Vector Control Att F

A d V A N c E m E N t o f t H E PraCtICE

 D I r E C t F r o M C D C e n v I r o n m e n t A L h e A Lt h S e r v I c e S B r A n c h

Public Health Performance
Management: Opportunities for
Environmental Public Health
Lcdr

Justin Gerding,

mPh, rehS

Julianne Price,
rS

e d i t o r ’s n o t e : NEHA strives to provide up-to-date and relevant
information on environmental health and to build partnerships in the
profession. In pursuit of these goals, we feature a column from the
Environmental Health Services Branch (EHSB) of the Centers for Disease
Control and Prevention (CDC) in every issue of the Journal.
In this column, EHSB and guest authors from across CDC will highlight a
variety of concerns, opportunities, challenges, and successes that we all share
in environmental public health. EHSB’s objective is to strengthen the role of
state, local, and national environmental health programs and professionals
to anticipate, identify, and respond to adverse environmental exposures and
the consequences of these exposures for human health. The services being
developed through EHSB include access to topical, relevant, and scientific
information; consultation; and assistance to environmental health specialists,
sanitarians, and environmental health professionals and practitioners.
The conclusions in this article are those of the author(s) and do not
necessarily represent the views of the CDC.
LCDR Justin Gerding is an environmental health officer in the CDC Envi­
ronmental Health Services Branch. Julianne Price is the Florida Department
of Health’s Statewide Protocol for Assessing Community Excellence in Envi­
ronmental Health (PACE EH) coordinator and an environmental specialist
at the Indian River County Department’s Division of Environmental Health.

T

oday, profound changes are occur­
ring in public health. Many of those
changes are driven by the demand
for greater efficiency and effectiveness. In
response, opportunities are arising to help
meet this demand. For example, the Af­
fordable Care Act of 2010 includes among
many other provisions the Prevention and
Public Health Fund. That fund supports the
National Public Health Improvement Initia-

30

Volume 74 • Number 8

tive (NPHII) with the objective to ensure
public health goals are met efficiently and
effectively. During its first year, the NPHII
helped build health department capacity
in performance management by providing
$42.5 million to 76 state, tribal, local, and
territorial health departments (Centers for
Disease Control and Prevention [CDC],
2010). In addition, surveys by the Associa­
tion of State and Territorial Health Officials

(ASTHO, 2011) and the National Asso­
ciation of County and City Health Officials
(NACCHO, 2010) indicate that performance
management and quality improvement are
priorities for a large number of state and
local health agencies. Environmental pub­
lic health programs are an important part
of those performance and quality improve­
ment goals. Environmental public health
programs can contribute to and benefit from
collaborations within agency-wide public
health improvement efforts.
One important way environmental public
health departments can assess and improve
their own programs or systems is by using
the Environmental Public Health Perfor­
mance Standards (EnvPHPS). The EnvPHPS
provides a set of standards that describes
optimal performance and capacity with
which environmental public health programs
and systems can fulfill the 10 Essential
Environmental Public Health Services (see
sidebar). The EnvPHPS allow for in-depth
analysis of services and reveal areas for
quality improvement (CDC, 2011). In this
way, the EnvPHPS can be utilized to increase
the efficiency and effectiveness of environ­
mental public health services. A real-world
example can best show how the EnvPHPS
can help initiate performance management
and quality improvement activities in locallevel environmental public health.

Performance Management and
Quality Improvement in Indian
River County
In July 2011, the Indian River County
Health Department, Environmental Health
Department (IRCHD EHD) in Vero Beach,
Reprinted with permission from NEHA

