Hello! My name is Jenna and I am yet another CU nursing student. 

The Core Public Health Services draft gives a thorough overview of how “Public Health” should best be implemented in Colorado communities, however it is lacking in a few areas. I believe that utilizing some of the strategies that nurses employ during a community health assessment may benefit public health services in Colorado.

-         During the assessment phase, it would be important to incorporate a system that identifies the problems of highest priority, especially when multiple problems exist (Stanhope & Lancaster, 2006). Identifying priorities can best be done by investigating: 1) how difficult it would be to address the problem, 2) the consequences if the problem is ignored, 3) the community and population outcomes if the problem is not fixed, 4) the cost of putting the solutions in place, 5) the impact of politics, values in the community, and funding on the measures needed to fix the problem, and 6) the expectations of the community (Stanhope and Lancaster, 2006). Priorities should be identified after answering these questions, and the problems with the highest priority should be focused on first. 

-         The planning stage may benefit from a deeper analysis of the problems the community faces. It would be important to investigate the source of the problem as well as the effects it may have on the community (Stanhope & Lancaster, 2006). If you can identify the source of the problem, then in the future you may be able to prevent it. Recognizing the relationships between problems may also be helpful (Stanhope & Lancaster, 2006). If one problem is affecting or leading to another problem, it may be possible to manipulate one factor and have two good outcomes.

-         Implementation of interventions for community health problems is a component of public health that was only briefly touched upon in the Core Public Health Services draft. When thinking about implementing solutions, the method of implementation must be considered. Who is going to decide upon the change? (Will it be voted on by the public? Will it be decided by the government? Will it be put into place by the public health nurses?) How is the change going to be brought about? How is the public going to be notified and educated? (By flyers? Phone calls? E-mail? Written letters? Education classes?) Who is going to distribute the information? (Public Health employees? Volunteers?) Who is going to pay for the workers, the interventions, and the subsequent evaluation of the changes put in place? It is important to understand how a change is going to be enacted, because every community is different, and the intervention will have no effect if it does not reach the community members.

Resources:

Stanhope, M., & Lancaster, J. (2006). Foundations of nursing in the community:

            Community-oriented practice. St. Louis: Mosby Elsevier.  

The Colorado Department of Public Health and Environment. (2009). The core public

health services draft. Retrieved on November 22, 2009 from http://www.cophip.org/applications/RegistrationManager/publicForum.asp?topicID=25

On June 4, 2008, Governor Bill Ritter signed the Colorado Public Health Reauthorization Act.  It requires boards, agencies, and public officials such as The Colorado Department of Public Health and Environment and The State Board of Health to collaboratively develop state and local public health plans that set priorities for the public health system in Colorado.  “The primary purpose of the Act is to assure that core public health services are available to every person in Colorado with a consistent standard of quality.”  (CDPHE,  2009).  The ten goals of the Colorado Statewide Public Health Improvement Plan are as follows: 

·         Goal 1:  Optimal community, environmental, and personal health

·         Goal 2:  Equitable access to core public health services

·         Goal 3:  Highest quality programs and services

·         Goal 4:  Accountability

·         Goal 5:  Collaborative leadership

·         Goal 6:  Effective use of public health resources

·         Goal 7:  A well-trained workforce to serve Colorado

·         Goal 8:  Communicate the value of public health

·         Goal 9:  Partnerships

·         Goal 10:  Community participation

Optimal community, environmental, and personal health are key points that any health care provider should identify as educational points with every patient.  The anticipated outcome of this goal, stated by the Colorado Department is “…the public health system will ensure optimal health for all Coloradans from birth to old age.”  (CDPHE,  2009).  Even though Colorado was ranked one of the slimmest states in the nation, Governor Bill Ritter tells CalorieLab, Inc. “We’re not spared from the national obesity epidemic, and we must remain vigilant in order to guard against it. We’re doing all we can to encourage Coloradans — especially our kids — to take advantage of the natural resources our state offers in order to stay fit, healthy and happy.”   (CalorieLab, Inc.  2008)

To give our nation the best chance at successfully integrating a healthier lifestyle for generations to come, our wisest option is to begin with our school age children.  Currently, and due to the financial climate in our nation, schools are experiencing budget cuts at alarmingly high rates.  These budget cuts nearly always affect the Physical Education aspects of our children’s education.  The poorly developed idea of forcing PE cuts not only limits the amount of education our children receive in this content area but also teaches them that their physical well-being is simply an option.  The successful implementation of this Act will give our children a better chance at learning what healthy lifestyles are as well as the opportunity to teach the generations after them the importance of living healthy.  That being said, is there any talk about additional funding for schools or options for schools to consider for this needed funding?   

