Arnold School of Public Health

SOUTH CAROLINA TURNING POINT RECOMMENDATIONS

RECOMMENDATIONS

A.	Governmental public health agencies should focus on supporting local efforts to improve health by:
	Taking a leadership role when necessary and appropriate; Actively partnering with community groups, including non-profit organizations, businesses, the faith community, schools, local government, physicians and other health care providers, hospitals, community and neighborhood leaders, general community members, the media, and others in improving health; Providing community groups with assistance and information on health indicators and services, training, community mobilization, and staff support; and Regularly using different methods of gaining community feedback from a variety of individuals and community groups.
B.	Needs and priorities differ among communities. Governmental public health agencies should assist communities in evaluating their individual and overall needs and on setting priorities to meet identified needs.
C.	Governmental public health agencies should allow flexibility in service delivery, local involvement and control, collaboration and data dissemination, recognizing there may be legal, regulatory and resource restrictions.
D.	Representative groups reflective of the total community should be involved in decisions that affect them, such as health initiatives and environmental decision-making.
E.	The Department of Health and Environmental Control (DHEC) should link environmental and health staff and data. There should be a clear point of coordination for planning, information sharing, training, and follow-up with community inquiries.
F.	DHEC should continue transferring individual medical services to other private medical providers, retaining those services essential to protecting the public's health and not provided by the private sector. Analysis of financial impacts and access to care associated with this transition should be ongoing.
PROGRAMS AND SERVICES
A.	State and local public health efforts should promote healthy lifestyles for the entire population. Basic, positive prevention messages should be sent through many channels, emphasizing the following areas:
	physical activity; good nutrition; prevention and cessation of tobacco use; prevention of alcohol and other substance abuse; mental health; injury prevention and safety; preventive health education, screening and services; and violence prevention.
B.	State public and private leaders should develop a plan to address the health care needs of the uninsured and underinsured, with the goal of assuring coverage of care for all South Carolinians.
C.	Governmental public health agencies, the Department of Transportation, other linked governmental public health agencies, and others should support initiatives to develop statewide transportation options. These systems are part of the solution to problems of air quality, access to health care, isolation of the elderly, and transportation for employment. Support should also be given to local and regional efforts for pedestrian walks and bike trails.
D.	Governmental public health agencies and private health care providers should collaborate with consumers to prevent, identify, treat, and manage costly medical problems, such as HIV/AIDS, sexually transmitted diseases, tuberculosis, individuals diagnosed with alcohol and/or drugs and mental health problems (dually diagnosed), medically fragile children, and people with chronic diseases.
E.	Governmental public health agencies should work with other organizations, such as managed care organizations and insurance regulators, to assure quality of care in managed care plans.
F.	Public health organizations should establish an inclusive process for discussing health care issues in an ethical framework to improve public understanding of difficult health care problems and identify commonly supported solutions. This process should be developed and carried out in partnership with the state's universities, seminaries and other committees of professional health care organizations and institutions.
G.	Governmental public health agencies should ensure access to accurate, reliable, and timely population-based public health and environmental health laboratory services for all providers of public health services.
H.	Governmental public health agencies should work with others to expand efforts to educate policy makers, the construction industry, real estate developers, home owners, and the general public about issues related to the safe construction and maintenance of private wells and septic tanks and to identify opportunities for grants and other funding for community water and sewer needs.
I.	DHEC should:
	Issue more protective septic tank regulations. Local health departments routinely receive complaints related to failing septic tank systems, although most system failures go unreported. Require business and industrial applicants to complete a community impact assessment as part of the permit application process. Evidence of benefit to the immediate community should be considered. Require business and industrial permit applicants to show consistency with local planning and zoning requirements, similar to existing requirements in the Solid Waste Management Act. Provide early public notice and participation on environmental permit applications. Collaborate with other governmental and linked public health agencies to support early and effective public participation in local decisions that affect the community's health. Provide public notice of violations of health and environmental laws and regulations in language the public understands.
