Multidisciplinary public health: what sort of victory?

Multidisciplinary public health (MDPH) has been a phenomenon in the UK of the 1990s and the early 21st century. Its achievement has been seen as a victory for non medical interests. While acknowledging this, the paper questions what sort of victory this represents. Public health in its sanitary phase in the mid-19th century was, after all, what passed for multidisciplinary with its mix of engineers, doctors and statisticians. Is the present simply a return to the sanitary phase? The paper argues that it is not, and that contemporary public health badly needs clearer definition. It identifies three dimensions of recent public health. Public health can be an occupation; a discourse or movement, and also an institutional location of which public health research is part. Looked at in this frame, public health has been multidisciplinary in the post war period. The development of public health research out of social medicine in the 1950s was multidisciplinary. Public health campaigning, separate from public health professionals, has also been multidisciplinary since the 1970s. Public health as an occupation has been preoccupied with its professional positioning. Will the wider multidisciplinary impetus of public health now be lost in a preoccupation with status?     

Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance

The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health.     

Spatial aberration vs. geographical substance: representing place in public health surveillance

Public health surveillance involves the routine and ongoing collection, analysis and dissemination of health information for a variety of stakeholders—including both public health officials and the public. Much of the current focus of public health surveillance is on detecting aberrations in space—largely inspired by concerns about bioterrorism and newly emerging infectious diseases. We argue that the current focus on spatial aberrations has limited the development of public health surveillance by excluding a more explicit geographical understanding and representation of place. A more place-focused public health surveillance could represent geography in ways that are useful to a broader audience, provide information on the social and physical contexts related to health, facilitate a better understanding of health inequalities, and can benefit from local knowledge. Geographers can make important contributions to public health practice by contributing to more meaningful definitions of place in the design and operation of public health surveillance systems.     

The impact of globalization on public health: implications for the UK Faculty of Public Health Medicine

BACKGROUND: There has been substantial discussion of globalization in the scholarly and popular press yet limited attention so far among public health professionals. This is so despite the many potential impacts of globalization on public health. Defining public health broadly, as focused on the collective health of populations requiring a range of intersectoral activities, globalization can be seen to have particular relevance. Globalization, in turn, can be defined as a process that is changing the nature of human interaction across a wide range of spheres and along at least three dimensions. Understanding public health and globalization in these ways suggests the urgent need for research to better understand the linkages between the two, and effective policy responses by a range of public health institutions, including the UK Faculty of Public Health Medicine. METHODS: The paper is based on a review of secondary literature on globalization that led to the development of a conceptual framework for understanding potential impacts on the determinants of health and public health. The paper then discusses major areas of public health in relation to these potential impacts. It concludes with recommendations on how the UK Faculty of Public Health Medicine might contribute to addressing these impacts through its various activities. RESULTS: Although there is growing attention to the importance of globalization to public health, there has been limited research and policy development in the United Kingdom. The UK Faculty of Public Health Medicine needs to play an active role in bringing relevant issues to the attention of policy makers, and encourage its members to take up research, teaching and policy initiatives. CONCLUSIONS: The potential impacts of globalization support a broader understanding and practice of public health that embraces a wide range of health determinants.     

A tale of two health literacies: public health and clinical approaches to health literacy

Public health concerns underlie a considerable portion of the global burden of disease, increasing the utility and need for promoting and assessing the knowledge about public health issues. Health literacy is generally agreed upon as a means to find, understand, analyze and use information to make better decisions about health and to ultimately reduce inequities in health. A public health literacy knowledge scale was tested in China, Mexico, Ghana and India. A somewhat unexpected finding, which was that experts 'scored' less on the scale than the general public, led to consideration of differences between clinical and public health approaches to health literacy and their implications. These differences in perspective, for instance consideration of single case effects versus impacts at the societal level, pose significant challenges to developing and assessing health literacy. We suggest that a comprehensive approach to health literacy will include both clinical and public health approaches.     