CalorieLab, Inc.  (2008).  Mississippi is the fattest state for 3rd straight year, Colorado still leanest, D.C. loses weight.  Retrieved from http://calorielab.com/news/2008/07/02/fattest-states-2008/

Colorado Department of Public Health and Environment. (2008). Colorado public health reauthorization act – SB 08-194 Executive summary. Retrieved November 20, 2009, from the Colorado Department of Public Health and Environment’s Web site:  http://www.cdphe.state.co.us/opp/publichealthact/SB194execsum.pdf

Colorado Department of Public Health and Environment.  (CDPHE).  (2009).  Uniting Public Health Conference.   Preparing for bridge day: 2009 draft plan for improving Colorado’s public health system.  Retrieved 11/21/2009, from http://www.cophip.org/applications/RegistrationManager
/my_documents/my_files/final.COPHIP_Draft_For_Bridge_Day_9.30.09.pdf

·         Public Health System Roles and Relationships: working together as equal partners to provide the best opportunity to achieve the greatest returns across every region of Colorado (Colorado, 2009).

          The concept of “working together” is merely a small aspect of the holistic concept of communication.  “Communication is a complex, ongoing, dynamic process in which the participants simultaneously create shared meaning in an interaction.  The goal of communication is to approach, as closely as possible, a common understanding of the message sent and the one received” (Sullivan, 2009, p. 122).  In regards to Public Health Improvement, this is definitely a key concept.  If Public Health, as a whole, is going to improve, communication between different parties will be extremely vital.

            As I read through the 2009 Draft Plan for Improving Colorado’s Public Health System, I was truly impressed with it’s organization, goals, and corresponding expectations.  As Stanhope and Lancaster point out, the purpose of any program “is to ensure that the results of an organized activity are consistent with the expectations” (Stanhope, 2006, p. 294).  Although, we are unable (at this time) to measure the results, I feel that the draft is absolutely wonderful; it is well on it’s way to a both positive and productive end.  The goal that the draft gives regarding communication is as follows:

·         “Continually improve state and local governmental public health agency communications and collaborative relationships. Review and expand formal and informal networks for communication, technical assistance, mentors, consultants, and support teams available for state and local agencies.”

                                                                                                -(Colorado, 2009, p. 12)

            According to Stanhope and Lancaster, there are eight basic components you need to ask yourself in order to create a quality program; they are as follows: 

·         What is being done now?

·         Why is it being done?

·         Is it being done well?

·         Can it be done better?

·         Should it be done at all?

·         Are there improved ways to deliver the services?

·         How much is it costing?

·         Should certain activities be abandoned and/or replaced?

                                    -(Colorado, 2009, p. 12)

            As I took some time to study each question, the only issue I found lacking was that of cost.  There is nothing in this draft which specifically talks about the costs of increased communication, technical assistance, mentors, consultants, and support teams.  It leaves the reader wondering, “how much will this cost?” and “do we even have the money?” 

            Overall, I feel that the communication portion of the 2009 Draft Plan for Improving Colorado’s Public Health System, is very promising.  The only recommendation I would give it would be to add a section on finances.

References

Colorado Department of Public Health and Environment.  (CDPHE).  (2009).  Uniting Public Health Conference.  Preparing for bridge day: 2009 draft plan for improving colorado’s public health system.  Retrieved 11/21/2009 from http://www.cophip.org/applications/RegistrationManager
/my_documents/my_files/final.COPHIP_Draft_For_Bridge_Day_9.30.09.pdf

Sullivan, E., & Decker, P.  (2009).  Effective Leadership and Management in Nursing.  New Jersey: Prentice Hall.

