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4. Proposed Work Plan
<br />HMA’s Understanding of Scope of Services
<br />The COVID-19 pandemic and the resulting community response have elevated community and
<br />public awareness of the role of public health departments. COVID-19 has also increased
<br />expectations for public health departments to address persistent and significant disparities in
<br />health outcomes. COVID-19 has not only caused examination of public health at a broad level—
<br />California’s public health spending per capita has remained relatively flat for the last 10 years,1
<br />but has also generated interest in reassessing existing models for public health delivery. In
<br />Santa Ana, the experience of COVID-19 has accelerated this interest. While Santa Ana
<br />represents approximately 10 percent of the County population, the percentage of positive
<br />COVID-19 cases has ranged from a high of almost one-quarter of the cases (August 2020) to
<br />approximately 17 percent of the cases in April 2021.2
<br />Similar to many jurisdictions in California, the City of Santa Ana is evaluating whether the
<br />existing structure of public health delivery is meeting its residents’ needs and is seeking
<br />proposals from qualified firms to provide a feasibility and fiscal evaluation of a municipal public
<br />health agency. Currently, all public health services for County residents, including Santa Ana,
<br />are provided through the Orange County.
<br />California law stipulates that municipalities 3 have responsibility for public health functions and
<br />that they may delegate this responsibility to counties. Due to the scope of responsibility and
<br />required infrastructure and related costs, most cities have opted to do this. The four notable
<br />exceptions in California are Long Beach, Pasadena, Vernon, and Berkeley.
<br />We understand that the City is interested in comprehensively exploring the operational, fiscal,
<br />and policy implications of alternative models to public health delivery. HMA’s proposed
<br />approach is grounded in the comprehensive experience of our team members working in public
<br />health departments and providing an independent, factual evaluation of the options and
<br />alternatives for the City’s consideration. We will ground our analysis in the experience of peer
<br />municipalities and transparency in key assumptions and drivers.
<br />Core to this project’s success is a comprehensive understanding of public health delivery
<br />systems. Public health department services include a mix of both mandated responsibilities and
<br />additional assumed responsibilities that vary by local context. The table below is reflective of our
<br />understanding of the public health field and these distinctions. Additionally, county government
<br />has broad discretion on the placement of public health within the larger county infrastructure.
<br />County public health functions can operate as an individual county department, as in the case of
<br />Los Angeles County, or as functions embedded within a larger health care agency, as in Orange
<br />and Riverside Counties.
<br />1 "State Health Compare - Per person state public health funding," SHADAC, accessed May 3, 2021,
<br />http://statehealthcompare.shadac.org/trend/117/per-person-state-public-health-
<br />funding#0/6/a/12,14,1,2,3,4,5,6,7,8,15,24,25,27/154.
<br />2 The population of Orange County, California, is estimated at 3,194,332 (2020) and Santa Ana at
<br />335,052. Source: Cal State Fullerton, Center for Demographic Research.
<br />3 ARTICLE 4. City Health Ordinances, Boards, and Officers [101450 - 101475]
<br />(Article 4 added by Stats. 1995, Ch. 415, Sec. 3.). Sect 101450.
<br />The governing body of a city shall take measures necessary to preserve and protect the public health,
<br />including the regulation of sanitary matters in the city, and including if indicated, the adoption of
<br />ordinances, regulations and orders not in conflict with general laws.
<br />(Added by Stats. 1995, Ch. 415, Sec. 3. Effective January 1, 1996.)
<br />EXHIBIT 1
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