costs in the US. For LHDs to be adequately positioned to promote population health and respond to epidemics, we see three urgent areas for action.
We suggest that in order to improve population health in the long term, there must be increased financial support for LHDs. The National Association of City and County Health Officials Survey (2016) showed that 93% of surveyed LHDs performed epidemiological surveillance activities, yet 22% of the LHDs reported that their budget was reduced compared to the prior year and anticipated cuts in the upcoming year. While the recent stimulus package enables the emergency transfer of funds to states and municipalities for COVID-19 activities, such funding does not provide the programmatic goal of better population health. Longer-term systemic changes are needed to ensure that LHDs can provide the maximum benefit to the communities they serve, by accelerating the integration of local public health and social services agencies with hospitals and health systems to deliver whole-person care.
Second, it is urgent to strengthen care coordination to promote the integration of LHDs with the medical care system under ongoing policy reforms, such as the implementation of Accountable Care Organizations, pay-for-performance, and requirements that non-profit hospitals demonstrate a community benefit. Our prior research suggests that LHDs care coordination and wellness promotion activities can make a meaningful improvement in population-level health.
Third, for LHDs to integrate service delivery alongside medical providers, they will need to catch up with hospitals on the use of information technologies. Health IT has been designed around the needs of the medical model of care, and significant effort is needed to enable real-time population health monitoring and reporting. Information technologies for LHD need to be standards-based (e.g., FHIR), in order to enable the transfer of data, but also provide a workflow that is responsive to the needs of public health practitioners.
COVID-19 has elevated preparedness and response on the policy agenda. LHDs have the lead role in responding to COVID-19 by communicating with the public about the risk of COVID-19, providing linkages between public health laboratories, hospitals, and health systems and the Centers for Disease Control. Now is the time to act to ensure that LHDs have adequate means and technologies to respond to emerging threats, both to COVID-19 as well as novel epidemics that are yet to come.