State Category: Florida

Q/A with Celeste Philip, MD, MPH Surgeon General and Secretary of the Florida Department of Health

This was published in Ready or Not? 2017.

TFAH: What are state public health responsibilities before a storm?

Dr. Philip: The Florida Department of Health (DOH) is designated as the lead agency for State Emergency Support Function 8 (EFS8), health and medical services. DOH coordinates the availability and staffing of special needs shelters; supports patient evacuation; ensures the safety of food and drugs; provide critical incident stress debriefing; and provides surveillance and control of radiological, chemical, biological and other environmental hazards.

DOH administers two statewide preparedness grants to build local capacity within the public health and health care community. The federal Public Health Emergency Preparedness (PHEP) grant supports all 67 county health departments (CHD) and public health laboratories in developing community preparedness, epidemiological surveillance and investigation, and medical countermeasure delivery. The Hospital Preparedness Program (HPP) funds 10 health care coalitions to build capabilities for medical surge, continuity of health care delivery, and preparedness partnerships among local health care partners.

TFAH: What are state public health responsibilities after a storm?

Dr. Philip: ESF8 assesses and stabilizes the public health and medical system; supports the ongoing sheltering of persons with special medical needs; coordinates patient movement and evacuations of health care facilities; conducts public health messaging; monitors, investigates and controls any threats to human health; and coordinates disaster behavioral health services with a sister agency.

During Hurricane Irma, ESF8 assisted with 76 patient movement missions that supported the transport of hospital, skilled nursing facility and assisted living facility clients. We conducted more than 1,000 post-impact facility inspections and more than 2,600 tests of public and private water systems and operated 113 special needs shelters.

TFAH: How do state health departments coordinate the public health response to a major storm?

Dr. Philip: Preparedness and response are driven by local leadership, personnel and assets. In Florida, each CHD coordinates and works directly with their local Emergency Management to meet the preparedness and response needs of their community. If the county Emergency Operations Center (EOC) cannot meet the local need, they request assistance through the state EOC via a web-based system that allows us to track and ensure completion of mission requests.

Based on these mission requests, the state ESF8 assesses regional and state assets. If the requested resources are not available in-state, ESF8 next looks to resources available from other states through the Emergency Management Assistance Compact (EMAC), or, in the case of a declared state of emergency, potential federal assets such as Disaster Medical Assistant Teams.

TFAH: Why are federal investments in public health critical on an ongoing basis?

Dr. Philip: During a major event, we are often shoulder-to-shoulder with our federal partners in the state EOC.  This includes representatives from HHS, ASPR, and also FEMA who help to coordinate any requests we make for federal assistance.

Federal investment is critical for building a public health infrastructure that has the capacity to prepare for and recover from weather and other hazardous situations. If states are better prepared to respond, requests for federal assistance may be lessened.  With the close succession of Hurricanes Harvey, Irma, and Maria, and wildfires in California, federal response agencies had to sustain their efforts across time and location which may not be feasible in the future.

TFAH: What federal programs and supports are critical for preparedness and response?

Dr. Philip: Both the PHEP and HPP statewide preparedness grants are important for public health preparedness and response. Preparedness programs in various HHS agencies hold meetings that provide training and networking opportunities for states.

TFAH: What is needed from the federal government to improve preparedness and response?

Dr. Philip: Knowing and having a relationship with our federal counterparts that will be deployed to the state EOC improves communication and manages expectations more effectively. A federal system that allows for tracking of deployed assets would improve situational awareness and real-time decision-making.

Better coordination of credentialing health care professionals between states would be helpful for patients who evacuate with their provider and for providers coming into disaster areas.

Streamlined and flexible funding to allow for nimble response as needed would greatly enhance public health’s ability to be effective.

TFAH: What lessons did you learn from the most recent storm? Was there anything different or new that happened?

Dr. Philip: Hurricane Irma posed a unique challenge because the track was very unpredictable, meaning that more hospitals decided to evacuate and more residents decided to shelter. This storm at some points was 500 miles wide – which exceeded the width of our state. And, personnel could not be moved around in advance of the storm as the track changed to support other counties in the new path. EMAC, federal and contracted assets were mobilized to support sheltering operations but some counties had to wait until the storm passed to receive additional staffing.

Because of the surge in last minute registrations to special need shelters, comprehensive planning and placement for each registrant could not be conducted resulting in the shelter having to accept clients with medical needs that exceeded the shelters’ level of care capacity.

Moving forward, we recognize a need to anticipate future storms that may impact much, or all of the state, a scenario not contemplated prior to Hurricane Irma. For DOH, statewide emergency response efforts could be bolstered by improving planning for our special needs residents, including better training and increased collaboration with other state agencies and the private sector to support Floridians with special needs.