J.	The legislature should adopt laws giving DHEC the authority to deny permits based on the applicant's past environmental record or its record at other sites.
K.	The legislature should enact laws that aid in the cleanup and reuse of abandoned and or underused industrial or commercial sites where development is complicated by possible environmental contamination. DHEC should work with others to increase public participation in the decision-making process concerning these sites to ensure that future use is consistent with community wishes.
L.	In partnership with business and industry, DHEC, local governments, and other public service providers should continue to emphasize pollution prevention as the preferred environmental strategy for business and industry in South Carolina and to encourage innovative approaches to promote pollution prevention and waste reduction.
M.	DHEC should continue to work with others to minimize water pollution from surface runoff from sources like farms, urban areas, forestry, construction and mining. This runoff, called "nonpoint source pollution," is the largest contributor to pollutants entering South Carolina's surface waters.
N.	State public policy should support private and local efforts to increase the use of Purchase of Development Rights for preserving "green spaces" and other environmentally sensitive areas.
O.	Public health organizations should review model state "Smart Growth" legislation and examine the feasibility of similar laws for South Carolina. "Smart Growth" laws recognize the connections among development, quality of life, and healthy communities.
P.	Public policy should prevent negative health and environmental effects of population growth and housing and industrial development on quality of life in South Carolina.
HUMAN RESOURCES:
A.	Governmental public health agencies should collaborate in training their employees in those areas of knowledge and skills essential to improving the public's health. Training teams would include people from governmental public health, higher education, medical/health care systems, and other organizations.
B.	As appropriate for job responsibilities, training for current public health employees should include public health values, epidemiology/quality assurance/economics, research methods, informatics, communication, cultural competence, advocacy/policy development, and external coalition building/mobilization.
C.	Academic preparation programs should incorporate the critical knowledge and skills needed to improve community health and link practice with curriculum, research, and evaluation.
D.	Training for community members and public health organizations must identify and include knowledge and skills, such as communication, understanding and using data, and community mobilization, necessary to improve health in communities.
E.	Training for leadership in public health should be provided. For example, emerging public health and community leaders would benefit from a Community Leadership Institute; public health middle managers would benefit from management training; and current public health leaders should participate in the Regional Public Health Leadership Institute.
F.	There should be comprehensive planning for the location, number, and changing skills needed by the public health and health care work force to improve community health. This should include integrating current work force studies, tracking work force changes, undertaking new studies, and analyzing and reporting on work force composition and location.
G.	. Particular attention needs to be directed toward training agencies' local staff and other community members in the appropriate interpretation, use and dissemination of data to improve community health.
H.	Governmental public health employees who respond to public inquiries should be able to answer questions about services, products or general information about their agency and direct callers and clients to the appropriate area(s) for help. They should also be able to refer questions to other public health organizations based on general knowledge of their services and products.
INFORMATION RESOURCES:
A.	State and local governmental public health and other agencies should make information or data on health, environmental, social and demographic indicators easily available to local communities in a timely manner and understandable form for their use in identifying, prioritizing and addressing community health problems. Agencies should encourage communities to use this information.
B.	. Health care systems and public health systems should combine and analyze health, environmental, social and demographic data for their populations and work with governmental public health agencies to identify community health problems, monitor health status and track health outcomes.
C.	Health care and public health systems should use telehealth technology (e.g., full spectrum of applications using computers and telecommunications for health) to improve the delivery of health care services to their populations.
D.	Public health agencies and health care systems should use geographic information systems (GIS) to map health, environmental, social and demographic data to examine patterns of health and environmental concerns, such as land use, environmental justice, or infant deaths.
E.	Governmental public health agencies should work with the Governor's Information Resources Council (IRC) to implement the Turning Point recommendations. For example, the IRC recommends developing a statewide information policy to ensure that local, regional and state governments make appropriate information readily available to citizens and businesses.
