Building Public Health Programs for All: A Policy Approach in New York

The best way of ensuring access and integration for people with disabilities is involving people with disabilities in early conversations that matter, according to Theresa Paeglow, program manager, Disability and Health Program, New York State Department of Health. In that way, the needs of people with disabilities are built into program design and implementation, rather than being layered on top in the form of program modifications or additional services and components. It’s like building a house based on universal design versus building a typical home and adding lifts, ramps and other structural accommodations later.

Since 2009, all Requests for Proposals/Applications (RFP/A) issued by New York’s Department of Health’s Center for Community Health (CCH) have been required to reflect the needs of people with disabilities and minorities. The policy was extended to the Department’s AIDS Institute in March 2010.

The CCH’s inclusion policy is working. Program procurement considers the needs of people with disabilities throughout the funding life cycle. To ensure all runs smoothly, Disability and Health works with other programs throughout the procurement process, ensuring they have the data and resources they need to attract applications that meet the needs of people with disabilities.

As part of this process, Disability and Health also helps programs develop a scoring protocol for the review process, which reflects the policy’s intent. Bringing all these pieces together can both improve and sustain access and integration in public health programs and services.

So what does the process look like?

An RFA/RFP has three basic components: statement of need/background, work plan (strategies and methods), and evaluation. Applicants must integrate people with disabilities into every section. In the need section, the RFA must identify people with disabilities as a priority and present data on health disparities or underserved status.

In the work plan, the applicant describes its methods for achieving the intent of the RFA, and the description must explain how people with disabilities will be integrated into the program or service. In the evaluation, the applicant explains how it will achieve the integration and outcomes outlined in their work plan. The inclusion policy directs programs to capture disability-related elements in the scoring criteria for the review tool.

The goal is to encourage respondents to think carefully both about the needs of people with disabilities and about how the project can ensure integration. For example, all CCH programs must consult with Disability and Health to develop procurements that build in integration and accessibility for people with disabilities. The procurement process takes an average of 20 months, so projects funded under the inclusion policy are really just getting off the ground, but Disability and Health is monitoring developments carefully.

The CCH houses all public health programs in four divisions: Chronic Disease, Family Health, Nutrition and Epidemiology. The divisions include 24 bureaus and more than 150 programs. There are multiple procurements within programs and multiple contracts funded within each procurement. The CCH has approximately 3,100 contracts for public health programs and services, with an annual aggregate value of $1.3 billion

Since the policy’s effective date, Disability and Health has worked on the development of 20 procurements. Seventeen of these have been released and eight have executed contracts. Review and selection are complete in nine of the procurements, which are in various stages of the approval process. Three RFAs are still pending release. Program areas include obesity, cancer services, tobacco, reproductive health, asthma, adolescent pregnancy prevention, worksite wellness, nutrition outreach and food security. Once these 20 procurements are finalized, they will support 330 contracts with an annual aggregate funding of $123.5 million.

In working with programs in the procurement development process, Disability and Health determines whether previous procurements included a disability focus. To date, only one — osteoporosis — had recognized people with disabilities as a priority. So the inclusion policy represents an enormous shift of attention to a population that has been largely overlooked in the past.

What happens after projects are funded?

Given that resources are so scarce, Disability and Health focuses its post-procurement support on funded initiatives that reside in its “home” — the Bureau of Community Chronic Disease Prevention. In addition to the Disability and Health Program, the bureau houses the Obesity Prevention Program, Diabetes Prevention and Control Program, Healthy Heart Program, Asthma Program and Healthy Communities initiative.

There is a considerable time lag between recipient selection and contract execution. During this interval, the programs prepare to oversee the work of new contractors. After contract managers are assigned, Disability and Health provides technical guidance. For example, for the Creating Healthy Places to Live, Work and Play, Disability and Health demonstrated how the required strategies should address disability. Paeglow participates on the Leadership Team for all initiatives funded within the Bureau. Programs and contract managers know that Paeglow is always available for guidance, and she checks in with them on a quarterly basis, regularly reviewing contractor progress reports to troubleshoot and keep abreast of progress.