Nemours Children’s Health System

Nemours is an integrated pediatric health system committed to improving the health of children. Established in Delaware in 2004, Nemours Health & Prevention Services were first created to help children grow up healthy by integrating treatment and prevention of illness. They work with community partners to influence policies and practices to improve children’s health. Through family-centered care in children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania, and Florida, as well as world-changing research, education, population health, and advocacy, Nemours fulfills the promise of a healthier tomorrow for all children — even those who may never enter the doors. The work is financed by Nemours operating budget and with limited external grants. To read more about this innovative program, see this brief two-page summary [link].

Improving the Health of Communities by Increasing Access to Affordable, Locally Grown Foods

BY MICHEL NISCHAN, CEO and Founder, Wholesome Wave

When my son was diagnosed with type 1 diabetes, I became painfully aware of the direct connection between food and health. As a chef, this realization caused me to transform the way I fed my family and customers. Fresh, nutrient-dense, locally grown foods became the foundation for the type of diet that would give my son and restaurant guests the best long-term health.

Quickly, though, I recognized that not every family can afford to purchase healthy foods. As a result, I founded Wholesome Wave in 2007.

Wholesome Wave is a 501(c)(3) nonprofit dedicated to making healthy, locally and regionally grown food affordable to everyone, regardless of income. We work collaboratively with underserved communities, nonprofits, farmers, farmers’ markets, healthcare providers, and government entities to form networks that improve health, increase fruit and vegetable consumption and generate revenue for small and mid-sized farms.

Double Value Coupon Program

In 2008, we launched the Double Value Coupon Program (DVCP), a network of more than 50 nutrition incentive programs operated at 305 farmers markets in 24 states and DC. The program provides customers with a monetary incentive when they spend their federal nutrition benefits at participating farmers markets. The incentive matches the amount spent and can be used to purchase healthy, fresh, locally grown fruits and vegetables.

Farmers and farmers’ markets benefit from this approach, and have been key allies as we work towards federal and local policy change.  In 2013, federal nutrition benefits and DVCP incentives accounted for $2.45 million in sales at farmers’ markets.

Communities also see an increase in economic activity.  The $2.45 million spent at local farmers’ markets creates a significant ripple effect. In addition to the dollars spent at markets, almost one-third of DVCP consumers said they planned to spend an average of nearly $30 at nearby businesses on market day, resulting in more than $1 million spent at local businesses. We also see that the demographics of market participants are more diverse – our approach breaks down social barriers and allows consumers who receive federal benefits to be seen as critical participants in local economies.

Equally as important, people are eating healthier. Our 2011 Diet and Behavior Shopping Study indicated 90 percent of DVCP consumers increased or greatly increased their consumption of fresh fruit and vegetables – a behavior change that continues well after market season ends.

Today, the program reaches more than 35,800 participants and their families and impacts more than 3,500 farmers. Combined with the new Food Insecurity Nutrition Incentives Program in the latest Farm Bill, this approach is now being scaled up with $100 million allocated for nutrition incentives over five years.

Fruit and Vegetable Prescription Program

We developed the Fruit and Vegetable Prescription Program (FVRx) to measure health outcomes linked to fruit and vegetable consumption. The four to six month program is designed to provide assistance to overweight and obese children who are affected by diet-related diseases such as type 2 diabetes. In 2013, the program impacted 1,288 children and adults in 5 states and DC. Nearly two-thirds of the participants are enrolled in SNAP and roughly a quarter receive WIC benefits.

The model works within the normal doctor-patient relationship.  During the visit, the doctor writes a prescription for produce that the patient’s family can redeem at participating farmers’ markets. The prescription includes at least one serving of produce per day for each patient and each family member – i.e., a family of four would receive $28 per week to spend on produce. In addition to the prescription, there are follow-up monthly meetings with the practitioner and a nutritionist to provide guidance and support for healthy eating, and to measure fruit and vegetable consumption.  Other medical follow-ups are performed, including tracking body mass index (BMI).

FVRx improves the health of participants. Forty-two percent of child participants saw a decrease in their BMI and 55 percent of participants increased their fruit and vegetable consumption by an average of two cups. In addition, families reported a significant increase in household food security.

Each dollar invested in the program provides healthier foods for participants, boosts income for small and mid-sized farms and supports the overall health of the community. As with the DVCP, there are benefits for producers and communities.  In 2012 alone, FVRx brought in $120,000 in additional revenue for the 26 participating markets.

In less than seven years, Wholesome Wave has extended its reach to 25 states and DC and is working with more than 60 community-based organizations, community healthcare centers in six states, two hospital systems, and many others. Our work proves that increasing access to affordable healthy food is a powerful social equalizer, health improver, economic driver and community builder.

Wholesome Wave is working to change the world we eat in. As the number of on-the-ground partners increases, we get closer to a more equitable food system for everyone.  This means healthier citizens and communities, and a more vibrant economy nationwide.