NEWS

Note: For a list of North Carolina counties
involved in the academy, see end of release.

UNC academy teaches public health officials to manage, generate revenue, like business pros

CHAPEL HILL -- On one side: public health officials grappling with all manner of threats, new and old, that require fast, decisive action: SARS, bioterrorism, AIDS, hurricanes, floods and more.

On the other: governments strapped for cash and forced to slash budgets. But whether the money is there or not, health officials must respond when the threat of an epidemic arises.

Such unforeseen and unbudgeted emergencies can require screenings, inoculations and other potentially expensive operations. They also require health professionals who know medical and environmental sciences inside-out to think, instead, like CEOs with master’s degrees in business and years of management experience.

"Nothing requires strategic thinking today as much as public health, with all the outbreaks that can occur," said Dr. Jim Johnson, business management professor and co-director of the Management Academy of Public Health at the University of North Carolina at Chapel Hill.

Designed and operated by UNC’s Kenan-Flagler Business School and School of Public Health, the academy is the first and only such training program in the country. It seeks to help public health officials deal with the difficult issues they face today by teaching them management skills including finance, delegation, motivation and decision-making. They also write business plans with the help of UNC coaches, seek funding from foundations or other sources and execute the plans in their jurisdictions, aiming to generate new revenue while also improving public health.

With the start of a new class this week (July 27-Aug. 1) of 97 officials from three states, the academy begins a new life at UNC as a program endorsed and partly funded by the Centers for Disease Control and Prevention, which hopes to replicate the academy nationwide.

The CDC’s interest stems from the resounding success of a four-year pilot phase of the academy that ended last spring. Conducted by the two UNC schools, the pilot was funded by private grants and administered by the Centers for Disease Control Foundation, which is related to the CDC but operates independently.

Near the end of the four years, the foundation hired an independent consultant to evaluate the pilot phase. That study found that the pilot spent $2 million to train its first 500 graduates, who then used the training to generate $6 million in revenue for their public health departments.

"It was our belief that this program needs to continue," said Dr. Paul Halverson, a former UNC public health faculty member, who now directs the CDC’s division of public health systems development and research. "We agreed to help support the program with an eye toward expanding it and making it available throughout the country."

The new class comprises teams from 20 public health departments in the Carolinas and Virginia, including representatives of nine North Carolina counties, plus staffers of the National Association of City and County Health Officials. The association’s decision to participate marks an important vote of confidence for the academy, said Dr. Stephen Orton of the School of Public Health, academy manager.

The pilot program graduated 593 public health professionals from four states, including representatives of 19 North Carolina counties, Orton said.

The pilot stemmed from conversations among representatives of the CDC, the U.S. Health

Resources and Services Administration of Rockville, Md., the W.K. Kellogg Foundation of Battle Creek, Mich., and the Robert Wood Johnson Foundation of Princeton, N.J. They thought public health officials, who face increasing varieties of challenges, needed formal management training; they donated $4 million to the CDC Foundation to study the issue. The foundation issued a request for proposals and, in 1999, awarded a grant of $2.8 million to the two UNC schools for the pilot program.

UNC directors thought they had a winner long before the four-year pilot phase was over. Nevertheless, the independent consultant’s findings of an estimated $6 million in revenue bowled them over.

"That was just stunning to us," said Dr. Janet Porter, associate dean for executive education in the School of Public Health and co-director of the academy with Johnson. "It demonstrated that if you make people better managers of limited resources, it can result in increased money back in the community to improve public health."

Each graduate receives a certificate and may earn six hours of credit toward a master’s degree in either public health or business. Each class begins with a week of business study in Chapel Hill. Some teams bring what the academy calls community partners: representatives of their local hospitals, health organizations, social services departments or other related entities.

After the first week, the teams return to work in their home departments but continue to study through online courses, a regional conference and consultation with their coaches. Ten months later, they return to Chapel Hill to present their business plans.

Public health schools are required to teach environmental health, biostatistics, epidemiology, health behavior and health education, policy and administration, plus such specialties as nutrition or child and maternal health, Porter said. In addition, today’s world presents new challenges for study: bioterrorism such as the anthrax cases after 9/11, SARS (Severe Acute Respiratory Syndrome), monkeypox, West Nile virus, mad cow disease and Lyme disease. That doesn’t leave students much time for business courses.