Patient public involvement (PPI) in health literacy research: Engagement of adults with literacy needs in the co-creation of a hospital-based health literacy plan

Background

People with literacy needs can experience many challenges in accessing, understanding and using health services and health information. Such challenges can adversely impact patient-provider interactions and ultimately, health outcomes. Healthcare providers need to be aware of health literacy (HL) to address the demands of healthcare systems, improve their interactions with communities and patients and promote patient engagement for improved health outcomes.

Methods

This paper reports on a process of patient and public involvement (PPI) with participants in an adult literacy programme acting as PPI contributors to identify priority areas for a local hospital HL action plan and to develop a protocol for a PPI process with other groups. A qualitative community-based participatory research study design informed by principles of PPI was undertaken, drawing on the tools of participatory and visual methods, open discussion and workshop format to facilitate a process of co-creation. Three workshops with six PPI contributors took place to identify issues to be included in the hospital action plan. PPI contributors identified issues and grouped these into priority areas using discussion and ranking procedures.

Results

Key areas prioritised for HL action by the PPI contributors were: verbal communication, emphasising the patient's right to understand, and improved understanding of medication use. These were incorporated into the action plan. The workshop format and process were deemed acceptable to the group and input on improvements will be incorporated into further work in this area.

Conclusion

PPI acts as a lever in the knowledge translation process. Genuine engagement with service users can meaningfully contribute to relevant and sustainable changes to services as well as foster the empowerment of service users.

Patient or Public Contribution

Members of the public with literacy needs actively participated in the co-creation of a HL action plan for a local hospital and in the development of a protocol for a patient and public process for HL research.     

Building healthy public policy

Policies in literacy and health need to address two perspectives: how basic literacy skills influence the health of populations and individuals; and health literacy--the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. There are three potential areas for action to improve literacy and health literacy: the health system, the education system, and within the broader sphere of culture and society. Despite some increasing attention in the last 20 years, low literacy levels remain a major problem in Canada. Policies need to be sensitive to culture, especially among Aboriginal peoples, Francophones and new Canadians. Public policies are needed to: Improve literacy outcomes (for example, support for a pan-Canadian literacy strategy, early childhood education and family literacy programs, and efforts to reduce high school drop out). Improve health literacy (for example, support integrated policy and program development across sectors, integrated research and knowledge translation initiatives, and efforts to build links between literacy and health networks). Reduce disparities by strengthening levels of literacy and health literacy among vulnerable groups.     

Connecting for health literacy: health information partners

This article describes a community-based health information partnership to address health literacy and health information inequalities in marginalized communities. Public health, medical, literacy, and library practitioners promote health literacy through outreach, training, and professional development activities in community settings. They create learning environments for people to develop the necessary knowledge and skills to better understand health information and health policy so they can make decisions concerning personal and community health. Outreach activities focus on visits to neighborhood health centers, health fairs, health exhibits at union meetings and conferences; training programs involve hands-on, peer-led computer classes for people living with HIV and for the general public; and professional development programs connect librarians, health providers, public health workers, and literacy teachers in joint planning and learning. Several learners currently participate in and lead community health education programs and HIV advocacy. The coalition's strength develops from strongly shared objectives, an absence of territoriality, and a core active leadership group.     

Defining Digital Public Health and the Role of Digitization,Digitalization, and Digital Transformation: Scoping Review

BackgroundThe recent proliferation and application of digital technologies in public health has spurred interest in digital public health. However, as yet, there appears to be a lack of conceptual clarity and consensus on its definition.ObjectiveIn this scoping review, we seek to assess formal and informal definitions of digital public health in the literature and to understand how these definitions have been conceptualized in relation to digitization, digitalization, and digital transformation.MethodsWe conducted a scoping literature search in Ovid MEDLINE, Embase, Google Scholar, and 14 government and intergovernmental agency websites encompassing 6 geographic regions. Among a total of 409 full articles identified, we reviewed 11 publications that either formally defined digital public health or informally described the integration of digital technologies into public health in relation to digitization, digitalization, and digital transformation, and we conducted a thematic analysis of the identified definitions.ResultsTwo explicit definitions of digital public health were identified, each with divergent meanings. The first definition suggested digital public health was a reimagination of public health using new ways of working, blending established public health wisdom with new digital concepts and tools. The second definition highlighted digital public health as an asset to achieve existing public health goals. In relation to public health, digitization was used to refer to the technical process of converting analog records to digital data, digitalization referred to the integration of digital technologies into public health operations, and digital transformation was used to describe a cultural shift that pervasively integrates digital technologies and reorganizes services on the basis of the health needs of the public.ConclusionsThe definition of digital public health remains contested in the literature. Public health researchers and practitioners need to clarify these conceptual definitions to harness opportunities to integrate digital technologies into public health in a way that maximizes their potential to improve public health outcomes.International Registered Report Identifier (IRRID)RR2-10.2196/preprints.27686     

