DPH Prevention Framework

Draft

Mission Statement:

Protect and promote the health of all San Franciscans.

Prevention Goals [1] :

1.     Prevent premature death, disability, disease and injury due to preventable causes.

2.     Reduce and/or eliminate health disparities among segments of the San Francisco population.

Guiding Principles:

1.     Focus on the health of populations and consider the effects of health conditions throughout the life cycle.

2.     Collect all relevant available evidence on important health conditions and their major determinants.

3.     Prioritize prevention decisions based on defined criteria, including evidence about preventable burden of disease in population and effects on inequities.

4.     Identify and address root causes, determinants of health and their interactions. [The main determinants of health are social, economic, cultural, environmental, health services and personal health practices.]

5.     Apply multiple level best practice strategies for the entire spectrum of health determinants. [This includes coordination with public, private and nonprofit organizations beyond DPH; and collaboration across sectors and levels within the DPH.]

6.     Promote genuine public partnership.

7.     Evaluate interventions for their effects on population-based outcomes and use evaluation results for future planning and budgeting.

Support Structure:

1. Prevention is listed as a workgroup under the Integration Task Force, a Department wide group that focuses on integration system and policy issues. 

2. Prevention is planned as a special topic on the Community Programs Managers and Medical DirectorsÕ Meeting agenda on a quarterly basis (starting October 2002). 

3. Invite public partnership through community groups and to utilize existing public advisory groups towards prevention effort.

Proposed Steps and Resources:

 

Action

Detail

Lead

Resources/Issue

1.

Establish an objective analysis of the state of San FranciscanÕs health.

Produce evidence about burden of disease/injury/disability in the population such as Disability Adjusted Life Years (DALYs) and leading determinants of burden of disease. 

In the long run, establish and refine an ongoing review of the health status of the community and its sub-groups.

Community Health Epidemiology section, with other epidemiological and program units

Based on San Francisco health data, Healthy People 2010 and other literature.

2.

Produce evidence about major determinantsÕ contribution to burden of disease.

This includes attribution to etiology.

Community Health Epidemiology section, with Health Promotion and expertise from different DPH sections, e.g. Environmental Health.

Scientific literature, San Francisco data where available, knowledge of staff throughout the department.

3.

Create and implement a process to identify and prioritize prevention objectives Department wide and among sections.

The criteria to be determined might include: effects on population health and disparities; need; mandates; social injustice; availability of effective options; availability of resources; and emerging public health issues and concerns.

High-level management staff , assisted by a team of selected public health workers. 

Small group reviews and makes recommendations on top public health concerns at large group convenings, e.g., quarterly Management Team Meeting.

Management and budget committee to prioritize and re-direct funds.

Healthy People 2010.

4.

Identify prevention options in priority areas based on efficacy, effectiveness and cost effectiveness.

This includes identifying a range of prevention interventions/strategies/ methodologies based on best practices, efficacy and cost effectiveness. 

Core public health units (Health Promotion, Community Health Epidemiology, Environmental Health, etc.) are available to assist clinical providers.

Health Promotion, Community Health Epidemiology Section, Environmental Health and a team of selected public health staff. 

Small work group(s) review and makes recommendations on top public health concerns large group, e.g., quarterly Management Team Meeting).

Use academic /research institutions and other related organizations. Review scientific literature and San Francisco conditions.

5.

Decide on priority prevention interventions  for implementation.

Intervention may include a host of activities that address policy, practice and training.

Identify evaluation measures and indicators once interventions are selected.

High-level management staff assisted by staff as needed; program managers in priority action areas.

Review scientific literature and San Francisco conditions.

6.

Implement, monitor and evaluate prevention activities.

This includes policy analysis and supporting community collaborations.

Program management staff of sections that are addressing prevention issues.

Community Health Epidemiology section,  Health Promotion section, IS (BIS, LCR), DHS, DCYF, community groups, etc.

this draft 9/02

[1] National Healthy People 2010 major objectives as well as a component of the DPH 2000 Strategic Plan.