The Turning Point Initiative- Planting the Seed

New Hampshire was awarded a two-year planning grant in 1997 through Turning Point: Collaborating for a New Century in Public Health, a program of the Robert Wood Johnson (RWJ) and W.K. Kellogg Foundations. New Hampshire was one of fourteen states originally awarded a grant to transform and strengthen the public health infrastructure in the United States so that states, local communities, and their public health agencies, could respond to the challenge of protecting and improving the public's health in the 21st century.

Related Information
"Public Health Partnerships: A New Hampshire Dance"
Published in the Winter 2002 issue of "Transformations in Public Health", this article describes the role of the Turning Point initiative in the promotion of local, state, and non-governmental organization (NGO) partnerships to achieve shared social goals.

Download »
A New Hampshire Dance
[PDF, 526 KB] Over 250 representatives from state public health agencies, hospitals, health centers, networks and coalitions, schools and academic institutions, businesses, non-profit agencies, the legislature, civic organizations, faith organizations, and foundations met to develop a Public Health Improvement Plan [PDF, 324 KB] for the State of New Hampshire, which outlined priority action areas for the improvement of public health capacity.

The recommendations contained in the Public Health Improvement Plan include policy and operational changes intended to address systemic limitations that were serving as barriers to optimal health improvement. A major finding of the assessment was the lack of an established local public health system. In most of New Hampshire's 234 cities and towns, the only local public health resource is a health officer, often employed as a building inspector with no formal education or training in public health. Thus, police, fire, school nurses and nonprofit health and human service providers fulfill roles typically assigned to local public health officials in other states. Unfortunately, no formal mechanism existed for coordinating the delivery of public health services at the local level among these diverse public health stakeholders.

A key recommendation of the planning process was the development of a community level public health capacity to protect and promote the public's health.

The Public Health Networks- Bearing Fruit

In response, the State of New Hampshire began funding community public health partnership in 2000 to develop models for improving local public health. These partnerships involved a wide variety of stakeholders in the communities working together to address complex public health issues. Four Public Health Networks were funded in 2001 with funds provided by the Robert Wood Johnson Foundation. These four Public Health Networks covered 39 towns and cities, representing 15% of the State's population.

Following the tragic and historic events of September 11th and the anthrax attacks along the east coast, Congress appropriated funds through the Public Health Threats and Emergencies Act to improve the readiness of public health agencies throughout the nation to respond to a bioterrorism attack and other public health emergencies. The New Hampshire Department of Health and Human Services recognized the importance of a strong state and regional public health infrastructure to effectively perform essential public health functions needed to respond to a public health emergency. Priority was given to appropriating a portion of the funding awarded to New Hampshire to expand the Public Health Networks to cover additional communities. With the funding provided by the Centers for Disease Control and Prevention (CDC), the Public Health Networks were tasked with local public health infrastructure development, including emergency preparedness planning. Beginning, in 2006, the State funded Public Health Networks that served all 234 cities and towns.

The Regionalization Initiative- Coming to Maturity

In 2007, it was recognized that maintaining Public Health Networks focused almost exclusively on emergency preparedness would be challenging and that other important public health capabilities were not being adequately addressed from a statewide perspective. A Public Health Regionalization Initiative Task Force was convened with the goal of developing a performance-based public health delivery system, including the provision of all 10 essential services throughout New Hampshire. The task force envisioned a public health system based on national accreditation standards and linked to government. There was consensus that the state would retain certain functions, such as infectious disease investigation and laboratory services and that core staffing and infrastructure was needed regionally to deliver essential public health services through the Public Health Networks.

In 2009-2010, each Public Health Network and their partners conducted an assessment of the regional public health system to gauge improvements since the beginning of the Turning Point Initiative. Three assessments were done in each region: a capacity assessment to identify regional public health assets and gaps that may lend themselves to being regionalized; a governance assessment to gather information on potential governance structures for regional public health and determine the level of readiness in each region to take on this function; and a financial assessment of local and regional public health financial resources.