Promoting the health of our community is an important goal that is shared by members of our Healthy Capital District Initiative (HCDI). This initiative involves a sponsoring committee made up of the local health departments, hospitals, community health centers, health care insurers, and medical societies of the three counties in the Capital Region of New York State. The New York State Department of Health has been a supportive partner as well. The opportunity to participate in the Turning Point program has strengthened our collaborative effort and enables us to plan for sustainable systems change that will improve the health of our community.

We remember well the national debate on health care reform that started in 1993. Since then, health care delivery systems have undergone dramatic changes despite the lack of an adopted national health care policy. Even prior to those national discussions, many states were considering and implementing their own reform plans to address the growing concerns about health care access, quality, and costs. The importance of a strong public health system seemed to be missing in many of those discussions. In New York State, there has been a shift to an unregulated rate-setting process for Medicaid, an expansion of managed care, and an ambitious move toward Medicaid Managed Care that have led to changes in our local health care system. These changes have affected the delivery of public health services and have led to some thoughtful discussions about which services are essential, how they should be delivered, and by which entities.

Creating Public Health Partnerships

The changing health care marketplace has indeed created opportunities for the field of public health to examine its role and to establish new linkages. The Albany County Health Department (ACHD) was once a direct provider of pediatric and obstetrical services, primarily for under-served and Medicaid populations. The changes in the health care system have led to a "Partnership for Healthier Communities" that enabled the ACHD to strengthen its public health outreach and enabling services by divesting of the direct delivery of medical care. This was done through collaborative agreements with major health care providers in the tri-county area. Our health department and hospital partnership is included as a case study in an important reference entitled Medicine and Public Health: The Power of Collaboration that was recently published by the New York Academy of Medicine. As stated in the monograph, partnerships can indeed be powerful enough to make meaningful improvements in the health of our communities.

HCDI is an outgrowth of our health department and hospital partnership. Following a report by the New York State Public Health Council that identified twelve statewide priority areas for public health action, the HCDI developed into an unprecedented community approach to improve the health of the citizens within the Capital District counties of Albany, Rensselaer, and Schenectady through community health assessment, prioritization, and planning. HCDI has brought leaders in health care together with the three county government officials to form a team that can collaboratively implement this regional health improvement program. The University at Albany School of Public Health and the Council of Community Services have been key partners as well, providing expert technical assistance and consultation, and the Community Foundation of the Capital Region has provided some valuable financial resources.<

The Impact of Turning Point

The opportunity to participate in the Turning Point grant is very important to our initiative. First, as with most projects, funding is vital to successful planning and implementation. Second, Turning Point provides us with access to expertise from its staff and contact with colleagues nationwide who are Turning Point participants. This second point may be the more valuable component to us. By drawing upon the breadth of experience of our fellow Turning Point colleagues, we will be in a better position to transform and strengthen our own health care and public health system. Third, an intangible benefit we have noted is that our planning and sponsoring committees, already enthusiastic about our healthy community initiative, have been further energized by the opportunity to participate in the national Turning Point program. Finally, our participation in Turning Point adds another dimension of accountability as we move ahead with our proposed activities and the implementation of our future recommendations. We are committed to moving beyond the planning stage. Having access to seed planning and implementation funds allows us to complement existing community assets in the most cost-effective manner to increase our chances of long-term success.

For HCDI, the timing of the grant from Turning Point could not be better. The planning activities are now in full swing as we enter the first year of Turning Point. The goals and objectives of our local Turning Point initiative also coincide well with a statewide strategic planning process that is currently underway which will, in part, recommend revisions to the regulations that define and fund the assessment, planning, and delivery of public health services in New York State.

Though the future is never certain, our vision is clear. In these times of change, it has been said that we are at a crossroads, a turning point, and we eagerly set out in new directions. We look forward to sharing our experiences and hearing from other Turning Point participants who are thoughtfully deliberating about public health in the new millennium.

James Crucetti is the Commissioner of the Albany County Department of Health. Thomas Morris is a Preventive Medicine resident at the University at Albany School of Public Health/New York State Department of Health. Joseph Pofit is the Vice President for Strategic Planning at Mercycare/St. Peter's Hospital. All three of these individuals and organizations are active participants in the Healthy Capital District Initiative, one of three local-level Turning Point grantees in the State of New York.