Florida, began its own performance manage­
ment and quality improvement process.
The process included five other Florida
local environmental public health depart­
ments that facilitated EnvPHPS assessments
for their respective environmental health
systems. The assessments involved a wide
range of participants from both public and
private agencies and from specific areas
such as environmental quality, laboratories,
and civic organizations. Florida Depart­
ment of Health NPHII funds supported
the EnvPHPS assessments. Because of
environmental health staff involvement
in collaborative planning, a portion of the
state’s funds was utilized to support options
for environmental health–focused quality
improvement activities through use of the
EnvPHPS or the Protocol for Assessing
Community Excellence in Environmental
Health (PACE EH).
IRCHD EHD chose to conduct an
EnvPHPS assessment because it allowed a
systems-based approach that considered
the public and private entities, individuals,
and associations that contribute to the
delivery of environmental public health
services. The assessment results revealed
that among the 10 Essential Environmental
Public Health Services, the most significant
gaps were in #9: evaluate effectiveness,
accessibility, and quality of personal and
population-based environmental public
health services and #10: research for
new insights and innovative solutions to
environmental public health problems.
Following gap analysis, IRCHD EHD devel­
oped an action plan that identified specific
areas for improvement. Here are several
areas in which IRCHD EHD plans to imple­
ment quality improvement projects:
• coordinate data sharing among agencies
with program overlap,
• develop relationships with higher learning
and research institutions,
• share research findings from studies to
which the department contributed, and
• foster increased collaboration of partners and
understanding of roles and responsibilities.
The EnvPHPS assessment gave IRCHD
EHD the opportunity to evaluate the quality
of its services against national standards. It
also provided a starting point for discussing
service gaps and necessary improve­
ments. IRCHD EHD will now use quality
Reprinted with permission from NEHA

10 essential environmental Public health services
1. Monitor environmental and health
status to identify and solve community environmental public health
problems.
2. diagnose and investigate environmental public health problems and
health hazards in the community.
3. inform, educate, and empower
people about environmental public
health issues.
4. Mobilize community partnerships
and actions to identify and solve
environmental health problems.
5. develop policies and plans that
support individual and community
environmental public health efforts.

improvement frameworks to develop and
implement projects that improve program
and service quality, build capacity, and
increase effectiveness and efficiency. Addi­
tionally, the EnvPHPS assessment and
quality improvement activities produced
benefits beyond simply identifying gaps.
The EnvPHPS helped to build relationships
and unite environmental public health
system stakeholders and partners. Cheryl
Dunn, IRCHD EHD manager, stated, “I was
surprised by the assessment results that
blew away my idea of how environmental
health staff and other community part­
ners perceived our system. Therefore, the
assessment opened an avenue for discus­
sion, education, and quality improvement.”
As performance management in public
health continues to gain momentum, more
opportunities for environmental public
health will arise. These opportunities provide
openings to improve public health systems,
environmental public health services, and
ultimately community health status. Visit
www.cdc.gov/nceh/ehs/envphps/ for more
information about the EnvPHPS and quality
improvement, including a new tool kit to
help programs prepare for, conduct, and
follow up on an EnvPHPS assessment.

6. enforce laws and regulations that
protect environmental public health
and ensure safety.
7. Link people to needed environmental
public health services and assure
the provision of environmental public
health services when otherwise unavailable.
8. Assure a competent environmental
public health workforce.
9. evaluate effectiveness, accessibility,
and quality of personal and population-based environmental public
health services.
10. research for new insights and
innovative solutions to environmental
public health problems.

Corresponding Author: LCDR Justin Gerding,
Environmental Health Officer, Environmental
Health Services Branch, Division of Emer­
gency and Environmental Health Services,
National Center for Environmental Health,
CDC, 4770 Buford Highway, N.E., M.S. F-60,
Atlanta, GA 30341. E-mail: [email protected].

References
Association of State and Territorial Health
Officials. (2011). Profile of state public
health (vol. 2). Retrieved from http://www.
astho.org/uploadedFiles/_Publications/
Files/Survey_Research/ASTHO_State_
Profiles_Single%5B1%5D%20lo%20res.pdf
Centers for Disease Control and Prevention.
(2010). National public health improve­
ment initiative factsheet. Retrieved from
http://www.cdc.gov/stltpublichealth/docs/
NPHII%20Fact%20Sheet_NM.pdf
Centers for Disease Control and Prevention.
(2011). Environmental public health perfor­
mance standards: Improving service in
communities factsheet. Retrieved from http://
www.cdc.gov/nceh/ehs/Docs/Factsheets/
EnvPHPerformanceStandards_factsheet.pdf
National Association of County and City
Health Officials. (2010). 2010 national
profile of local health departments. Retrieved
from http://www.naccho.org/topics/infra­
structure/profile/resources/2010report/
index.cfm

April 2012 • Journal of Environmental Health

31