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HomeMy WebLinkAboutCommunity Health Board - 2023.2.10 Board Packet Supporting Documents - 02/10/2023Minnesota’s local public health system works to protect, promote and improve the health of all Minnesotans. This system consists of approximately 70 local public health departments, which are organized as 51 community health boards (CHBs). CHBs are the legally recognized governing bodies for local public health in Minnesota. A CHB may be a single county or city health department, or multiple local health departments working together. CHBs are mandated by state statute (Minn. Stat. §145A) to perform core public health services, which are funded by a combination of local, state and federal dollars. Local public health departments partner with other government agencies and community organizations such as schools, law enforcement, social services, nonprofits and health care providers to coordinate high quality, collaborative public health programs that fulfill state mandates and address local health priorities. Core Services Mandated by the Local Public Health Act (MN Stat. §145A) 1. Assure an adequate public health infrastructure e.g., Assess health priorities with community input; develop community health improvement plans to address identified needs and monitor progress. 2. Promote healthy communities and healthy behaviors e.g., Track data trends (leading causes of death, birth outcomes); implement health promotion strategies based on community needs and priorities. 3. Prevent the spread of infectious disease e.g., Monitor immunization levels and perform outreach to high-risk groups; run immunization clinics; investigate outbreaks and conduct contact interviews with individuals exposed. 4. Protect against environmental health hazards e.g., Implement Childhood Blood Lead Case Management Guidelines; abate public health nuisances; monitor food and water illness data. (Note: Some local agencies also have delegation agreements with state agencies for licensing, inspecting and enforcement of food, pools and lodging establishments, the Safe Drinking Water Act, and/or the MN Clean Indoor Air Act.) 5. Prepare for and respond to disasters, and assist communities in recovery e.g., Develop and maintain response plans to address needs during disasters and emergencies (infectious disease threats like COVID-19 or TB, natural disasters, terrorist attacks); enforce emergency health orders. 6. Assure the quality and accessibility of health services. e.g., Identify barriers to health care service and gaps in service; implement strategies to increase access to health care. An Overview of Minnesota’s Local Public Health System Structure, Mandates & Funding Funding for Local Public Health Local tax levies are the single largest source of local public health funding, accounting for 35.7% of all expenses. In total, more than half (51%) of expenses are locally-generated. Federal funds contribute the next largest share (34%), while state funds make up just 15%. Compared to the nation as a whole, Minnesota’s local public health departments rely more heavily on local funding.1 The Local Public Health Grant is the state’s main investment in our local public health system, yet it accounts for just 6.2% of funding and has decreased as a percentage of expenditures over time, placing a greater burden on local tax levies to meet core, state mandate services and emerging community needs. The Local Public Health Grant and local tax levies are two sources of flexible funding for local public health departments. Flexible funding is crucial to our local public health system, as many state mandates and core public health services are not well supported by categorical grants. It allows local governments to direct dollars where they are needed most to better address the diverse needs and local public health priorities of Minnesota communities. However, despite significant investments at the local level, the proportion of flexible funding in the system has decreased by more than 50% since 1979. A statewide increase to the Local Public Health Grant is needed to restore local capacity to meet state mandates, address emerging priorities and relieve local tax levies. Public Health’s Return on Investment • Every 10% increase in public health system spending results in a 7% decrease in infant mortality and a 3% decrease in heart disease mortality.2 • In Minnesota, investing $10 per person per year in proven community-based programs to increase physical activity, improve nutrition and prevent tobacco use could produce annual net savings of $316 million per year.3 • Increases in local health department (LHD) spending per capita are associated with a 7% decrease in infectious disease mortality and a 6.6% decrease in cardiovascular disease (CVD) mortality, which suggests regions served by LHD’s with more funding have fewer infectious disease and CVD deaths.4 • A 2017 study found a 10% increase in local public health spending per capita was associated with a 0.8% reduction in adjusted Medicare expenditures per person after one year and a 1.1% reduction after five years.5 About the Local Public Health Association of Minnesota The Local Public Health Association of Minnesota (LPHA) is a voluntary, non-profit organization that works to achieve a strong local public health system through leadership and collective advocacy on behalf of Minnesota’s county, city and tribal local public health departments. The Association represents more than 230 public health directors, supervisors and community health services administrators throughout the state. LPHA is an affiliate