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HomeMy WebLinkAboutPresentation - #06CITY OF SANTA ANA FEASIBILITY AND FISCAL EVALUATION SERVICES FOR A MUNICIPAL PUBLIC HEALTH AGENCY INTERIM REPORT TO CITY COUNCIL FEBRUARY 15, 2022 Feasibility Analysis and Fiscal Evaluation Project Plan 2 Provide Framework and Options for the City’s Consideration Comparative Cost, Staffing, & Revenue Analysis (Pending) Evaluate How Public Health Department Advances City’s Priorities Reviewed and summarized mandated and statutory responsibilities Evaluate Community Conditions Identified significant trends Provide comparison to County data Understand and Assess City’s Priorities and Interests Interviewed City Council Members Mapped input Completed Tasks Pending Tasks Final Deliverable (partially complete) City Council members expressed commitment to supporting residents’ health needs and emphasized City’s unique value in understanding and meeting resident needs 3ASSETSCHALLENGESOPPORTUNITIESRISKS•Opportunity to tailor public health education messages to unique needs and context of Santa Ana residents •Provide more timely responses and with more nuanced approaches to Santa Ana resident needs •Improve /develop services and interventions that work for their residents, understanding the City’s unique population and needs •Ability to access and secure funds •Capacity to develop required infrastructure •Impact of public health department on other City priorities, budget and resources •Insufficient capacity to address underlying inequities •Recognition of the important role of public health education in improving health outcomes •Strong understanding of Santa Ana residents and how to effectively support their health needs •Demonstrated responsiveness during COVID-19 crisis •Commitment to informed decision making and an appreciation for a comprehensive and informed process •Shared goal of taking better care of the health and well-being of the residents of Santa Ana •Lack of knowledge of public health requirements and associated financial operational, policy requirements necessary to operate •Unclear whether having a municipal public health department would solve the underlying problems which lead to disparities and inequalities Understand and Assess City’s Priorities and Interests Community Conditions Assessment 4 Provide Framework and Options for the City’s Consideration Comparative Cost, Staffing, & Revenue Analysis (Pending) Evaluate How Public Health Department Advances City’s Priorities Evaluate Community Conditions Understand and Assess City’s Priorities and Interests Assessment Focused on Social Determinants of Health ✚Social determinants of health (SDOH) represent the conditions in the environments where people are born, live, work, play, worship and age that affect a wide range of health functioning and quality-of-life outcomes and risks ✚Examples of SDOH✚Healthy Behaviors –Rates of smoking, access to nutritious foods, physical activities✚Exposure to violence, racism, and discrimination✚Living Conditions –Safe housing, water, air✚Economic Conditions –Income, job opportunities, education ✚Significant research has been done linking the impact of SDOH to quality of life, health disparities, and life expectancies ✚These factors increased risk of exposure and severity of the most recent COVID experience 5Source: Healthy People, 202, US Department of HHS, Office of Disease Prevention and Health Promotion Community Assessment Key Findings ✚Multiple health disparities among people who reside in the City of Santa Ana ✚Historically, people of color experience greater obstacles in acquiring and maintaining health, wealth, and opportunity. City of Santa is minority majority locale, with predominantly Hispanic residents, and has the second largest population of foreign-born residents in the county. ✚Santa Ana residents have,on average, less education and lower income than the Orange County population in general.These differences are significant in comparison to other Orange County cities. ✚Santa Ana residents fare far worse than comparison cities in several health outcomes including rates of Type -2 Diabetes,Childhood Obesity and Maternal Health indicators such as pre-term birth rates and pregnancies among adolescents. ✚COVID-19 pandemic has exacerbated and highlighted these disparities. 6 Santa Ana COVID-19 Risks 7Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL ✚Orange County COVID-19 Vulnerability Map generates a risk score to illustrate how likely a population is to be affected by COVID-19✚Santa Ana produced some of the highest risk scores in the county (darker colors indicate higher risk scores) Orange County COVID Vulnerability Map 2020 https://www.advanceoc.com/orange-county-equity-map/#covid-affected-region Given population health conditions, communities in Santa Ana are at a greater risk of not only contracting COVID-19, but also experiencing severe symptoms and death. Statutory and Regulatory Analysis 8 Provide Framework and Options for the City’s Consideration Comparative Cost, Staffing, & Revenue Analysis (Pending) Evaluate How Public Health Department Advances City’s Priorities Evaluate Community Conditions Understand and Assess City’s Priorities and Interests Statutory and Regulatory Analysis 9Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL +How are public health functions organized in California? +What are the mandates of public health departments? +What are related public health regulations and funding streams? Key Questions per Scope of Work To what degree does a public health function advance the City’s priorities and interests? At what cost and impact? Overview of Public Health in California 10Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL Public health is organized and managed through State and local agencies +Responsibilities are delineated in California