Disability and Health offers educational opportunities for all contractors involved in the initiative. The program recently held a webinar targeted to Creating Healthy Places to Live, Work and Play contractors — yet open to all interested parties — on accessible trail design and development, and is currently planning two additional webinars on accessible gardening and serving people with visual impairments.

Creating Healthy Places to Live, Work and Play initiative

One of the first procurements released under the Inclusion Policy was Creating Healthy Places to Live, Work and Play. The aims of the initiative are to prevent obesity and type 2 diabetes by implementing policy, systems and environmental changes that step up physical activity and encourage healthful eating. Policy, systems and environmental changes are the fundamentals of CDC Director Dr. Thomas Frieden’s public health framework — population-wide changes that make the healthy choice the default choice, such as schools serving only low-fat or skim milk.

Twenty-two New York counties are funded under the Creating Healthy Places to Live, Work and Play initiative, and five-year project periods began October 1, 2010. Total annual funding is roughly $4.3 million.

The Creating Healthy Places to Live, Work and Play RFA prescribed 20 strategies, which fell into four categories:

  1. Increase the availability of places to be physically active
  2. Create community landscapes that are conducive to physical activity
  3. Increase the availability of fresh fruits and vegetables
  4. Increase the healthful quality of foods offered for sale

One strategy is creating, improving and/or promoting neighborhood trails and enhancing the “streetscape.” Others include introducing community gardens and establishing grocery stores in food deserts — areas lacking sufficient fresh and healthy food.

A Closer Look: Select Creating Healthy Places to Live, Work and Play contractors

North Country Healthy Heart Network/Rural Action Now
This contractor is helping to strengthen the Master Trails Plan for the Village of Saranac Lake in Adirondack Park, a highly travelled recreation area. North Country Healthy Heart Network/Rural Action Now ensures that each trail plan considers accessibility, trail surface and other elements to enable people with disabilities to navigate the trail. Each trail plan identifies needs and prioritizes actions, which are now part of the master plan.

North Country Healthy Heart Network/Rural Action Now has done important work around the Complete Streets concept, which requires transportation planners and engineers to consistently design and operate the entire roadway with all users in mind — including people with disabilities.

To ensure that these projects receive the right input, North Country Healthy Heart Network/Rural Action Now engages local independent living centers and others with disabilities. For example, the cover of its Complete Streets guide displays an image of someone who is blind, shows the proper sidewalk width, and addresses cross slopes and potential obstacles along travel routes.

North Country Healthy Heart Network/Rural Action Now advocated for the creation of the “Healthy Infrastructure Advisory Board,” which addresses support for healthy lifestyles in their community and includes people with disabilities. The board’s bylaws specifically call for the inclusion of people with disabilities.

Glens Falls Hospital
Glens Falls Hospital, which operates in Warren and Washington counties, is educating builders, homeowners, code enforcement officers and others about universal design and aging in place. They focus first on the home environment and have partnered with the Tri-County Housing Taskforce.

The hospital is also partnering with its local independent living center on several activities, such as attending planning board meetings (trying to pass visitability) and is considering collaborative learning opportunities with Lowes and Home Depot. It plans to conduct a series of seminars with the target audience in spring 2012. To start conversations with its audiences, the Glens Falls Hospital developed a two-page pamphlet introducing the principles of universal design and the basic elements of visitability, along with the improvements in quality of life these design principles can deliver to a community.

Also in the works is a parks revitalization plan to make all parks in Glens Falls accessible over the next three years and a plan for complete streets in three towns or villages.

Cayuga County Health and Human Services
Cayuga County Health and Human Services focuses on Auburn’s transportation system. The contractor is trying to develop a more diverse panel of options for public transportation and integrating access in those plans, again with input from local independent living center. It is also developing a new recreational trail in the town of Montezuma.