Undergraduate public health at 4-year institutions: it's here to stay

Undergraduate public health education at 4-year institutions, those with and without graduate public health education, has grown rapidly during the first decade of the 21st century since the IOM recommended that "all undergraduates have access to education in public health." Much of this growth has been guided by the Educated Citizen and Public Health initiative, a collaboration of arts and sciences and public health educators that encourages introductory course work in public health, epidemiology, and global health plus undergraduate minors and majors in public health. The Educated Citizen and Public Health model, as opposed to existing professional models, envisions core public health education based on the Association of American Colleges and Universities' Liberal Education and America's Promise essential learning outcomes that encourage experiential learning, evidence-based thinking, a global and community focus, plus integration and synthesis. Public health education in this model provides solid generalist grounding for graduate education in public health as well as a range of graduate disciplines from the health professions to international affairs and from law to business. In addition, it helps ensure a broad range of college graduates who understand and support public health approaches. The Healthy People 2020 objective to increase the proportion of 4-year colleges and universities that offer minor or major in public health should help propel additional growth, especially in 4-year colleges without graduate public health education. Integrative curricula designed as part of the reform of undergraduate education provide opportunities to make evidence-based public health approaches available to a large number of undergraduates.     

Health literacy among university students in Greece: determinants and association with self-perceived health,health behaviours and health risks

Background

Health literacy is widely considered as a key determinant of health and a priority in the public health policy agenda. Low health literacy has been associated with poorer health states, broader inequalities and higher health systems’ costs. In the present study we bring into focus the functional health literacy among university students in Greece, researching and assessing mainly their ability to apply basic knowledge in a health context.

Methods

The study was carried out during the period 15–30 April 2013, among a random sample of 1,526 students of 14 Higher Tertiary Public universities and Technological Educational Institutes in Greece. The objective of the study was to assess the functional health literacy among university students in Greece, adopting the short four-item comprehension test of Bostock and Steptoe. Summary statistics, correlations and regressions were used to assess the determinants of health literacy and the association with self-perceived health, health behaviours and health risks.

Results

Economic factors, such as family income, demographic factors, such as gender, and health behaviours and risks, namely consumption of alcohol, smoking and physical workout are associated with the level of health literacy and health status of the participant. While the results of the study are consistent with previous work in this area, several findings worth further research.

Conclusions

Though, health promotion interventions in Greece include health literacy as one of the basic pillars of the public health policy agenda, it is clear, that health literacy needs to become a key policy issue in Greece, mainly focusing in young ages, where healthy (or unhealthy) behaviours are established affecting the health through the life span.     

Health Literacy Research and Practice: A Needed Paradigm Shift

As a field of research, a viable approach to improving health outcomes, and an important area of policy, health literacy has experienced significant growth and considerable evolution since its broad introduction in the 1990s. Despite that history, far too many practitioners, researchers, and policymakers focusing on clinical medicine, health systems, public health, and health policy remain unaware of and unaffected by the best practices of health literacy. While the inherent promise of health literacy is improved health and well-being, the bulk of research has focused on identifying the negative effects of a lack of health literacy. This strategy is a hindrance to further identifying the utility and increasing the uptake of lessons learned about health literacy in government, business, health care systems, and society. The field needs to reverse direction away from that deficit model of health literacy and focus collective efforts on a positive model of how health literacy can and should be prioritized and utilized to improve health at lower costs. This shift from framing health literacy as a problem to proving the viability and strength of health literacy as a solution will present to policymakers a clear choice to either adopt and promote the best practices of health literacy or suffer the consequences of being the leader who ignored a proven, viable solution to the currently unsustainable health care expenditures and ever-increasing burden of preventable disease, disability, and early death.     

