Overview: Minnesota's State-Local Partnership

Introduction

The state-local public health partnership initiated by the CHS Act is fundamental to the success of Minnesota's public health system. The CHS system is, in essence, an infrastructure for public health in Minnesota – a systematic organization of local health authorities that makes it possible for state and local governments to combine resources to serve public health needs.

The CHS system recognizes the different needs of communities around the state, provides the flexibility to address specific needs, and promotes direct and timely communications between state and local health departments. The CHS system is a responsive, successful, and cost-effective state and local partnership that relies upon shared goals and a strong desire to work together to improve the lives of all Minnesotans.

Many aspects of Minnesota’s public health system make it an effective partnership. State and local governments share responsibility and a mission for public health. The State CHS Advisory Committee helps to coordinate policy development and planning. State and local governments jointly develop goals and guidelines and share responsibility for public health in Minnesota. Communities regularly assess their health status with the assistance of the MDH. And multiple channels of communication make it possible to share information on a regular basis.

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Shared Authority, Responsibility, and Accountability

Protecting the public's health is so basic, and the consequences of not protecting the public's health are so serious, that both the state and federal constitutions contain provisions to ensure this protection.

Through the CHS partnership, state and local public health departments share authority and responsibility for protecting public health. Minn. Stat. § 144.05 describes the commissioner of health's general duties, and Stat. § 145A describes the purpose of the Community Health Boards.

These two sections of statute highlight the interdependency of state and local governments in meeting their public health responsibilities:

State Government

"The state commissioner of health shall have general authority as head of the state's official health agency and shall be responsible for the development and maintenance of an organized system of programs and services for protecting, maintaining, and improving the health of the citizens..." (Minn. Stat. § 144.05).

The state also plays a critical role, both in oversight of county responsibilities and also in assuring that local governments have the resources they need to carry out those responsibilities.

Mutual accountability for public health means that the state must: clearly and consistently communicate the legal expectations of local government and the benefits of maintaining a strong public health system; work with local governments to identify effective tools for management; and assist local governments to secure the financial resources necessary to effectively protect and promote the public’s health.

Local Government

"The purpose of sections 145A.09 to 145A.14 is to develop and maintain an integrated system of community health services under local administration and within a system of state guidelines and standards" (Minn. Stat. § 145A.09).

When counties form Community Health Boards, they retain their local governmental responsibilities for basic health protection. In addition, they are required to assess the health problems and resources in their communities, establish local public health priorities, and determine the mechanisms by which they will address the local priorities and achieve desired outcomes.

Another example of this joint responsibility is that the commissioner of health may direct local health boards to take public health action. For example, in the case of communicable diseases, "a board of health shall make investigations and reports and obey instructions on the control of communicable diseases as the commissioner may direct..." (Minn. Stat. § 145A.04, subd. 6). In addition, the commissioner may enter into formal or informal agreements with local agencies, such as when the commissioner delegates duties to CHBs (Minn. Stat. § 145A.07).

The CHS systems helps to define shared roles* among state and local governments, which in turn helps to eliminate the duplication of efforts and to provide a cost-effective means of delivering public health services that are customized to meet the needs of local communities.

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A Shared Mission and Vision

The mission of the community health services partnership is to lead efforts to protect and promote the health of all people in Minnesota.

Community health services are designed to: “…protect and promote the health of the general population…by emphasizing the prevention of disease, injury, disability, and preventable death through the promotion of effective coordination and use of community resources, and by extending health services into the community” (Minn. Stat. § 145A.02).

The system also is strengthened by a mission statement shared among state and local public health departments (see box, below). The CHS mission statement was created jointly by state and local public health representatives in 1990 and revised in 1996. It reflects the positive working relationship and willingness to cooperate and collaborate that characterizes Minnesota's public health system. The mission statement provides a context for community health planning and goal setting that combines the perspectives and strengths of state and local government.

Together with the mission statement, the vision (below) – developed as part of a strategic plan – helps to set direction and purpose for what Minnesota’s public health system hopes to accomplish in the next few years.

The vision for the public health system in Minnesota is of a strong and dynamic partnership of governments, fully equipped to address the changing needs of the public's health.

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Coordinated Policy Development

As a part of the original CHS Act, the Minnesota Legislature created the State CHS Advisory Committee (SCHSAC, pronounced “shack”). SCHSAC, now in its 27th year, continues to play an important role in many aspects of the state-local CHS partnership. The purpose of the committee, as described in Chapter 145A, is to advise, consult with, and make recommendations to the commissioner of health on matters relating to the development, maintenance, funding, and evaluation of community health services in Minnesota. (Minn. Stat. § 145A.10, subd. 5a(a))

SCHSAC works together with the MDH to develop public health policies that represent the perspectives of local communities. SCHSAC provides recommendations to the commissioner of health, and the commissioner in turn may ask SCHSAC to review public policies of statewide significance.

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Jointly Created Goals and Guidelines

Shared goals are another product of the state-local partnership. State and local governments jointly determine both long-term and short-term goals for public health in Minnesota. These goals are used as guidelines for state and local priority setting. Jointly created goals also provide a standard against which to evaluate performance.

Public Health Goals

The document Healthy Minnesotans: Public Health Improvement Goals contains a set of statewide public health goals for Minnesota. The vision for Healthy Minnesotans is “Healthy people in healthy communities: a shared responsibility.” This statement is based on the spirit of collective responsibility and the concept that all people in society share responsibility for improving health.

The 2004 goals were developed collaboratively by the Minnesota Health Improvement Partnership (MHIP), a broad coalition representing state and local public health agencies, community organizations, business, health plans, communities of color, and others. The foundation for the development of the statewide goals is the local planning process, in which the 53 CHBs conduct assessments and identify priority health problems. In addition, the MHIP gathered valuable insights and perspectives from a wide range of Minnesotans, including voices from health plans, populations of color, and businesses.

The goals in Healthy Minnesotans create a blueprint for ensuring that Minnesota remains one of the healthiest states in the nation. The document contains a narrative, specific objectives and strategies for each topic presented in a goal. See www.health.state.mn.us/divs/chs/phg/intro.html for more information.

Guidelines

Each year, SCHSAC works with the MDH to design an annual work plan to address the important issues related to community health services, and to develop policy recommendations for the commissioner. After the work plan is determined, SCHSAC works with MDH staff to address the issues. Work groups are formed to develop policy recommendations for the commissioner. The standards and guidelines developed through SCHSAC serve as policies that CHBs may use to address public health problems within their community.

Effective Communication Channels

Communication between state and local public health occurs through several channels. These include:

  • Regular meetings of SCHSAC and its subcommittees.
  • Consultation and technical assistance provided through MDH program staff as well as staff located at MDH district offices.
  • Vital statistics and surveillance data provided from the MDH for use in local planning and priority-setting.
  • Current research and health information provided on-line and at conferences;
  • The Health Alert Network (HAN), an electronic resource for public health staff, health care providers, emergency workers, and others, to exchange information during a disease outbreak or disaster.
  • Conferences and workshops, including a jointly-planned annual conference attended by over 400 state and local public health officials.
  • A quarterly newsletter, the CHS Commentary, that discusses public health issues of statewide interest.
  • A regular mailing from MDH to local public health professionals and elected officials.
  • Videoconferencing and satellite broadcasts, including communication from MDH about national programs.
  • Development and maintenance by MDH of e-mail distribution lists, broadcast fax lists, and other methods of rapid communication.
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