About the Central New Hampshire Health Partnership

Mission & Overview Public Health Advisory Council (PHAC)Central NH Public Health Network Organizational Structure Region Served Funding

Mission & Overview

The Central New Hampshire Health Partnership (CNHHP) is a collaborative of organizations working to enhance and improve community health and public health-related services throughout the region. The mission of CNHHP is to improve the health and well-being of Central New Hampshire communities by collaborating to optimize prevention, access, and coordination.

Public Health Advisory Council (PHAC)

PURPOSE AND FUNCTION

The role of the Public Health Advisory Council (PHAC) is to advise the Regional Public Health Network (RPHN) by identifying regional public health priorities based on assessments of community health; guiding the implementation of programs, practices and policies that are evidence-based to meet improved health outcomes; and advancing the coordination of services among partners.

The purpose of the PHAC is to perform the following functions:

Identify and prioritize regional community and public health needs.
Encourage the development and coordination of appropriate community and public health services and programs.
Encourage, promote, and support community engagement on public health issues.
Advise the Central NH RPHN members on all major policy matters concerning the nature, scope, and extent of community and public health concerns and responses.

MEMBERSHIP. The PHAC includes a broad membership body that meets at least quarterly. Current membership includes high-level staff representation from partner organizations in the Central NH RPHN.

Central NH Regional Public Health Network

Mission and Overview

The Central NH Regional Public Health Network (RPHN) is a regional collaboration, working to enhance and improve public health-related services within the region. The Central NH Health Partnership (CNHHP) hosts the Central NH RPHN, one of 13 regional public health networks in New Hampshire. Each public health network includes a host agency that convenes, coordinates, and facilitates a broad partnership of organizations and individuals who contribute to or have a stake in the health of their region. Each host agency provides leadership through a regional Public Health Advisory Council (PHAC) and provides a variety of services including Public Health Emergency Preparedness and Substance Misuse Prevention.

The mission of the Central NH Regional Public Health Network is to build a sustainable public health partnership that serves our communities. CADY, Inc. acts as the fiscal agent of the Regional Public Health Network.

What Is Public Health?

Public health is the practice of preventing disease and promoting good health within groups of people– from small communities to entire countries. Public Health is YOUR health. It embodies everything from clean air to safe food and water, access to healthcare and safer communities.

Through public health planning and prevention initiatives, the public gets sick less frequently, children grow to become healthy adults through adequate resources including health care, and our community reduces the impact of disasters by preparing people for the effects of catastrophes such as hurricanes, floods and terrorism.

Public Health Emergency Preparedness & Response

The Central NH Regional Public Health Network (RPHN) provides leadership and coordination to improve the readiness of partners to mount an effective response to public health emergencies and threats. The Public Health Emergency Preparedness initiative of the RPHN includes the maintenance of a regional annex, which includes plans for response to and recovery from public health emergencies that impact communities in the region. CRPHN also works with local Emergency Management Directors to strengthen and develop regional sheltering plans to respond to the needs of the communities during events.

The Central NH region serves approximately 31,000 residents. It is the responsibility of local municipalities to promote health, prevent disease and injury, and provide protection from public health threats. During a crisis, appropriate and prompt response and communication allows the Central NH Regional Public Health Network (RPHN) to work effectively with its partners, engender public trust in its scientifically-based health recommendations, and perform its public health mission.

Regional Coordinating Committee (RCC)

The Central NH Public Health Response must maintain very close coordination and communication with certain agencies and institutions in order to carry out its functions should a public health emergency occur. A critical element of this plan is the integration of public health personnel and information into the emergency planning structure. Therefore, the following agencies and municipalities participate on the Central NH RPHN’s RCC:

Grafton County
Grafton County Dispatch
Mid-State Health Center (MSHC)
Speare Memorial Hospital (SMH)
Pemi-Baker Community Health (PBCH)
Newfound Area Nursing Association (NANA)
Lakes Region Mental Health Center
Plymouth State University (PSU)
Communities for Alcohol & Drug Free Youth (CADY)
Granite United Way, Whole Village Family Resource Center
American Red Cross, Granite Chapter
NH Department of Health & Human Services (NH DHHS)
NH Homeland Security/Emergency Management (NH HSEM)
Starr King Fellowship
Plymouth Congregational Church
Rumney Baptist Church
Becket Family Services
Freudenberg
SAU 2
SAU 4
SAU 23
SAU 48
SAU 68
The Holderness School
Town of Alexandria
Town of Ashland
Town of Bridgewater
Town of Bristol
Town of Campton
Town of Ellsworth
Town of Hebron
Town of Groton
Town of Holderness
Town of Lincoln
Town of Plymouth
Town of Rumney
Town of Thornton
Town of Waterville Valley
Town of Wentworth
Town of Warren
Town of Woodstock

Flu Clinics in Schools

The Central NH RPHN partners with local schools to vaccinate students against seasonal influenza. This program prioritizes schools where children are less likely to be insured or have other barriers to being vaccinated. For more information about this initiative, contact the RPHN Emergency Preparedness Coordinator, Angel Ekstrom, at (603)238-3583 or aekstrom@midstatehealth.org.