"Many who come here end up in jobs managing people or money," Porter said. "But what they have learned about is disease outbreak and how to test wells."

Functioning like a for-profit business is a revolutionary concept to some public employees, who are used to limiting operations to only what scarce tax dollars can fund.

"Government entities are being asked to do more with less, and there aren’t enough funds coming down from the state and federal levels to meet the needs that are there," Johnson said. "You’ve got these crises that come and no money with which to handle them. You almost have to be entrepreneurial. Ask yourself the question: ‘How do I raise revenue to live up to my mission of protecting the public health?’ "

Profits aren’t taxable as long as the departments immediately use them to provide other services, Johnson said: "In this way, they can subsidize other public health programs that need the money."

Dare County may be on its way to realizing that goal. County public health director Anne Thomas sent two teams to the academy, in 2001 and 2002, and also attended herself. The result: two business plans that won blue ribbons for the best in their class and are under way:

• Peer Power, a health education program of the Dare county schools and health department, aims to promote healthy behavior and reduce chronic diseases. The Kate B. Reynolds Charitable Trust of Winston-Salem gave Thomas’ department $400,000 to run the program, now in its third year, for five years. The department was able to hire two new public health educators who also are certified teachers; they developed curricula for high school students to teach to middle school students, with innovative exercises designed to encourage healthy lifestyles. Students earn academic credit for teaching the course. In the long run, Dare may be able to generate revenue by marketing this program model to other health departments.
  
  
• Miles for Smiles sends a dentist in a van to schools in Dare and parts of Hyde County, combating the statewide shortage of dentists and access difficulties for residents of remote regions in these coastal counties. The van visits schools and serves children 19 and under who are on Medicaid or Health Choice or have little or no health insurance. The latter pay low fees on a sliding scale based on their income. The same Reynolds trust gave Dare another $200,000 to launch Miles for Smiles. Since it began in February, Thomas said, it has billed about $60,000.

It was the promise of management training that convinced Thomas to send her staff to the academy. "But never in my wildest dreams did I think that we would start programs as a result that are

operating and earning revenue and meeting community health needs," she said. She and her staff had the ideas for the two programs, she said, but the academy "encouraged us to develop them, to look at different means to accomplish our goals. It gave us the tools to create a business plan, do financial projecting and think on a larger scale."

During the pilot phase, tuition was free. Now, it is $5,500 per person, or $4,500 if their state sends more than one team. But that didn’t hurt enrollment: 124 applied for the 97 slots in the new class.

Because CDC is supporting some operational costs, Orton said, UNC provided partial scholarships to some teams. But about a third of the students are fully funded by their departments.

"People in public health want to learn how to do their jobs better," Porter said. "We have fabulous word of mouth on the academy. It’s an incredible testimony to the effect of this program that health departments with very limited dollars want to spent it on this opportunity."

Many managers come to the academy overwhelmed by the increasing demands of their field and the traditional confines of public agencies, Johnson said: "Government makes decisions at the speed of dinosaurs, whereas a majority of the issues we face today require immediate action. They require speed, agility and flexibility."

He challenges the managers to rise above the mindset of 20 reasons why they can’t do something and asks, "What are the reasons that you can? You think highly successful people aren’t overwhelmed? Sure they are. This academy is about getting people to think competitively, getting light bulbs to go on."

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Note to editors: Local public health departments and their business plans developed in the academy are available at http://www.maph.unc.edu. N.C. counties with public health officials who have graduated from the academy and produced business plans are: Ashe, Avery, Beaufort, Buncombe, Burke, Chatham, Cumberland, Dare, Davie, Durham, Forsyth, Gates, Halifax, Hertford, New Hanover, Robeson, Stokes, Watauga and Wilkes. N.C. counties with officials attending now are Beaufort, Buncombe, Gaston, Halifax, Northhampton, Person, Pasquotank, Wake and Warren.

Contacts: Dr. Jim Johnson, 919-962-1535; Dr. Janet Porter, 919-966-7356 or 966-2248; Dr. Stephen Orton, 919-966-8125.

News Services contact: L.J. Toler, 919-962-8589.