statue, primarily the Health and Safety Code and California Code of Regulations Title 17 +CA Department of Public Health has ultimate authority for interpretation regarding California’s public health laws +Range of responsibilities include monitoring, inspection, public education, crisis response Counties fulfill public health responsibilities for most jurisdictions +In Orange County, public health duties are embedded within Health Care Agency (HCA) +HCA has additional responsibilities for mental and behavioral health services, public guardian, and operation of some direct clinical services Santa Ana’s Health Interests 11Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL Health Care Services Delivery (Health & Mental Health Services) Public Health (Mandated & Discretionary Responsibilities) Health Promotion (Social Determinants of Health) How do Santa Ana’s interests align with California’s mandated public health responsibilities? Context for Public Health: Health Promotion 12Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL +Promoting healthy conditions in the environments where people live that affect a wide range of health functioning and quality-of-life outcomes +Examples include safe housing, transportation, exposure to violence, racism, and discrimination, access to education, job opportunities, nutritious foods, physical activities, and safe water and air +Overlaps with public health functions related to community education, promoting healthy lifestyles, housing inspections, and tobacco control Health Care Services Delivery (Health & Mental Health Services) Public Health (Mandated & Discretionary Responsibilities) Health Promotion (Social Determinants of Health) Context for Public Health: Health Care Services Delivery 13Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL +Delivery of physical and mental health services funded through public and private sources +Publicly funded health care services are provided through Medi-Cal (CA version of Medicaid) +In Orange County, the Medi-Cal delivery model is comprised of two primary entities: +CalOptima organizes physical health care +OC Health Care Agency organizes mental health and substance use disorder care +Public duties overlap in terms of promoting access, education and referral to health care services Health Care Services Delivery (Health & Mental Health Services) Public Health (Mandated & Discretionary Responsibilities) Health Promotion (Social Determinants of Health) Context for Public Health: Public Health Responsibilities 14Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL +Reduction and containment of diseases and health threats within the public domain +Within this scope are diverse and specific responsibilities for monitoring, reporting, and responding to disease threats, particularly communicable disease and taking actions to limit and mitigate the impact on the public +Reporting requirements are specified by format and time requirements +Inspection requirements specified by facility, conditions, and scope of review Health Care Services Delivery (Health & Mental Health Services) Public Health (Mandated & Discretionary Responsibilities) Health Promotion (Social Determinants of Health) Public Health Responsibilities: Four Domains 15Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL Health Assessment & Epidemiology (Reportable Conditions & Diseases) •Vital statistics (birth and death records) •Reportable disease conditions •Assessment of morbidity, mortality and health risks •All mandated responsibilities with specific reportable diseases, methods and timeframes •Subsidized by State funds Health Protection – Environment (Inspection & Investigation) •Inspection and investigation (food, vector, tattoo, recreational water, water, solid waste, jails, hazardous waste, hazardous materials) •Vector -borne disease •Lead poisoning, monitoring, and reporting •Specific inspections requirements by facility type and/or material •Mandated and discretionary responsibilities •Fees/State funding Health Prevention - Communicable Disease (Monitoring & Response) •Immunizations •Public health laboratory •Communicable disease control and investigation (including STDs and TB) •Communicable disease outbreak response •Mandated and discretionary responsibilities •Specialized staffing for public health labs •Fees/State funding Health Promotion – Maternal & Child Health (Public Education & Coordination) •Maternal child health •Public health education •Public health nursing •Tobacco prevention and control •Largely mandated responsibilities •State and grant funding •Discretion on the level of services provided See Appendix for detailed review of each domain including statutory provisions and potential funding sources Execution of Public Health responsibilities requires mobilizing a coordinated, simultaneous response 16 Scenario: A daycare center reports that multiple children have exhibited similar symptoms and suspect that it may be connected to a food borne illness Disease Investigation/ Epidemiology •Receive case reports •Investigate level of risk •Determine control measures •Explore whether any health officer orders are necessary Environmental Health •Assess food handling procedures and food access •Assess facility conditions Public Health Lab •Conduct/confirm testing •Identify strain of disease/strain-typing Public Health Nursing •Interview and index all contacts •Provide guidance to parents and facility workers Health Education •Alert the public, as appropriate •Provide proactive education, as appropriate Review of Public Health Responsibilities ✚City’s priorities align strongest with Public Health responsibilities in terms of Health Promotion including community education ✚Assuming this responsibility, requires City to assume additional complex responsibilities in terms of:✚Inspection✚Investigation✚Monitoring and