of the Association of Minnesota Counties. For more information, please contact: Kari Oldfield, Director | koldfield@mncounties.org or (651) 789-4354 1 National Association of County and City Health Officials, 2016 National Profile of Local Health Departments (MN % local funding to national average: 49% to 30%, MN State funding to national state funding average: 15% to 21%, MN Federal funding to national federal funding average: 36% to 36%, other sources of national CHB funding average: 13%) 2Mays, GP, and Smith, SA, “Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths,” Health Affairs, doi:10.1377/hlthaff.2011.0196, 2011 3 Trust for America’s Health, “Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities,” February 2009 4 Erwin, PC, et al., “The Association of Changes in Local Health Department Resources with Changes in State-Level Health Outcomes,” Am J Public Health, April 2011 5 Public Health Spending and Medicare Resource Use: A Longitudinal Analysis Of U.s. Communities, Glen Mays-Cezar Mamaril - https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.12785 Updated: 1/28/2021 Locally- generated funds 51% Federal funds 34% State funds 15% MINNESOTA COMMUNITY HEALTH BOARD FUNDING, 2018 About SCHSAC https://www.health.state.mn.us/communities/practice/schsac/about.html The State Community Health Services Advisory Committee, or SCHSAC, advises the health commissioner and provides guidance on the development, maintenance, financing, and evaluation of community health services in Minnesota. Membership consists of one representative from each of Minnesota's 51 community health boards. Members meet quarterly with the health commissioner to discuss public health issues of mutual interest, and in workgroups between SCHSAC meetings to address and respond to critical public health issues. At a glance The State Community Health Services Advisory Committee (SCHSAC, pronounced like "shack") was created by the Minnesota Legislature in 1976 as a component of the Local Public Health Act. The purpose of SCHSAC, as described in the Local Public Health Act, is to advise, consult with, and make recommendations to the Commissioner of Health on matters relating to the development, funding, and evaluation of community health services in Minnesota. SCHSAC meets four times per year; an Executive Committee meets more frequently: • Agendas and other materials are made available prior to meetings. • At this time, meetings are held virtually. • The commissioner of health and MDH Executive Office staff attend meetings whenever possible. • Members are reimbursed for travel and parking; lunches are provided at in-person meetings. • SCHSAC develops and annual work plan to focus activities; much of the work plan is accomplished through smaller workgroups. SCHSAC workgroups engage in problem solving and policy development and submits recommendations to health commissioner. Recommendations are adopted by community health boards, implemented statewide through guidelines, used as basis for developing local and state policy. • Minnesota public health leaders support and sustain SCHSAC through commitment and active participation. • SCHSAC informs policy development, strengthens state-local relationships and communication, and builds support for public health. • Member local elected officials and public health directors and administrators embody the state's commitment to protecting, maintaining, and improving health of all Minnesotans. Membership and meetings SCHSAC is comprised of one representative from each community health board in Minnesota. Members are largely local elected officials and local public health directors/ administrators. The main body of SCHSAC meets quarterly with the commissioner of health. Each community health board selects one person to represent their board on SCHSAC, and one alternate. The 11-member SCHSAC Executive Committee consists of representatives from all regions of the state. SCHSAC conducts a majority of its work through workgroups and subcommittees, which meet between SCHSAC's main quarterly meetings. Each workgroup usually meets for one to three years, depending on its charge and duties. These workgroups identify, discuss, recommend responses to critical public health issues, and consist of SCHSAC members and other subject matter experts. Each fall, SCHSAC sponsors the Community Health Conference for local elected officials; local and tribal public health administrators, directors, and staff; community-based organizational leadership and staff; MDH leadership and staff; other public health professionals. Responsibilities of members and alternates Members and alternates are expected: • To attend SCHSAC meetings and other assigned meetings • To serve on workgroups, subcommittees, and review groups as requested by the chair • To prepare for active participation in discussion and decision-making by consulting with their community health boards and community health services staff, and by reviewing meeting materials • To act as the liaison between the community health board and SCHSAC • To inform the community health board and alternate member on SCHSAC activities and actions 1 Original version adopted 2014 Revised: 2020, 2022 BYLAWS OF Partnership4Health Community Health Board Article I Name/Purpose Section 1: The name of the Community Health Board shall be Partnership4Health Community Health Board (P4HCHB), as established in the Joint Powers Agreement between the Counties of Becker, Clay, Otter Tail, and Wilkin to establish a joint entity Community Health Board. Section 2: Partnership4Health is organized for the purpose of providing public health services pursuant to Minnesota Statute 145A, and the foundation for a strong local public health system to meet the challenges of the future. As outlined in the National Association of Local Boards of Health, the six functions of public health governance are: 1. Policy Development: to lead and contribute to the development of policies that protect, promote, and improve public health while ensuring that the CHB and its joint participants remain consistent with the laws and rules to which it is subject. 