Making Prevention Work on a Budget: An Integrated Approach for Local Health Departments

For many years, population-level prevention was weakened by siloed funding streams, competing agendas, resources primarily dedicated to treatment, and a lack of consistent focus on evidence based strategies. With the emergence of the National Prevention Strategy and key national prevention initiatives like Let's Move, the recognition and role of prevention is changing. Traditional approaches to prevention and wellness that focused on addressing one condition or risk at a time or focused solely on counseling and education are becoming passé, and the field of public health is moving toward integrated programs and policies that address the “upstream” and interrelated reasons why people get sick in the first place. One locality that has championed a unique and integrated, prevention-focused approach to health and wellness is Marin County, California. The Department of Health and Human Services (HHS) Administrator, responding to an era of diminished funds, staffing and other resources, established a priority on developing an integrated, sustainable approach to prevention. Key prevention staff came together and formed a new Prevention Hub, an inter-departmental initiative that pools resources and talent of all six divisions within HHS: Public Health; Alcohol, Tobacco & Other Drugs; Social Services; Mental Health; Aging/Adult Services; and Policy & Planning. This presentation will include an overview of the purpose of the Hub, how it was developed, and how it is organized, funded, and staffed. A description of factors that have contributed to the Hub's success, including blended funding approaches, sustained leadership commitment, and leveraging of new and existing community partnerships, will be discussed. Key initiatives led by the Hub will be presented that demonstrate the benefits of blending prevention topics and strategies. Recommendations for similar localities to develop and sustain this model will be described.