Hoosiers Realize Quality Improvements from Use of the National Public Health Performance Standards


Communities with fewer dollars are scrambling to help even more people.

Communities around the country are hurting. Unemployment, rising medical costs, the deterioration in housing values, and a surge in crime are pulling at the very fabric of community life. While lawmakers are busy evaluating where to make cuts in services in order to balance state and local budgets, communities with fewer dollars are scrambling to help even more people.

Health officials in Indiana have taken a different—and more successful—approach to doing more with less in a time of economic stress. Using a set of assessment “instruments” designed by the National Public Health Performance Standards Program (NPHPSP), the Indiana State Department of Health has been working to steer locally-based collaborative community assessment, strategic planning, and implementation of services to improve the health of vulnerable communities.

The department has leveraged the razor-sharp focus of these instruments to assess the condition and responsiveness of the Indiana public health system—as well as some 40 local public health systems—and to answer the critical questions “Are we doing the right things?” and “How can we improve our performance?”

The NPHPSP instruments aid health officials in bringing together disparate community groups to address problems that negatively affect public health. This process, though not easy or without conflict, facilitates the development of a common mission and objectives. If successful, the effort results in the realignment of community resources for a singular purpose.  

Since the NPHPSP launch in 2002, 35 states have participated in this process. Indiana has been a leader, forging ahead to identify areas of need and to improve public health, one community at a time.

So far in Indiana, 40 county health departments each have established partnerships with 15 to 20 grassroots organizations—including civic groups, schools, local businesses and industries, transportation entities, health providers, gyms, grocers, churches, and charities. The process—which involves comprehensive data gathering and analysis, monthly meetings, work force development—helps each partnering organization recognize and appreciate its role in the scheme of the public health system.

And it’s working. The counties are making tangible progress in improving the quality of public health, and are becoming local leaders in efforts to draw attention to areas of need, and to find financial and legislative resources to address those needs.

After three years, this initiative has resulted in the creation of the Indiana Public Health System Quality Improvement Program (PHSQIP), which pursues a statewide mission to protect the public and improve the health of local communities. The new program’s mission is already being confirmed in numerous ways in counties across the state.

Dubois County—“Ours is a county of German ethnicity where people believe in pulling themselves up by their bootstraps,” says Donna Oeding of the Dubois County Indiana Health Department. “It took time for some to realize they may need the help of others.”  Dubois, with 41,000 residents, is located in the southwestern part of the state, and is served by a single hospital that also serves residents from six other nearby counties.

An NPHPSP assessment on the birthrate and health of newborns in Dubois over the past few years indicated a preponderance of mothers-to-be opting to deliver their babies in the 34th or 35th week of gestation by Caesarean section, to meet personal or job-related schedules. Out of the NPHPSP assessment grew a “Healthy Baby” educational program that health officials hope will encourage mothers-to-be to abandon elective Caesareans and opt instead for healthier, full-term births.

In another instance, a local Dubois industry – a county health department partner – provided proof that its biggest employee-related expense was underwriting the cost of mental health prescription medications. To help solve that problem, money was allocated to hire a mental health physician so Dubois residents have a real doctor to turn to for diagnosis and treatment, rather than medicating their worries away.

 Delaware County—Up in the mid-eastern county of Delaware, population 114,000, local public health partners recognized the importance of the assessment process as they evaluated what county health department spokesman Robert Jones calls “troubling aspect of childhood obesity, and its growing significance on the population as a whole.”


“It gets worse as time moves on and too challenging to make changes with adults,” Jones says, “But children are more apt to be open to change.” As a result of the assessment, the county so far has dedicated some $30,000 in grant money to innovative exercise programs for children—including runs, walk-a-thons, tai chi and yoga classes, swimming and healthy eating activities, as well as basketball and hula hoop contests, to name a few. Thanks to this effort—dubbed “Healthy Living, Take Charge!”—nearly 4,000 kids have gotten off their collective butts over the last two years and joined in the fun. “We still have a long way to go,” says Jones, “but at least the youth are paying attention.”

Allen County—An extraordinary example of how cross-communication among partners produced a positive outcome and policy change occurred in northeastern Allen County, home to 350,000 residents, and to Ft. Wayne, the county seat. The county also is home to many Burmese émigrés who arrived in the area in 2006, when the State Department and the Government of Thailand helped thousands of refugees escape the repressive Burmese military dictatorship.

Part of the area’s rich heritage is the St. Joseph Community Health Foundation, a partner with the Ft. Wayne/Allen County Health Department. It was to the Foundation’s Community Resource Center that the new Burmese residents first came to get much-needed vaccinations and to learn to navigate the community health care system. The Center also provided English as a Second Language instruction and job training.

The new émigrés also underwent a battery of health screenings. Everything seemed fine until the youngest among them, pre-school-age children, began exhibiting symptoms of ill health. Teachers and public health nurses were the first to notice that their charges, healthy as colts when they arrived in 2006, were becoming sick. Now four-year-olds began presenting developmental delays, tummy aches, headaches and irritability—all symptoms of lead or arsenic poisoning.

The public health department conducted research and canvassed door-to-door, taking samplings of foodstuffs and other items to which the children might be exposed. The culprit, as it turns out, was from the old country. Parents and caregivers were homeopathically treating constipation by administering a native digestive powder known as Daw Tway or Daw Kyin, which was delivering 200 times the acceptable level of lead to the children, and as much as 23,000 ppm of arsenic.

Screening of 119 of the Burmese youngsters confirmed that 14 suffered from increased anemia rates and either lead or arsenic poisoning. Word of the poisonings spread like wildfire, and the product was taken off local store shelves. News of the dangerous discovery even made it back to Burma, where the military-led State Peace and Development Council banned the manufacture and use of the digestive in that country.

Aiming high for future quality improvements in public health care delivery, Allen County now has hired the Bowen Research Center of Indianapolis to help health officials and partners create a comprehensive workforce development campaign, as well as a strategic plan that can lead to accreditation of the county’s Department of Health—and the subsequent recognition that comes with standard-bearing accomplishments.

On the heels of these successes, an additional 20 Indiana counties are scheduled to take up the NPHPSP assessment challenge in October 2010.


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