Holding Course for Health Impact:

The year 2019 marks an exciting leg of Delaware’s voyage to health improvement. The Delaware Division of Public Health (DPH) recently released a summary of the Delaware State Health Needs Assessment (DSHNA) and Delaware State Health Improvement Plan (DE SHIP) Recommendations Report.¹ This iteration of the DE SHIP charts four priority areas for Delaware’s health needs, and launches fourteen recommendations for addressing them.

The DSHNA identified four areas of priority focus:

• Chronic Disease

• Maternal and Child Health

• Substance Use/Misuse

• Mental Health

Fourteen recommendations were provided in the DSHNA to address priority areas:

• Reduce obesity by promoting healthy diet and exercise

• Increase access to healthy foods

• Improve the built environment

• Promote access to remote patient monitoring for those with chronic conditions

• Increase access to community health workers and care coordination

• Reduce lung disease (e.g. asthma, lung cancer, chronic obstructive pulmonary disorder)

• Increase the number of primary care physicians in underserved areas

• Increase the number of Medicaid dental providers in underserved areas

• Develop a focused effort to “make the healthy choice the easy choice”

• Embed education for pre- and inter-conception care in schools

• Reduce tobacco and tobacco-substitute use

• Reduce substance use

• Improve access to behavioral and mental health services

• Adopt a Policy, Systems, and Environmental (PSE) change approach to promoting health in all policies, incorporating a social marketing approach, and addressing the social determinants of health (DPH 2018).

These points were collectively charted by SHIP stakeholders, key informants, and community residents and leaders across Delaware through community meetings, brainstorming sessions, telephone interviews, surveys, and other assessment activities.¹ Inclusiveness is a critical and ongoing part of the SHIP process.² While government public health agencies such as the DPH are the backbone of a state public health system, they do not and must not work alone. To effectively shape health outcomes, they must build and maintain partnerships with other organizations and sectors, including communities and community based organizations, faith-based organizations, the health care delivery system, the education sector and academia, business, the media, housing, criminal justice, planning and land use, public safety, transportation agencies, and more.²

According to the Association of State and Territorial Health Officials, a SHIP is not designed to assess the performance of any one agency or program, but the state’s overall health system performance with the goal of quality improvement.² The National Public Health Accreditation Board explains that the purpose of a state health improvement plan is to “describe how the health department and the community it serves will work together to improve the health of the population of the jurisdiction that the health department serves. The community, stakeholders, and partners can use a solid SHIP to set priorities, direct the use of resources, and develop and implement projects, programs, and policies.”³ Therefore, the DE SHIP is not only a plan for DPH implementation, planning, and evaluation, but a system-wide guide for how organizations and sectors working across the state can partner to strengthen system capacity, align and move in common directions, and ultimately improve the health of the state’s population.

In 2013, the first cohort of health departments were accredited by the Public Health Accreditation Board (PHAB), a group formed in 2007 for the purpose of “improving the quality and performance of state, county, tribal, and territorial health departments in the United States.”³ Some evidence suggests PHAB’s mission has helped affect positive change.⁴ In a recent survey of accredited health departments, 90% said that accreditation stimulated greater accountability and transparency.⁴ Kaye Bender, PHAB President & CEO, refers to these as, “progressive, futuristic health departments” that “strive to use national performance standards and measures and peer review to hold themselves accountable for that journey toward excellence.”⁵ The first DE SHIP was published in 2014, and was a key component and required prerequisite for Delaware’s successful application for National Public Health Department accreditation in 2016.⁶ During a March 2016 site visit, PHAB noted in their report that Delaware had an increased focus on evidence-based practices and the widespread involvement of senior managers in learning collaboratives; partnerships that include universities and community partners, and robust quality improvement projects. PHAB summarized that, “these efforts hold great promise for Delaware affecting the health outcomes for the citizens of the state.”⁷

In terms of healthy system planning, Delaware aims to produce a SHIP at least every five years, incorporating stakeholder input at every phase. The identification phase included a statewide health needs assessment, and was followed by a planning phase.¹ With the recent dissemination of the 2018-2023 Delaware State Health Assessment and State Health Improvement Plan, Delaware has now fully moved into the action cycle, and is beginning to address the objectives laid out in the planning phase. Toward this effort, DPH contracted with the Partnership for Healthy Communities at the University of Delaware, working in collaboration with the Delaware Academy of Medicine/Delaware Public Health Association, to assess and communicate SHIP implementation progress to date, help identify and address gaps, and participate in engagement and assessment activities. Current emphasis includes dissemination of the plan, deliberate communication around the priority areas, and an effort to further engage stakeholders. Success requires the continued engagement of people and groups across disciplines, sectors, communities and organizations at every level across the state.² Several stakeholders highlighted in this issue of the Delaware Journal of Public Health have begun to share how their respective organizations or coalitions have aligned with the DE SHIP’s statewide goals and objectives. Articles in this issue highlight progress and milestones achieved in helping improve population health, explore shared SHIP priorities and objectives among diverse stakeholders, discuss gaps and opportunities for improvement, and describe plans and considerations for the future.

While we have just embarked on our latest SHIP journey, it is without question that having “all hands on deck” and working in a coordinated and unified fashion will help us collectively sail in the right direction. That said, Delaware’s SHIP is also a dynamic document and is expected to be updated and refined over the next five years. Annual reports will be issued, and stakeholder input will be solicited at SHIP statewide meetings and through regular communications between such events. As the work continues, the SHIP team will continue to invite and involve partners to come aboard, encourage all partners to make a clear commitment to improving the health of Delaware residents through engagement and alignment with the SHIP, and work collaboratively to stay the course for improved health outcomes. To learn more or share information about the role your community or agency plays in helping Delaware get in “shipshape,” please go to www.delawareship.org or contact Noel Duckworth, SHIP Project Manager, noel@udel.edu.

What’s Your Role in Delaware’s SHIP?

Some of the organizations and sectors involved in a state’s health system include:

• Healthcare providers such as hospitals, community health centers, mental health organizations, nursing homes and rehabilitation centers;

• Public safety organizations such as police, fire and emergency medical services;

• Human service and community-based organizations such as food banks, community gardens, public assistance agencies, and transportation providers, which assist people to access healthcare and receive other health-enhancing services;

• Educational and youth development organizations such as schools, faith institutions, youth centers, and other youth-serving groups and organizations;

• Recreational and arts-related organizations that contribute to the physical and mental well-being of the community and those who live, work, and play in it;

• Economic and philanthropic organizations such as employers, community development organizations, zoning boards, and community and business foundations that provide resources necessary for individuals and organizations to survive and thrive in the community;

• Environmental, violence-prevention, social justice and advocacy agencies or organizations which contribute to, enforce laws related to, or advocate for a safe and healthy environment. (National Association of County and City Health Officials, 2013)