Site Profile: Allegheny County Health Department
Population health is enjoying new prominence as a result of momentous shifts in how providers are reimbursed for providing care. But for public health practitioners the focus has always been on population health. This is true around the country and in Allegheny County, where the health department is poised to play a central role in enhancing the health system to bring measurable improvements in the health of the people of Allegheny County.
The Allegheny County Health Department was selected late this summer as one of the four initial sites for the Robert Wood Johnson
Current Standing: Allegheny County ranks 34 healthiest of 67 counties in Pennsylvania according to Health County Rankings.
Leader of the Initiative: Public health department
Collaborative: 70+ cross-sectoral partners
Potential Financing Mechanism Being Explored: Wellness Trust
Community Goals: Improvement in the identified priority areas
Allegheny County Health Department already laid some of the groundwork for this transformational venture with its Plan for a Healthier Allegheny (PHA).
“We are really excited that in Allegheny County the public health department is leading the charge and initiating change,” says Mary Ann Phillips, associate project director at Georgia Health Policy Center, the national coordinating center for Bridging for Health. “The Allegheny County Health Department already has the pieces in place—good relationships with the full complement of stakeholders. Dr. Karen Hacker, director of the public health department, brings experience bridging health care and public health and can bring all of the major players together to do something really innovative.”
The Timing Is Right for Public Health
One of the aims of the Affordable Care Act is to shift the focus of the health care system from treating illness to keeping people healthy. This has long been a central focus of public health and given this experience, public health has an opportunity to play a central role in reshaping the health system.
In addition to its wellness focus, public health also deeply understands how health is intertwined with social and environmental factors that affect communities. Given public health’s comprehensive view of the determinants of health, it is well positioned to bring together partners that historically have not worked with the traditional health system, including housing and education partners.
Allegheny County Has a Head Start
The Allegheny County Health Department undertook a significant community health planning effort in 2014 beginning with a community health assessment to gather a baseline measure of health status of the local population and to identify health-related needs and strengths of the county.
These efforts culminated with a community health improvement plan—Plan for a Healthier Allegheny—to determine major health priorities, overarching goals, and specific strategies that can be implemented in a coordinated way across Allegheny County. PHA is intended to serve as a vision for the health of the community and a framework for organizations to use in leveraging resources, engaging partners, and identifying their own priorities and strategies for community health improvement.
“Plan for a Healthier Allegheny is a living document that will help guide us toward our future goals,” says Hacker. “Success requires a collective approach that includes the continued commitment of our Advisory Coalition and broader countywide community participation. Our collaborative efforts will lead to greater and sustainable changes in public health.”
Priority Areas of Focus
Five priority areas for community health improvement were identified, in part from resident input. Each priority area has a series of objectives, metrics, and actionable strategies, which provide a roadmap for achievable health improvement. The priority areas include:
- Access: Improve access to health care services, insurance, and transportation
- Chronic Disease Health Risk Behaviors: Decrease preventable, chronic disease by addressing health risk behaviors including: obesity, poor nutrition, physical inactivity, smoking/tobacco use
- Environment: Reduce pollution and environmental hazards through a focus on air and water quality, as well as unconventional oil and gas production
- Maternal and Child Health: Reduce morbidity and mortality in women, infants, and children by focusing on asthma control, breastfeeding initiation, low birth weight, disparities in infant mortality, and improving parental support
- Mental Health and Substance Use Disorders: Cut mortality and morbidity associated with depression, drug, and alcohol use, in part, through integration of mental health into physical health services
Two overarching themes in the PHA—social determinants of health and health equity—were central to the Allegheny Health Department’s selection as a Bridging for Health site. The community health assessment found Allegheny County has both geographic and racial health disparities. The health department recognizes that health equity needs to be addressed and to do so effectively, the social determinants of health must be addressed across all five priority areas.
The Pieces of the Puzzle
Since the traditional health care delivery system does not historically address social determinants of health, more players outside of typical clinical care providers need to participate. The Allegheny County Health Department already established a cross-sectoral Advisory Coalition that brings together 70-plus foundations, government agencies, businesses, education providers, hospitals and health systems, non-profits, and community-based organizations. These stakeholders provided critical input for the planning of the comprehensive community health assessment and their participation will be equally paramount to implementing PHA.
Innovations in financing health system change are breaking new ground and will serve as a national role model for other communities exploring how to finance community health improvement. Allegheny County is one step ahead and has already built a coalition of foundations willing to jointly invest in the public health department infrastructure. The fund was used to support the community health assessment, an information technology assessment, and a behavioral risk survey. This experience of pooling multi-sources of funding for community benefit will inform the design and implementation of a financing mechanism designed to contribute directly to upstream factors affecting community health improvement.
As the national coordinating center for Bridging for Health, the Georgia Health Policy Center (GHPC) will provide technical assistance to the Allegheny County Health Department in designing financing mechanisms that improve outcomes, and rebalance and align investments in health. Additionally, GHPC will facilitate collaboration among stakeholders and aid in evaluating outcome success.