Developing an Annual Environmental Health Report for the Oneida Nation of Wisconsin

Transcription

1 Developing an Annual Environmental Health Report for the Oneida Nation of Wisconsin Environmental Public Health Leadership Institute Fellow: Jennifer Falck, R.S., MPA Environmental Health Supervisor, Oneida Nation of Wisconsin 3759 W. Mason St PO Box 365 Oneida, Wisconsin, Mentor: Joy Harris, MPH Modernizing Public Health in Iowa Coordinator, Iowa Department of Public Health Acknowledgements: Anthony Kuchma Wetland Program Coordinator, Oneida Nation of Wisconsin Jeff Mears, MPA Environmental Area Manager, Oneida Nation of Wisconsin Pat Pelky Environmental, Health & Safety Division Director, Oneida Nation of Wisconsin Eric Krawczyk, MPH, CHES Community/Public Health Officer, Oneida Nation of Wisconsin

2 EXECUTIVE SUMMARY: The Oneida Reservation is located in northeast Wisconsin, a few miles west of Green Bay. The reservation is split between Brown and Outagamie Counties, and encompasses 65,432 acres. The total population of tribal members living on the Oneida Reservation is 4,065, or about 25% of the 16,371 total membership. The local population continues to grow as tribal members move back to the area. Casino gaming came to the Oneida Nation of Wisconsin in the early 1990 s. Since that time, the Oneida Casino has become one of the most successful Indian owned casinos in the U.S. Once the tribe began to enjoy economic success, the building of infrastructure started to move at a break neck pace. Previous to our gaming success, the tribe contracted with Indian Health Service to complete all of the environmental, health, and safety needs of the reservation. Today, the Oneida Environmental, Health & Safety Division employs 37 people from various areas of discipline. The Environmental Health Department today is made up of an Environmental Health Supervisor, Registered Sanitarian, and an Injury Prevention Coordinator. The goal of this project has been to increase the capacity of our environmental health program by improving the program monitoring that we do. The Oneida Nation of Wisconsin has not developed an integrated annual environmental health report. This is primarily a result of how Oneida, along with many tribes across the nation have been built. Historically, the Indian Health Service built the environmental health and public health services to be separate. Oftentimes, the environmental health staff and the engineering staff were grouped together, while the public health staff was housed in the tribe s medical clinic. In Oneida, the public health department is housed in Oneida Community Health Center, while the environmental health services are housed with our Environmental, Health, and Safety Division. INTRODUCTION/BACKGROUND: A disconnect has resulted from this physical and organizational separation. The result has been an absence of high quality collaborative decision making about the services we provide. There is no picture of environmental public health in Oneida. Our specific status on many different environmental public health issues is unclear. Without a clear picture of our status, we are unable to make the best program decisions. My project is to develop a report format that can be used for annual reporting purposes. This will be one of the first cross-departmental annual reports the tribe has developed. A cross functional team is advising me how to develop a useful annual report, collecting data from many different sources. This project had brought several issues to light. Primarily-the availability of Oneida specific data. There is a lot data available for the two counties that are situated on the Oneida Reservation. Brown County, located on the eastern half of the reservation has a population of 226,778. Outagamie County, located on the western half of the reservation has a population of

3 160,971. There is a total of 21,321 people living on the Oneida Reservation. However, only 4,143 (19%) of those people are Oneida tribal members. So the data that the counties collect is not specific to Oneida tribal members. We have relied on that data for years. However, bringing those data sets together, and combining it with the Oneida data we do have, will provide 1) a picture of Oneida s environmental public health status, 2) it will identify gaps in data that we can then begin to fill, and 3) it will help us to begin to work toward developing in roads to working with our internal data collectors, as well as external agencies (primarily at the state level). Problem Statement: Without the capacity to look at Oneida s environmental public health status at a given point in time, we cannot make the best programmatic decisions. Behavior Over Time Graph: While the demand for better program evaluation continues to increase, 1) access to data is not reliable, 2) as departments continue to work in silos, fragmentation increases. Lastly, there has been movement toward better measures, but the progress has been slow. Behavior Pattern Graph Demand for Better Program Evaluation Availability or access to data Level of fragmentation Movement toward a good data system TIME

4 Causal Loop Diagrams and Applicable Archetypes: Shifting the Burden Causal Loop Quick Fix Information Silos Dept s. Acting on Their Own Service Gaps Go Unnoticed Side Affects Uninformed Decision are Made Pressure to Improve EH Status Corrective Action Build a Good System Integrated Approach to EH Source of Problem

5 10 Essential Environmental Health Services: Based on the Environmental Public Health Performance Standards Assessment we completed, I chose to develop a project that would improve our ability to monitor health. This component was our lowest scoring component, as it was for many of the other departments represented. Figure 1: The Essential Environmental Health Services, Source: Public Health Functions Steering Committee National Goals Supported 1. Describe how your project seeks to support one or more of the CDC Health Protection Goals. Healthy People in Every Stage of Life: By improving the monitoring of the environmental public health status of tribal members, we can make programmatic decisions that can directly impact their health status. 2. Describe how your project supports any or all of these national goals or initiatives of the National Strategy to Revitalize Environmental Public Health Services. Build Capacity: Using technology and innovation to improve our capacity to monitor health will enable us to predict and respond to changing health needs.

6 3.Describe how your project supports any or all of the goals of the Environmental Health Competency Project. Assessment and Management: This project has provided the first steps to better assessment and management, two goals of the Environmental Health Competency Project.