2. Resource Stewardship: to assure the availability of adequate legal, financial, human, technological, and material resources to perform essential public health services. 3. Legal Authority: to exercise legal authority as applicable by law and understand the roles, responsibilities, obligations, and functions of the governing body, health officer, and contracted agents/staff 4. Partner Engagement: to build and strengthen community partnerships through education and engagement to ensure the collaboration of all relevant stakeholders in promoting and protecting the community’s health. 5. Continuous Improvement: to routinely evaluate, monitor, and set measurable outcomes for improving community health status and the public health departments/governing body’s own ability to meet its responsibilities. 6. Oversight: to assume ultimate responsibility for public health performance in the community by providing necessary leadership and guidance in order to support the public health departments in achieving measurable outcomes. Section 3: The CHB parties agree to abide by the terms and conditions of the Joint Powers Agreement, bylaws, policies, delegation agreements, and procedures adopted by the CHB. Article II Membership Section 1: The CHB shall be governed by a six-member board made up of the following: 2 Original version adopted 2014 Revised: 2020, 2022 1. One County Commissioner and one alternate shall be appointed from each of the four represented counties. 2. Two At Large community members may be recommended by the respective Public Health Director(s) and be appointed by the respective county boards of the Joint Participants. At large community members must be from two separate representative counties. Section 2: The appointment of all members to the CHB shall be by the respective appointing authority and shall be made by January 31st of each year. Section 3: Terms for the County Commissioners on the CHB shall be for one year with no term limits. Term for At Large community members shall be a three-year term and rotated among the 4 counties. Alternate terms for the two at large community members will allow for consistent guidance and leadership. Section 4: County Commissioner Board members shall receive per diem allowance and travel allowance through their respective appointing entity. At large community member shall receive per diem allowance and travel allowance as the Community Health Board may determine and which is consistent with Minnesota law. Article III Officers/Decision-making Section 1: There shall be a chairperson and a vice-chairperson each of whom shall be elected annually at the last meeting of the calendar year. Section 2: The chairperson shall preside at all Community Health Board meetings. The chair shall be responsible for representing official positions and statements formulated by the CHB. The chair shall also perform all duties common to the office of chairperson and as the CHB may designate. Section 3: The Vice Chair shall assume the powers and duties of the chairperson during periods of his/her absence and shall perform such additional duties and functions as the CHB may direct. Section 4: The recording secretary shall be furnished appointed by the P4H directors. The recording secretary shall keep the minutes of the CHB meetings and shall attend to the delivery of notices and agenda for CHB meetings and perform such additional duties as the CHB may direct. 3 Original version adopted 2014 Revised: 2020, 2022 Section 5: Each Community Health Board member shall be entitled one (1) vote on the CHB. Votes shall be cast in person by the member or an alternate. Voting shall be by voice vote. A quorum shall consist of members representing three (3) counties. All CHB actions shall be determined by a simple majority of the votes cast at a meeting of the CHB. Section 6: Vacancies, due to resignation or other reasons, shall be filled by appointment of the county boards. Officer vacancies will be filled by election at the next scheduled meeting. Article IV General/Special/Annual Meetings Section 1: All meetings of the CHB shall be conducted in a manner consistent with the Minnesota Open Meeting Law Chapter 13 D. There shall be a minimum of two meetings per year on such dates and at such times and places as the CHB shall determine. The last meeting of the year will be the annual meeting with elections and appointments. Special meetings or emergency meetings under Chapter 13 D may be called by the chairperson or upon request of two (2) or more counties. Notice of regular meetings shall be provided to each CHB member at least seven (7) calendar days prior to the date of the meeting and posted in accordance with the open meeting law. Notices shall include an agenda. All proceedings of the CHB shall be open to the public unless appropriately closed pursuant to law. All votes taken of members of the CHB shall be recorded and shall become matters of public record. Section 2: The CHB shall assure public input on public health matters relating to the development, maintenance, funding and evaluation of community health services via community member representation on the CHB and staff participation on community coalitions and workgroups. Article V Agents Section 1: The CHB may appoint and authorize agents to act on the CHB’s behalf and bind the CHB for the following purposes: A. To serve as the CHB’s agents according to Minnesota Statutes 145A in communicating with the Commissioner of Health between Community Health Board meetings, including receiving information from the Commissioner and disseminating information to the Commissioner on the CHB’s behalf. B. To sign and submit to the Commissioner the established local public health priorities and the mechanism to address the priorities and achieve statewide 4 Original version adopted 2014 Revised: 2020, 2022 outcomes within the limits of available funding according to Minnesota Statutes. 