F.	Governmental public health agencies should collect, analyze, and distribute local, county, regional and state data relating to key health issues.
FINANCIAL RESOURCES:
A.	Funding for state and local population health, prevention, and environmental health activities should be provided first through more flexible use of current resources and, if necessary, additional federal, state, and local government appropriations
B.	State governmental public health resources, such as staff expertise, materials, and funding, should support community efforts to improve health.
C.	State governmental public health agencies should identify and secure funding for computer technology and Internet access for local governmental public health agency staff.
D.	Public health organizations should help communities identify and secure resources for special studies that will help them plan and evaluate interventions to improve community health. These resources include methodological and analytical expertise, computer capacity, data entry and interpretation.
E.	State governmental public health and other human services agencies should collect, analyze, and make available to public health leaders and other interested parties expenditure data reported by the ten essential public health services.
Strategic Alliances/Public-Private Partnerships:
A.	State and local public health leaders and private health care providers and educators should communicate and meet regularly to identify high priority health problems and work collaboratively to reduce or eliminate them.
B.	Governmental public health agencies and private health care providers should collaborate on policy formation and the delivery of health care, especially preventive care.
C.	Governmental public health agencies and private health care providers should collaborate with community schools (including day care facilities) to increase the availability of comprehensive school health programs. A comprehensive school health program includes health services, health education, and a healthy school environment.
D.	Governmental and linked public health agencies, faith communities and affiliated organizations should organize a resource network that would increase awareness, collaboration and cooperation between faith communities and health organizations. This network should develop and maintain a list of people and organizations with demonstrated interest in faith and health collaborations to facilitate partnerships for the improvement of congregational and community health. The resource network also should provide leadership in addressing ethical issues in health care and health policy.
E.	DHEC and other governmental public health agencies should collaborate with mental health professionals to strengthen and improve services.
F.	groups should be included in the mainstream of public health decision-making.
Processes - Planning and Evaluation:
A.	. A single, comprehensive state health plan should be developed to guide health improvement efforts, identify common over-arching goals and set short-term and long-term priorities. DHEC, as lead public health agency in the state, should work with other public health organizations, private health care providers, business and industry, consumers, and educational institutions to develop the plan. Interventions should be determined by local communities. These state priorities would not replace local communities' priorities as referenced in Section I, Recommendations B, C and D of this document.
B.	. Priorities in the state health plan should be based on health, environmental, social and demographic data, as well as information about effective interventions for preventing, detecting, and treating the major health-related problems in the state. DHEC should expand monitoring and reporting on the effectiveness of interventions implemented by state and local health and medical care systems.
C.	Health and environmental programs in the state and in communities should be evaluated based on a standardized set of outcome and performance measure indicators, such as Healthy People 2010 objectives, that include community change and process components. Special attention should be given to health disparities. State and local leadership should set a time frame for reaching benchmarks of success for each health priority.
D.	. Academic research centers in collaboration with public health organizations should develop evaluation methods that monitor community changes in addition to mortality, morbidity, health behaviors and use of the health care system.
E.	State governmental public health agencies, private medical providers, and local community leadership should develop, implement, and evaluate several pilot projects to address the priority health problems and improve the health status of the community. These pilot projects should be based on effective interventions and community collaboration.
F.	DHEC should coordinate and conduct a comprehensive statewide planning process that ties the effects of population growth on quality of life in South Carolina to trends in health, environmental, social and demographic data. To initiate this process, DHEC should convene a state quality of life conference that includes all interested parties.
G.	A consortium of academic centers with appropriate expertise should be developed to analyze the effects of existing and proposed health and environmental policies. Reports should be distributed to the legislature, governor's office, public health agencies and others in the public health system. The policy consortium's expertise should be available to help community members and others review policy options for health and environmental issues.

Columbia, SC 29208 • 803-777-5032 • jcsalter@gwm.sc.edu