Improving organizational capacity to address health literacy in public health: a rapid realist review

Objectives

Despite the growing significance of health literacy to public health, relatively little is known about how organizational capacity may be improved for planning, implementing and sustaining health literacy interventions. This study aimed to connect decision makers in a public health agency with evidence of how organizational capacity may be improved for delivering health literacy services.

Study design

A rapid realist review of published and grey literature was conducted by a partnership between the Public Health Agency of Canada (PHAC) and the InSource Research Group.

Methods

Realist review methodology attempts to understand what works for whom under what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms and their relationship to outcome. This review was completed in collaboration with a reference panel (comprised of a broad range of PHAC representatives) and an expert panel. Literature searching was conducted using three databases supplemented with bibliographic hand searches and articles recommended by panels. Data were extracted on key variables related to definitions, strategies/interventions associated with increased organizational capacity, contextual factors associated with success (and failure), mechanisms activated as a result of different strategies and contexts, key outcomes, and evidence cited.

Results

Strategies found to be associated with improved organizational capacity for delivering health literacy services may be classified into three domains: (1) government action; (2) organizational/practitioner action; and (3) partnership action. Government action includes developing policies to reinforce social norms; setting standards for education; conducting research; and measuring health literacy levels. Organizational/practitioner action relates to appropriate models of leadership (both high-level government engagement and distributed leadership). Innovative partnership action includes collaborations with media outlets, those producing electronic materials, community organizations and school-based programs. Contextual factors for success include positive leadership models, interorganizational relationships, and a culture committed to experimentation and learning. Potential mechanisms activated by strategies and contextual factors include increased visibility and recognition of health literacy efforts, enthusiasm and momentum for health literacy activities, reduced cognitive dissonance between vision and action, a sense of ownership for health literacy data, and creation of a common language and understanding.

Conclusions

Government initiated interventions and policies are powerful strategies by which organizational capacity to improve health literacy may be affected. Using the foundations created by the government policy environment, organizations may improve the impact of health literacy interventions through supported distributed leadership.     

The evolving concept of health literacy

The relationship between poor literacy skills and health status is now well recognized and better understood. Interest in this relationship has led to the emergence of the concept of health literacy. The concept has emerged from two different roots - in clinical care and in public health. This paper describes the two distinctive concepts that reflect health literacy, respectively, as a clinical "risk", or a personal "asset". In the former case a strong science is developing to support screening for poor literacy skills in clinical care and this is leading to a range of changes to clinical practice and organization. The conceptualization of health literacy as an asset has its roots in educational research into literacy, concepts of adult learning, and health promotion. The science to support this conceptualization is less well developed and is focused on the development of skills and capacities intended to enable people to exert greater control over their health and the factors that shape health. The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness. These include more personal forms of communication and community based educational outreach. It recommends improved interaction between researchers working within the two health literacy perspectives, and further research on the measurement of health literacy. The paper also emphasizes the importance of more general strategies to promote literacy, numeracy and language skills in populations.     

国内外营养素养研究进展

目的 研究当前国内外营养素养进展,对营养素养与健康研究相关内容进行综合阐述。方法 以营养素养为主题检索中国知网、百度学术、PubMed、EMBASE、Web of Science等数据库,手动检索其部分参考文献,对文献进行整理归纳与总结。结果 营养素养是指个人获得,理解和处理/使用基本营养信息的能力;可分为功能性营养素养、批判性营养素养和互动性营养素养三类。经归纳总结发现对其有影响的因素包括媒介素养、营养教育、文化程度和收入等社会人口学因素。营养素养被视为对健康促进具有重要意义,但目前缺乏公认的评价方法和工具。结论 营养素养是一个新兴研究领域,国内外涉及其研究的文献有限,尚处于起步阶段,制定有效测量工具是一个亟需解决的问题。     