145A. C. To sign and submit to the Commissioner the CHB’s annual budget, revisions to the budget, and expenditure reports submitted according to Minnesota Statutes. 145A. D. To sign and execute, on behalf of the CHB, contracts for funding under Grants Contracts administered by the Commissioner of Health or other entities as deemed appropriate by the CHB. E. To appoint one representative and one alternate to serve on the State Community Health Services Advisory Committee (SCHSAC). Article VI Administrative and Program Management Section 1: Administration and Legal Consultant: Prior to December 31st of each year, the Community Health Board shall appoint one of the Joint Participants to serve as the CHS Administration and Legal Consultant agency for the Community Health Board for the next calendar year. The duties and responsibilities of the Administration and Legal Consultant Agency, and the relevant county officials shall be set forth in a separate document between the Community Health Board and the Governing Board of the appointed agency. Section 2: Finance: Prior to December 31st of each year the Community Health Board shall appoint one of the Joint Participants to serve as the Fiscal Agent for the Community Health Board, in cooperation with its Auditor for the next calendar year. The duties and responsibilities of the Fiscal Agent, and the relevant county officials shall be set forth in a separate document between the Community Health Board and the Governing Board of the appointed agency. Section 3: Assessment and Planning: Prior to December 31st of each year, the Community Health Board shall appoint one of the Joint Participants to serve as the CHS Assessment and Planning Agency for the next calendar year. The duties and responsibilities of the CHS Assessment and Planning Agency shall be set forth in a separate document between the Community Health Board and the Governing Board of the appointed agency. Section 4: Performance Management: Prior to December 31st of each year the Community Health Board shall appoint one of the Joint Participants to serve as the CHS Performance Management Agency for the Community Health Board for the next calendar year. The duties and responsibilities of the CHS Performance Manager Agency shall be set forth in a separate 5 Original version adopted 2014 Revised: 2020, 2022 document between the Community Health Board and the Governing Board of the appointed agency. Article VII Records, Accounts, and Reports Section 1: The books and records, including minutes and the originally executed Agreements, of the CHB shall be subject to the provisions of Minn. Stat. Ch.13. They shall be maintained by the Administrative/Legal and the Fiscal Agents for the CHB. Section 2: The CHB will ensure strict accountability for all funds of the organization and will require reports on all receipts and disbursements made to, or on behalf of the CHB. All funds shall be accounted for according to generally accepted accounting principles and shall be subject to an annual audit by the State Auditor or auditor of choice. Section 3: An audit for the CHB will be completed in accordance with auditing procedures for the joint participant acting as the Fiscal Agent for the Board. Article VIII Budget and Accounting Services Section 1: Each public health department shall prepare and obtain approval of their respective budget and submit to the CHB Fiscal Agent. The budget preparation shall account for funding required as match for grants and projects; shared costs incurred for operation of the CHB or joint projects, and for the unique programs provided by the respective public health department. Section 2: In recognition of direct and indirect support services provided by each county for the cross-jurisdictional functions including administrative, accounting, auditing, legal services, community assessment, planning and performance management and administrative fee will be determined annually during the budget process. Section 3: The CHB shall obtain and maintain liability insurance and may obtain such other insurance it deems necessary. Section 4: The CHB will develop an annual budget, dependent upon budget reserves and/or anticipated continued grants, project funding, fees, contracts, and tax allocations. The budget may be modified as needed to meet the actual grant or funding amounts and requirements. Article IX 6 Original version adopted 2014 Revised: 2020, 2022 Bylaws Review & Amendment Section 1: These Bylaws will be reviewed yearly at the Annual meeting. Section 2: These Bylaws may be amended by a vote of the majority of the members of the CHB at any meeting of the CHB, provided that notice of such proposed amendments shall have been given in writing at least ten (10) days in advance to all members. The CHB shall forthwith notify the members of any and all amendments adopted.