Stanhope, M., & Lancaster, J.  (2006).  Foundations of Nursing in the Community – Community Oriented Practice.  St. Louis, Missouri: Mosby Elsevier.

My name is Joel, and I am a student in my senior year at the University of Colorado’s College of Nursing.  Along with myself, you may have noticed a rather large influx of responses from many of my fellow classmates—this in accordance with a recent assignment (optional) in partial fulfillment of our Public Health Nursing curriculum. I am sure that many of my fellow classmates are finding this course as unexpectedly fulfilling as I have. It has been a pleasure to see the valiant efforts our government, its subsidiary agencies, and concerned citizens put forth to ensure the well-being of so many others. Witnessing first hand the amount of work and resources required to fulfill this ongoing need has transformed my spark of interest in this subject to a definite willingness to render personal service. I look forward, more and more, to the days where in I am assigned to help in reassuring the health of our community by delivering immunizations or vaccinations to those in need. Therefore, I am already investigating avenues where in I might be able to volunteer other such similar services on a regular basis after my upcoming graduation and subsequent transition into the field of professional nursing.

That being said, I have a brief inquisition concerning one particular element within the recent proposal addressing this state’s position, and potential resolution, concerning its public’s health. In response to the Colorado Public Health Reauthorization Act, signed by Governor Bill Ritter on June 4^th, 2008 (Colorado Public Health Reauthorization, 2008, p.1); the Colorado Department of Public Health and Environment issued the DRAFT Colorado Health Improvement Plan in order to address this multifaceted issue (2009 Draft, 2009, p. 27). Within this rather complex and comprehensive proposal, underneath the content heading Core Public Health Services, is a list of 10 Essential Public Health Services developed by the Core Public Health Functions Steering Committee (p. 27). Identified in section numbers 4, 5, and 8 within this segment, are specific references to the development and utilization of professional and public resources to attain the proposed plans goals. Being a current representative of the healthcare community, with even growing credentials; how might I become more involved in aiding this great cause? More so, how can I find the information to guide me in this venture?

It is clearly evident that those overseeing this extremely important project have utilized a wide variety of resources. Why then, if the world of online technology is implemented in the spread of the news of this project, is it not being used to support in its subsequent resolution? Is there some form of link within this project’s website to aid the direction of public/professional volunteer enrollment? Am I simply missing it? Would not your plans be further benefited by a direct link to volunteer information and potential registration?  Likewise, if I could find a way to offer my services towards achieving this magnificent goal; what type of liability do I personally hold? Is there some sort of method to protect the charitable provision of medical services by a licensed healthcare professional?

I will personally strive to find the information I seek—though I believe wholeheartedly that you may be losing countless numbers of other willingly individuals due to the increased effort required to find this necessary information. I believe greatly in the validity of the Colorado Health Improvement Plan —as do many in my similar position (2009 Draft, 2009, p. 27). Therefore, it would seem prudent for this project’s leaders to consider these and other similar inquisitions when they reveal their final proposal in the upcoming months. As a proud Colorado resident and community member—I thank you for your efforts and time concerning this all important endeavor.

Sincerely,

            Joel R. Jacquart

References

Colorado Department of Public Health and Environment. (2008). Colorado public health reauthorization act – SB 08-194 Executive summary. Retrieved November 20, 2009, from the Colorado Department of Public Health and Environment’s Web site: http://www.cdphe.state.co.us/opp/publichealthact/SB194execsum.pdf

Colorado Department of Public Health and Environment. (2009, September 23). 2009 Draft plan for improving Colorado’s public health system. Retrieved November 20, 2009, from the Colorado Department of Public Health and Environment’s Web site: http://www.cophip.org/applications/RegistrationManager
/my_documents/my_files/final.COPHIP_Draft_For_Bridge_Day_9.30.09.pdf

The Core Services portion of the Colorado Public Health Reauthorization

Act addresses 10 Essential Public Health Services, one which states “encourage a competent public health workforce” (CDPHE, 2009, p.1). Goal 7 in the Reauthorization Act is to obtain a well-trained workforce to serve Colorado (CDPHE, 2009, p. 3). I believe that in order to obtain a truly competent public health workforce, cultural competence should be added to the public health services. Cultural competence is defined as """"a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations"""" (Linkins et al., 2002).