Health literacy in Ireland: reading between the lines

Health literacy may be defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. While health literacy has become a vibrant area of international research, Ireland has lagged behind and to date few data exist. This article summarises the research that has been carried out in Ireland, highlighting key findings and recommendations. With several new initiatives in place such as the Crystal Clear health literacy Awards, it is expected that Ireland will lag behind in this field no longer. Inadequate health literacy is at epidemic levels in Ireland and is fast becoming recognised as a national issue. Simplification of the healthcare system, in its entirety is required but the much needed financial investment will only be made after original research, demonstrating successful interventions has been conducted. With a trend worldwide towards personalized medicine, this theme should be extended to include tailor-made personalized health care information. An investment in health literacy will ultimately increase a patient's self-esteem, compliance, capacity to self-manage and most importantly patient outcomes and safety.     

The evolving concept of health literacy

The relationship between poor literacy skills and health status is now well recognized and better understood. Interest in this relationship has led to the emergence of the concept of health literacy. The concept has emerged from two different roots – in clinical care and in public health. This paper describes the two distinctive concepts that reflect health literacy, respectively, as a clinical “risk”, or a personal “asset”. In the former case a strong science is developing to support screening for poor literacy skills in clinical care and this is leading to a range of changes to clinical practice and organization. The conceptualization of health literacy as an asset has its roots in educational research into literacy, concepts of adult learning, and health promotion. The science to support this conceptualization is less well developed and is focused on the development of skills and capacities intended to enable people to exert greater control over their health and the factors that shape health.The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness. These include more personal forms of communication and community based educational outreach. It recommends improved interaction between researchers working within the two health literacy perspectives, and further research on the measurement of health literacy. The paper also emphasizes the importance of more general strategies to promote literacy, numeracy and language skills in populations.     

儿童青少年健康素养研究现状与进展

提升健康素养可以有效降低儿童青少年发生健康危险行为和不良健康结局的风险。近年来全球关于儿童青少年健康素养的研究呈逐年上升趋势，对已有研究进行综述，发现目前尚未检索到通用的儿童青少年健康素养定义和内涵，且各国多采用成人健康素养代替或做适当调整，未充分考虑儿童青少年的阶段性发展特征及独特健康需求；评价指标体系和工具多样化，也使得研究结果可比性不足，难以得到一致、可靠的研究结论。未来需继续探讨提出更为全面和实用的定义及内涵，并研制可推广至全国的标准化评价工具。     

Making the Case for Laws That Improve Health: A Framework for Public Health Law Research

Context: Public health law has received considerable attention in recent years and has become an essential field in public health. Public health law research, however, has received less attention.Methods: Expert commentary.Findings: This article explores public health law research, defined as the scientific study of the relation of law and legal practices to population health. The article offers a logic model of public health law research and a typology of approaches to studying the effects of law on public health. Research on the content and prevalence of public health laws, processes of adopting and implementing laws, and the extent to which and mechanisms through which law affects health outcomes can use methods drawn from epidemiology, economics, sociology, and other disciplines. The maturation of public health law research as a field depends on methodological rigor, adequate research funding, access to appropriate data sources, and policymakers’ use of research findings.Conclusions: Public health law research is a young field but holds great promise for supporting evidence-based policymaking that will improve population health.     

Health literacy and adolescents: a framework and agenda for future research

Health literacy is an important issue in public health today, especially as patients are taking a greater role in obtaining information about their health. Health literacy is commonly defined as 'the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions'. While there is a large body of literature concerning health literacy and adults, few studies have focused on adolescents. Adolescents may have less interaction with the health care system and lower health care costs than adults, but they are increasingly involved with their health care, especially those with chronic illness. They are frequent users of mass media and other technology to access health information and are a target group for many health-related educational interventions. Adolescents are also at a crucial stage of development, learning skills they will carry with them into adulthood. The goal of this paper is to provide a summary of issues justifying the importance of studying health literacy as it relates to adolescents and to provide a framework and suggestions for future research.