Reporting✚Operations of a Public Health Lab ✚State is currently reviewing requirements for creation of municipal public health functions, and we anticipate that the State is unlikely to allow limited scope public health functions 17 Proposed Framework 18 Provide Framework and Options for the City’s Consideration Comparative Cost, Staffing, & Revenue Analysis (Pending) Evaluate How Public Health Department Advances City’s Priorities Evaluate Community Conditions Understand and Assess City’s Priorities and Interests Discussion of Assessment Framework and Options 19 What are the City’s priorities for public health? How does a Public Health Department advance City priorities? What is associated revenue, cost, and implementation? What are other options to advance the City’s priorities? Conduct peer and County and assess: Infrastructure and workforce requirements Revenue and funding for start-up and ongoing operations State process requirements What is associated revenue, cost, and implementation? Explore community- oriented health promotion models such as: Chief Health Strategist model Value -added or supplemental public health investments Next Steps ✚Receive direction from the City Council on further analysis ✚Complete analysis based on City Council direction ✚Prepare draft and final report 20 Appendix Detailed Analysis of Statutory & Regulatory Requirements 21 Community Assessment Data Sources ✚Collected and synthesized quantitative data from the latest public available sources including: California Department of Education –Physical Fitness Test California Department of Finance Projections California Department of Public Health and California Conference of Local Health Officers –2020 County Health Status Profiles California Employment Development Department (EDD) Labor report California Health Interview Survey (CHIS) Centers for Disease Control and Prevention (CDC) various databases Substance Abuse and Mental Illness (SAMHSA), National Survey on Drug Use and Health (NSDUH) The Orange County Equity Map (OC Equity Map) Orange County Health Care Agency Life Expectancy Report United States Census Bureau American Community Survey (ACS) 22Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL City of Santa Ana: Summary Profile ✚Santa Ana is second most populous City in OC and 13th in the State with a population of approximately 332,000 ✚Younger population than OC overall✚26% under 17 vs.OC at 22%✚Only 10% above 65 vs. OC at 15%✚Multi-generational families ✚More diverse population✚78% Hispanic vs. County at 34% 23 Social Determinants of Health: Healthy Behaviors 24Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL ✚In 2018, 49.4% of teens were overweight or obese and 28.4% of adults were obese* ✚Santa Ana school district has some of the highest rates of obesity in 5th and 9th graders in Orange County** ✚Obesity during childhood has a 70% likelihood of continuing into adulthood. This type of consistent weight gain from childhood to adulthood may increase individual’s risk for chronic diseases such as cardiovascular diseases and diabetes ✚In 2018, the prevalence of diabetes is significantly higher in Santa Ana (11.4%) than in Orange county (8.9%) and California (10.6%) *AskCHIS™ Neighborhood Edition retrieved from https://askchisne.ucla.edu/ask/_layouts/ne/dashboard.aspx#/ **California Department of Education retrieved from https://www.cde.ca.gov/ Obesity rates in Santa Ana are some of the highest in the county. Obesity has a high correlation to diabetes, which over time can lead to a variety of additional heart complications and decreases overall life expectancy. Social Determinants of Health: Economic Conditions 25Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL Data retrieved from OCHealthierTogether.org November 2021 Santa Ana fares lower than the County average on key socioeconomic indicators, particularly housing related costs and educational outcomes. Social Determinants of Health: Healthy Behaviors 26Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL Santa Ana’s rates of pre-term births and adults who are obese, who smoke, and who lack access to health insurance are at least 10% worse than Orange County. Data retrieved from OCHealthierTogether.org November 2021 Social Determinants of Health: Poverty & Social Progress ✚Overall, the City of Santa Ana has far more children living in poverty (26.6%) than Orange County (15.2%) and the State (19.5%) ✚Additionally, residents may have few opportunities for economic progress as measured by the Social Progress Index:✚Analyzes gaps and opportunities within neighborhoods by understanding the relationship between social progress and economic development. Composite score accounting for data around basic human needs, foundations of wellbeing / quality of life, and resources for upward opportunity✚Lighter colors (yellow and green) have lower calculated Social Progress Scores; Darker Colors (blue and purple) have higher calculated scores 27Source: https://www2.deloitte.com/global/en/pages/about-deloitte/articles/social-progress-index-results.html Orange County Santa Ana Santa Ana COVID-19 Risk/Vulnerabilities 28Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL Orange County COVID Vulnerability Map 2020 https://www.advanceoc.com/orange-county-equity-map/#covid-affected-region 38 of the most vulnerable Census Tracts in OC are within Santa Ana’s boundaries. Rates of COVID-19 in Santa Ana 29Copyright © 2021 Health Management Associates, Inc. All rights reserved. PROPRIETARY and CONFIDENTIAL Orange County COVID Vulnerability Map 2020 https://www.advanceoc.com/orange-county-equity-map/#covid-affected-region The City of Santa Ana had the highest concentration of COVID-19 cases in Orange County (as 12/1/21 –50,173 cases). Santa Ana had approximately 15% of the reported cases across the County, while representing only 10% of the County population.