 In order to inform, educate, and empower people you need to address how a person’s culture affects their health experience. Under the workforce development section of the Reauthorization Act, Strategic Recommendation 5 suggests an “increase in public health workforce diversity by race, gender, age, and by profession” (CDPHE, 2009, p.20). While this is a step in the right direction, it still does not address the need for specific culturally sensitive training among the public health workforce. We need to step back and ask ourselves: Are our public health agencies reflecting culturally competent practice?

In today’s diverse society it is not uncommon for a public health workers culture to differ from their clients and therefore training should be implemented to encourage an understanding of how to deliver culturally competent care. In order to decrease health disparities in other cultures, public health workers must develop an understanding of the health issue as it relates to a person’s values and beliefs. Healthy people 2010 gives us an example of cultural competence as it relates to the Native American population and their culture around drinking (CDPHE, 2005). The US healthcare system tends to view alcoholism as a disease. In the Native American culture, disease occurs if there is a disharmony between the individual and the spirit world (CDPHE, 2005). Therefore, typical medical interventions and education may not be an appropriate way to decrease alcoholism within this culture. In the public health arena we must always consider how a person’s culture affects their health and personal life choices.

 The development of cultural competence is an ongoing process and therefore constant assessment and evaluation needs to occur to address the discrepancies in culturally competent care. The Health Resources and Services Administration (HRSA) funded a project team to develop an assessment tool to evaluate the level of cultural competence in healthcare agencies (Linkins et al., 2002). The goals of their project were to: “1) develop an analytic framework for assessing cultural competence in health care delivery organizations; 2) identify specific indicators that can be used in connection with this framework; and 3) assess the utility, feasibility and practical application of the framework and its indicators” (Linkins et al., 2002). I believe that the Reauthorization Act needs to outline a specific method for the assessment of cultural competence and it can easily be modeled after the HRSA’s “assessment profile”. To obtain a detailed view of HRSA’s assessment profile please visit http://www.hrsa.gov/culturalcompetence/indicators/.

The Colorado Reauthorization act should help set the standard for the implementation of culturally competent care in public health agencies. Assessment tools and implementation practices can be outlined with the help of the HRSA’s guideline.

References:

Colorado Department of Public Health and Environment. (2009). Draft core services. Retrieved  November 20, 2009, from: http://www.cophip.org/applications/RegistrationManager/my_documents/
my_files/web.DRAFT_core_services_10.14.09.pdf

Colorado Department of Public Health and Environment. (2009). Draft plan for improving Colorado ’s public health system. Retrieved   November 20, 2009, from: _Draft_For_Bridge_Day_9.30.09.pdf

Colorado Department of Public Health and Environment. (2005). Healthy colorado 2010. Retrieved November 20, 2009, from: http://www.cdphe.state.us 

Linkins, K. W., McIntosh, S., Bell, J., Chong, Umi. (2002). Indicators of cultural competence in health care delivery organizations: An organizational cultural competence assessment profile. Health Resources and Services Administration. Retrieved November 20, 2009, from: http://www.hrsa.gov/culturalcompetence/indicators.

     According to Healthy People 2010 (2000, pg. 23-3), the mission of public health is to "fulfill society's interest in assuring conditions in which persons can be healthy."  Responsibilities of public health agencies include preventing epidemics and the spread of disease, protecting against environmental hazards, preventing injuries, encouraging healthy behavior, helping communities recover from disasters, and ensuring that everyone has access to quality health care (Healthy People 2010, 2000, pg. 23-3).  On June 4th, 2008, Colorado Governor Bill Ritter signed the Colorado Public Health Reauthorization Act, which requires the Colorado Department of Public Health and Environment (CDPHE) to develop a statewide public health improvement plan by December 31st, 2009 (CDPHE, 2009).  The draft of this plan has 10 goals aimed at improving public health in Colorado (CDPHE Public Health Act, 2009, pgs. 2-3).