7 Project Logic Model: GOAL: Increase the capacity of Oneidal environmental health programs to monitor the environmental health status of their community. RESOURCES & INPUTS FUNDING Annual budget TECHNOLOGY Appropriate software MIS-technical assistance TIME 2-4 hours per week ACTIVITIES PROJECT DESIGN Plan project Plan & hold meeting IMPLEMENTATION Develop database Receive and input data Draft report Finalize annual report OUTPUTS TIER meetings held Primary data Database Draft Report Final Report SHORT & LONG TERM OUTCOMES & IMPACTS SHORT Annual report will provide a snapshot of our environmental health status. We can use the report for budgeting, staffing, planning, providing service, etc. LONG Tribe will be able to make better decisions about environmental health services. An overall improvement of environmental health status. RESULTS BEHAVIOR Appropriate services delivered to the right people Efficient system in place to provide & report services Increased ability to make better program decisions Increased capacity to manage strategically.

8 PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES: Program Goal Increase the capacity of Oneida s environmental health programs to monitor environmental health status of their community. Health Problem Many tribal environmental health programs do not have the capacity to look at a comprehensive picture of the environmental health status of a given community, at a given point in time. Without this ability, programs cannot make the best decisions about programming, budgeting, staffing, etc. Ineffective decision making could lead to inefficient service, inappropriate service, etc. Outcome Objective By January 2010, an annual reporting system will be in place that produces an annual environmental health status for the Oneida Nation of Wisconsin. Determinant The number of data pieces made available for the project. Impact Objective By January 2010, an annual report will be written that demonstrates the environmental health status of the Oneida Community for the 2008 calendar year. This report will be updated annually. Contributing Factors 1. People respond to information requests on time. 2. Departments have the information requested in an accessible format. 3. Lack of buy in to the project. Process Objectives 1. By September 1, 2009, tribal environmental health departments received an invitation to a project kick off meeting to discuss the project. EVENT: Meeting 2. By September 15, I began to develop a draft report. EVENT: Report draft started 3. By November 1, 2009, data was requested from the Oneida Community Health Center, and other data components that were available on line, were identified. EVENT: Start collecting data. 4. By December 30, 2009 a draft annual environmental health report was written. EVENT: Draft report written

9 METHODOLOGY: Event: Stakeholder Interviews In May, 2009 I held two stakeholder interviews with my immediate managers, and my division director. They were able to help me vet out some details about this project, including their expectations for a final product. Activity: Research Throughout much of the summer months I looked at annual environmental health reports from all over the country, and used some of those components in the draft report. Event: Information Session On September 29, I held an informational session for the pertinent environmental public health departments. I primarily shared my work plan with the group and received validation from the group that I was on the right track with the project. Activity: Data Gathering & Report Writing In November I began requesting data, collecting data, and developing the annual environmental health report format. RESULTS: This process of writing the annual report has proved to be difficult. First, we share land and jurisdiction with several other agencies. There are two counties and nine townships that also lay claim to the jurisdiction and land held within the boundaries of the reservation. Secondly, there is very little data specific to Oneida tribal members living on the Oneida Reservation. For reporting purposes, both the county health departments, and the Oneida Community Health Center, collect data for Native Americans/Alaska Natives, not specifically Oneida tribal members. CONCLUSIONS: Although the annual environmental health report is not complete, it has accomplished several things; A better relationship between the Oneida Community Health Center and the Environmental, Health & Safety Division. We now understand a little bit more about each other, and will be able to collaborate more effectively in the future. The report has generated a lot of discussion about what data is critical for us, and what s not. For example, we have confirmed that collecting airshed data is not a priority for us. In addition, we will work with the Oneida Community Health Center to improve some of the environmental health information system coding for foodborne illness and preventable injuries. The project was successful in that we now have a format for annual reporting, and that many data gaps were identified.

10 LEADERSHIP DEVELOPMENT OPPORTUNITIES: Jennifer Falck, R.S., MPA What has struck me most about this past year, has been meeting environmental public health professionals from all over the country, and learning about their struggles. It has been invaluable to me to reaffirm that other professionals have the same challenges I face. I will continue to foster these relationships and hope the Institute continues to develop ways for graduates to network. The focus of my Leadership Plan as stated, was to improve my diversity skills. What that has come to mean- is that I want to seek out colleagues and professionals that don t always agree with me, and I want to be more effective at communicating with them. In the past year I have begun to participate with teams I hadn t previously worked with, and I have invited people to my project team who provide different perspectives to the work I do.

11 ABOUT THE EPHLI FELLOW Jennifer is an Oneida Tribal member, and works for the Oneida Tribe s Environmental, Health & Safety Division (EHS), as its Environmental Health Supervisor. She currently manages the Environmental Health Program and the Injury Prevention Program. She has worked for EHS for 11 years. For the past 2 years, her daily work has focused on program evaluation and implementing success indicators and measures for the EHS Division. She graduated from the University of Wisconsin- Stevens Point with a B.S. in Integrated Natural Resource Management. She received a Master s In Public Administration from the University of Wisconsin-Oshkosh in May In 2005, the Indian Health Service awarded Jennifer the Bemidji Area s Environmental Health Professional of the Year Award, representing all tribal environmental health professional in Wisconsin, Michigan, and Minnesota. She has represented the Bemidji Area at the national level, and has lobbied in Washington, D.C. on behalf of the 34 tribes she represents there. Jennifer would like to thank her colleagues, her husband, and the Oneida Tribe for the opportunity to participate as an EPHLI fellow.

12 REFERENCES 1. Carl Osaki, RS, MSPH. Northwest Center for Public Health Practice, 10 Essential Environmental Health Services. 2. CDC NOW: Health Protection Goals. 3. Environmental Health Competency Project: Recommendation for Core Competencies for Local Environmental Health Practitioners.