Emergency Volunteers

The Central NH RPHN coordinates efforts to recruit, train, and deploy a volunteer Medical Reserve Corps (MRC) during public health emergencies. The MRC supports local emergency responders to provide emergency public health services throughout the region. MRC volunteers include medical, public health, and general professionals. For more information about the Central NH MRC contact Angel Ekstrom (603)238-3582.

Organizational Structure

The concept of a public health system, as described by the Centers for Disease Control and Prevention (CDC), is a complex network of individuals and organizations that have the potential to play significant roles in creating the conditions for health. The component parts of a potential system can improve health individually, but when they work together toward a health goal they act as a true system – a public health system.

The organizational structure of the Central NH Regional Public Health Network (RPHN), with CADY, Inc. as fiscal agent, includes a Public Health Advisory Council (PHAC), a Substance Misuse Prevention (SMP) Leadership Team/Subcommittee, a Substance Use Disorders Continuum of Care (CoC) Leadership Team/Subcommittee, Public Health Preparedness Leadership Team/Subcommittee, with additional subcommittees and workgroups created as needed.

Region Served

The Central New Hampshire Public Health Region includes the towns of Alexandria, Ashland, Bridgewater, Bristol, Campton, Ellsworth, Groton, Hebron, Holderness, Lincoln, Livermore, Plymouth, Rumney, Thornton, Warren, Waterville Valley, Wentworth, and Woodstock. CNHHP serves approximately 30,000 people living in these 18 communities.

Population Demographics

The Central NH Public Health Region has an older population than the state as a whole: 17.7% of our total population is aged 65 years or older compared to 15.3% for the state overall. Central NH’s population is growing, but at a rate slower than New Hampshire overall.

Population Health Indicators

Clinical Care

Access to care requires not only ability to pay and access to insurance, but also access to health care providers. While high concentration of physician specialists has been associated with higher (and perhaps unnecessary) utilization, sufficient availability of primary care physicians is essential for preventive and primary care, and, when needed, referrals to appropriate specialty care. Population ratio to primary care physicians (PCPs) represents the number of individuals served by one physician in a county, if the population was equally distributed across physicians. A lower ratio is better for this indicator, however geographic distribution must be considered in evaluating its impact. While Grafton County ranks at the lowest (most favorable) ratio in the range for New Hampshire, the data belie what we know to be true for our region. There is a misallocation of primary care physicians in Grafton County which translates to a shortage for our Central New Hampshire service area. Because of the concentration of medical resources, including physicians, in the region surrounding Dartmouth Hitchcock Medical Center and other Dartmouth Health affiliates in Grafton County, the population ratio to Primary Care Physicians at the county level is very low. However, Grafton County is large geographically and the residents of our service area are generally located more than an hour from richly resourced medical service hubs, creating a shortage of PCPs and other physicians for our service population.

Social Determinants of Health and Mental Health

Our approach to community health improvement takes a social determinants perspective. Social determinants of health (SDoH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life risks and outcomes. The impact of social determinants on health status and outcomes are far-reaching and well-documented. Environmental conditions also set the stage for our mental health and emotional well-being. Social and economic inequities in our living conditions can be root causes and contributors to mental illness. Some social determinants are “proximal” – environmental and experiential factors that impact our health and mental health directly. These include adverse childhood experiences (ACEs), social inclusion and access to services. Other social determinants are “distal” – they exert their influence indirectly. Distal social determinants of health and mental health apply pressure to the more proximal determinants to create compound affects. Examples of distal social determinants include employment, food security, educational attainment, income equality, and housing stability.

Poverty and Income Inequality

Poverty and income inequality contributes to every domain individual and community health and well-being. The percentage of individuals in the Central NH Public Health Region living with incomes at or below 100% of the federal poverty level (10.6%) is notably higher than the rate for New Hampshire overall (7.9%). In addition, the percentage of households with children headed by a single parent is higher in the Central NH Public Health Region (33.7%) than in New Hampshire overall (28.7%). The median household income in the Central NH Public Health Region is significantly below that for New Hampshire, at $58,383 compared to $74,057 for the state overall.

Income inequality within a community can have broad health impacts, including increased risk of mortality, poor health, and cardiovascular disease. Inequality can accentuate differences in social class and status and serve as a social stressor to youth, families and individuals. Communities with greater income inequality can experience a loss of social connectedness, as well as a decrease in trust, social support, and a sense of community for all residents. Income inequality is measured by the ratio of household income at the 80th percentile to income at the 20th percentile. A higher inequality ratio indicates greater division between the top and bottom ends of the income spectrum.

Education

Level of education has a strong influence on health risk and outcomes in every domain. Individuals with a high school diploma are more likely to have longer life expectancy and improved quality of life. Level of education is related to smoking status, exercise habits, and better physical health including lower rates of diabetes and improved self-reported health. Adults with a high school diploma are more likely to be employed and earn more, on average, than their less educated counterparts. School funding adequacy is a measure of the average gap in dollars between actual and required spending per pupil among public school districts (lower is better). Required spending is an estimate of dollars needed to achieve U.S. average test scores in each district. For Grafton County, our gap in school funding is higher (worse) than NH overall.