     For the purpose of this discussion, I would like to more closely examine three of these goals.  First of all, the purpose of Goal number 1 is to optimize community, environmental, and personal health (CDPHE Public Health Act, 2009, pg. 2).  This goal recognizes the importance of improving the distribution and quality of public health services, as well as improving health disparities and addressing environmental issues that directly impact health.  According to the plan, two of the ways the CDPHE hopes to accomplish this is by developing a system for networking and sharing across local governmental public health organizations, and by researching other states and other Colorado government agencies for models (CDPHE Public Health Act, 2009, pgs. 9-11).  Sharing information among counties and researching successful public health models in other states will allow the CDPHE to identify the most successful methods of improving the distribution and quality of public health services.  The CDPHE also states in the plan that a specific set of environmental health indicators will be created to track environmental health problems and priorities at the state, regional, and county levels (CDPHE Public Health Act, 2009, pg. 6).  This will help to identify and address environmental health problems in Colorado.

     Another goal of the Colorado Public Health Reauthorization Act is Goal number 2, which aims to provide equitable access to core public health services to all Coloradans (CDPHE Public Health Act, 2009, pg. 2).  This goal states that the public health system must serve all Coloradans equally, and that "limitations in access to, utilization of, and quality of health services due to geopolitical, environmental, socioeconomic, and cultural barriers must be avoided."  Included in this goal is ensuring that "every Coloradan in every county has equal access to public health services" (CDPHE Public Health Act, 2009, pg. 2).  One of the specific components of the plan aimed at addressing this goal is expanding the use of technology to include more participants around the state (CDPHE Public Health Act, 2009, pg. 12).  This would he help ensure that more Coloradans had access to new equipment and technology that could help them better treat or prevent certain illnesses.  In addition, the plan states that, "Public health agencies will provide or assure the provision of and direct people to public health core services based on priorities from a community health assessment" (CDPHE Public Health Act, 2009, pg. 4).  This component of the plan would help to ensure that Coloradans most at risk of health problems would be encouraged and directed to receive public health services.

     The third goal of the Colorado Public Health Reauthorization Act that I would like to examine is Goal number 7, which aims to provide a well-trained workforce to serve Colorado (CDPHE Public Health Act, 2009, pg. 3).  This goal seeks to address the fact that Colorado's public health professionals are faced with the challenge of providing a wide range of public health services, often without adequate support and insufficient training.  This plan aims to develop, employ, and maintain a highly trained, competent workforce through a commitment to lifelong learning, linking practice to formal education, and placing a greater emphasis on recruitment and retention strategies (CDPHE Public Health Act, 2009, pg. 3).  According to the CDPHE (Public Health Act, 2009, pgs. 13-17), the plan would evaluate and expand existing state-specific training programs, create training opportunities for new public health directors, develop consensus on public health core competencies, and develop training modules based on nationally recognized public health core competencies and specialized competencies agreed upon in Colorado.  In terms of recruitment, the plan would integrate public health into existing health care "pipeline" programs aimed at high school and college students, identify programs and scholarship opportunities for potential students, and identify academic programs throughout the state that can be strengthened with public health content (CDPHE Public Health Act, 2009, pg. 18).  Promoting public health programs and encouraging students to enter the field of public health would not only increase the workforce, but would also help Coloradans to become more aware of public health programs throughout the state.

     In conclusion, the Colorado Public Health Reauthorization Act has numerous goals aimed at improving public health services in Colorado, and is a positive step towards achieving this goal.  The plan includes goals aimed at improving and protecting the health of the public, ensuring that all Coloradans have access to quality public health care, and ensuring that public health professionals are better trained and educated for a career in public health.  While the specific funding and methods of the plan still need to finalized, this plan appears to address many of the public health deficiencies in Colorado and can be viewed as an encouraging step towards improving both the quality of and access to health care services in Colorado.

REFERENCES

Colorado Department of Public Health and Environment.  (2009).  Colorado Public Health Reauthorization Act.  Retrieved November 19, 2009, from http://www.cdphe.state.co.us/opp/pubhealthact.html

Healthy People 2010.  (2000).  Public Health Infrastructure.  Retrieved November 19, 2009, from http://www.healthypeople.gov/Document/pdf/uih/2010uih.pdf

The goals of the Colorado Statewide Public Health Improvement Plan are necessary in order to provide direction upon which intervention efforts and resources will be allocated. �As defined in the Act [Public Health Act of 2008], �Public health� means the prevention of injury, disease, and premature mortality�� (Colorado Department of Public Health and Environment [CDPHE], 2009, p.2). This is a powerful statement that is spring loaded with promise to restore health to the residents of Colorado. Prevention is the key to breaking the cycle of adverse health.

The ten goals as listed provide a platform for the Improvement Plan, however in my opinion, they are lacking in the importance and urgency of promoting prevention. Specifically, Goal one (addressing �optimal community, environmental, and personal health�) and Goal three (addressing the �highest quality programs and services�) are the most appropriate areas to incorporate the vital component of prevention (CDPHE, 2009, p.2). The topic of prevention is relevant to all Coloradoans and has potential to be the turning point toward achieving a better state of health among communities.

Health care continues to be a hot topic in our nation�s agenda. Now, more than ever, there is a push to promote involvement in preventative health measures (Cohen, Neumann, & Weinstein, 2008). Healthy People 2010 speaks to the importance of prevention in their mission of public health by �preventing epidemics� and �preventing injuries� as well as stressing the importance of informing, educating, and empowering communities to make changes in their health issues (Healthy People 2010, p.23-3). Likewise, the Institute of Medicine (IOM) provides a framework for strengthening public health education; advising goals targeted toward �prevention of epidemics� and �prevention of injuries� (2002, p.1). Even President Barack Obama has expressed that �too little is spent on prevention and public health.� (Cohen, Neumann, & Weinstein, p.661)

The notion of prevention requires commitment and collaboration through the partnerships among communities and health care professionals. It is imperative for the services of public health to charge forward carrying out the mission of prevention and health promotion (Berkowitz, Nicola, Lafronza, & Bekemeier, 2005). It is necessary for the Colorado Statewide Public Health Improvement Plan to incorporate methods of prevention into the goals of the Plan in order to promote an ongoing improvement in health shaping the future of Colorado.

References

Berkowitz, B., Nicola, R. M., Lafronza, V., & Bekemeier, B. (2005). Turning point�s legacy. Journal of

Public Health Management and Practice, 11(2), 97-100.

Cohen, J. T., Neumann, P. J., & Weinstein, M. C. (2008). Does preventive care save money? Health

economics and presidential candidates. Retrieved November 16, 2009, from

http://content.nejm.org/cgi/reprint/358/7/661.pdf

Colorado Department of Public Health and Environment. (2009). 2009 Draft plan for improving

Colorado�s public health system. Retrieved November 16, 2009, from

http://www.cophip.org/applications/RegistrationManager/
my_documents/my_files/final.COPHIP">

Healthy People 2010. (n.d). Public health infrastructure. Retrieved November 17, 2009 from

http://www.healthypeople.gov/Document/pdf/Volume2/23PHI.pdf

Institute of Medicine. (2002). Who will keep the public healthy? Educating public health professionals

for the 21st century. Retrieved on November 17, 2009 from

http://books.nap.edu/html/educating_health_professionals/
reportbrief.pdf

As a student at University of Colorado, College of Nursing, we learn that all plans of action need to have goals and a way to measure progress.  During our leadership training, we learned about the Plan, Do, Study, and Act cycle for improving outcomes.  A look at the National Public Health Performance Standards Program on the CDC website indicates that performance improvement shows change through measuring outcomes and targeted goals (CDC, nd).

Centers for disease control and prevention, nd. National public health performance standards program performance improvement.  Retrieved on November 15, 2009. http://www.cdc.gov/od/ocphp/nphpsp/PIindex.htm

The draft plan is really quite good. I would, however, like to make a suggestion under the topic of Public Health System Roles and Relationships. Strategic Recommendation 4  might be better if the first sentence were deleted or moved. The second sentence: "Improve state and local coordination in policy development and encourage participation in the legislative policy" could be changed to "encourage participation in policy development at the federal, state and local level."

The first sentence about restructuring of the local public health organizations is, to me, an inside game. It is useful work to be done but will not likely impact public health in any great way. I would delete that sentence from the Recommendation, and adjust the action steps to mention, but not over-state that task.

Thank you. Lee Thielen, Exec. Director of the Public Health Alliance

After reading through the Core Public Health Services draft a few things stood out to me.

�Public health core services shall meet the needs of the population served by the county or district. In some jurisdictions, the services may be provided by other counties, community organizations or agencies; however, the county or district public health agency has an obligation to assure that core services are available� (Page 1, lines 12-15) (CDPHE, 2009).  I feel that if some counties public health is provided through a different county that we will see a discrepancy in the care available to these counties.  I would guess that the counties that would receive their public health from another county will be the less populated areas which tend to not have healthcare readily available to them as it is, public health services should be easily accessible to all member of the state. 

On page 5, lines 7-8; �Establish procedures for working across jurisdictional boundaries and/or for requesting assistance in the delivery of public health services� (CDPHE, 2009).  I think this is especially important.  If and when Colorado ever has a public health emergency, already having it in place, the ability for public health officials to work across the board will prove to be very beneficial.

The last thing that caught my eye in this draft was the section on Emergency Preparedness and Response (pages 3-4).  I am an EMT and know that in the case of a disaster all first responders, EMT, paramedics and firefighters will be a big part of the efforts.  It was not clearly stated how both EMS services and public health services would effectively work together.  I feel it would be very beneficial to have a plan clearly in place for the coordination of efforts of these two entities. 

The draft addresses many different aspects of Public Health in Colorado. As a current nursing student, I find the last section regarding Administration and Governance to be very important in the implementation of this improvement plan. Two bullets are of a concern that I feel need more clarification. The first is "maintain competent, appropriate staffing and other resources to ensure capacity for delivery of core public health services" (Draft Colorado Public Health Improvement Plan, 2009, p. 5, lines 1-2). What are the measures to be used to maintain competent and appropriate staffing? There are numerous aspects of education and promotion of health that will require numerous people to provide these public services. What will keep these employees in these positions? The government continues to make cuts and demand furloughs. Is there protection for these workers who will be providing these services? While the draft does not address specifics, these questions should be taken into consideration during the implementation process.

The second bullet point that stirs up emotion is the following: "Meet minimum quality standards in the delivery of public health services throughout the jurisdiction" (p. 5, lines 3-4). What are the quality standards to be met, who deciphers these and why sell the public short by meeting anything minimally? There are limitations to the services provided, including financial and personnel abilities. However, if it was your own child with whom standards were barely met, would you be pleased with the Public Health System? I think re-wording these lines would be appropriate to demonstrate to the public the importance of meeting quality standards with maximum efforts.

I am reviewing the Public Health Reauthorization Act for my Public Health Nursing class at CU and found the discussion board topics presented in this forum to be extremely interesting. I have always believed that everyone that resides in the United States should have access to basic health care services, especially public health services, regardless of where they live or who they are and was encouraged to read that Colorado has set out to accomplish this public healthcare plan. From reading this document, it seems that this project will be a tremendous undertaking for many different levels of professionals but one that will potentially provide the residents of Colorado with an increase in a healthier population as well as an opportunity to take control of their own health and wellness.

As for the document outlining the core public health services, I was encouraged to read the specific section regarding the development of assessments and programs aimed specifically towards Prevention and Population Health promotion. By assessing these individual Colorado communities, it will allow local agencies to target the specific health issues that are most prevalent and then formulate the required healthcare interventions and services needed for these areas. One specific line from this section of the document that definitely caught my attention was the inclusion of line 28 which speaks directly to the assurance of health care delivery in a culturally and linguistically appropriate manner (p. 3). With the significant amount of culturally diverse individuals residing in Colorado, it is of significant importance to constantly consider that cultural sensitivity is a huge component in providing effective healthcare promotion and prevention.   

With learning about these public health initiatives set forth by Colorado, I am looking forward to following how this plan will develop after full implementation as well as the progress and/or setbacks that are encountered along the way. To be drafting a plan such as this is such a tremendous step in the right direction to providing healthier options and access to care to future generations of individuals that make Colorado their home.

There may be value in more explicitly recognizing the value and need to include elected officials as participants within these goals