The role of academic health sciences centres in international health.

For many years, Canadian academic health science centres have been active in international health. This brief review describes the activities of the Canadian Society for International Health, the Canadian University Consortium for Health in Development, and McGill, McMaster and Ottawa universities. Three principles are derived from these examples. Health must be placed in the broader context of development, and international health initiatives must be intersectoral. Canadian universities can make a distinctive and important contribution to health and development internationally, but this requires a clear commitment to scientific excellence and social responsibility. Finally, Canadian institutions, as representatives of the North, have much to learn through collaboration and partnerships with institutions in the South.     

Diabetes in North Carolina: descriptive epidemiology and meaningful use of electronic health records

Diabetes is a major public health problem in North Carolina, affecting all sociodemographic groups. This commentary examines diabetes incidence, prevalence, disparities, morbidity, mortality, and costs. It also facilitates discussion about how the meaningful use of electronic health records can create new opportunities for collaboration between public health and clinical care professionals and organizations.     

Oral health in North Carolina: innovations, opportunities, and challenges

Dental disease can have negative and lasting effects on overall health and quality of life. The Institute of Medicine of the National Academy of Sciences reported last year that close to 5 million children in the United States did not receive needed care in 2008 because of costs. Increasing use of dental care has been selected by the U.S. Department of Health and Human Services as one of a small number of national leading health indicators, designating it as a national priority. Innovative initiatives have been undertaken in North Carolina to promote oral health, and there have been improvements in the state. For example, both the use of dental services among children and their oral health status are improving. Yet persistent and difficult challenges remain, such as ensuring an adequate workforce for the future, improving oral health literacy, maintaining existing programs, and resolving disparities in oral health and lifetime access to preventive and treatment services for all North Carolinians. This issue brief reviews some oral health initiatives and their outcomes--with a focus on youth. Commentaries in the policy forum also focus on access to oral health care; assessing, educating, and building the dental workforce; new practice models and trends; insurance innovation; and patients with special needs.     

Making nurses full partners in redesigning health care in North Carolina

The Institute of Medicine of the National Academies recommends that nurses take a lead in reforming health care but recognizes significant barriers to nurses assuming such roles. In North Carolina, nurses must be on hospital boards, active in health policy debates, and empowered at the bedside and must lead financial decisions that improve care and keep hospitals financially viable.     

Forging local level partnerships to make health programs possible

The quintessential difference between most successful rural health programs and unsuccessful ones is local leadership. The ways in which a community invites, values, develops, nurtures, and supports the involvement of diverse stakeholder groups form an important part of the base for local rural health program success. Successful programs are initiated by local stakeholder groups who are committed to collaboration, have a working governance structure, a good understanding of their health and healthcare challenges, and a plan for sustainability. A key first step for rural community health planning is to contact one's local state Office of Rural Health. Most ORHs will provide information, guidance, and technical assistance. There are many challenges in rural health, but there are also great successes. North Carolina communities fare better than many because the North Carolina Office of Rural Health has demonstrated how effective state and local leadership work together to directly benefit rural communities and rural people.     

Use of health information to improve care: the Southern Piedmont Beacon Community Grant

In 2009, the Office of the National Coordinator for Health Information Technology solicited proposals to participate in the Beacon Community Program. The program is designed to support communities with established reputations for adopting health information technology solutions. This commentary reviews Community Care of Southern Piedmont, a Beacon Community Program in North Carolina.     

Health reform from the perspective of a small and rural hospital

Health care reform introduces new challenges and opportunities for small and rural hospitals across North Carolina. Successful transformation will require a new vision for the health system, the establishment of solid primary care networks, the implementation of an improvement engine, and the creation of new partnerships to support evolving payment mechanisms.     

Honoring their service: behavioral health services in North Carolina for military service members, veterans, and their families

The North Carolina Institute of Medicine Task Force on Behavioral Health Services for the Military and Their Families examined the adequacy of Medicaid- and state-funded services for mental health conditions, developmental disabilities (including traumatic brain injury), and substance abuse that are currently available in North Carolina to military service members, veterans, and their families. The task force determined that there are several gaps in services and made 13 recommendations related to federal, state, and local community resources. This article reviews the work of the task force and current efforts to improve services in North Carolina.     

Enhancing community partnerships during a public health emergency: the school-located vaccination clinics model in Kanawha County, WV during the 2009 influenza A (H1N1) pandemic

Broad based community support is vital in developing a comprehensive national strategy to protect the public's health prior to, during and after a disaster such as pandemic influenza. When disaster strikes, the successful response is often dependent upon the degree of collaboration, coordination, and shared decision making occurring among a wide-ranging group of public and private stakeholders in the community. Since these preparedness and response activities must occur at a local level, the degree to which a certain community can become resilient after an event is directly dependent upon the success of the response activities. In order to protect its citizens, the Kanawha-Charleston Health Department (KCHD) led a comprehensive community based response to the 2009 Influenza A (H1N1) pandemic. By organizing a high level strategic team consisting of major community stakeholders, KCHD was able to develop broad based community support for its mitigation and countermeasure delivery strategies. The timely enhancement of the existing community partnerships enabled us to successfully conduct several response activities with local community support including school-located vaccination (SLV) clinics. We describe the process, results and challenges faced during our SLV clinics campaign which resulted in exceptionally high vaccination rates for school aged children compared to other jurisdictions across the nation. We also discuss how such partnerships can be sustained resulting in resilient communities and mention some strategies for those contemplating such partnerships in future public health emergency.     

The future of nursing and the health of North Carolinians: The North Carolina summit

Nurse leaders in North Carolina convened the Statewide Summit for Creating the Future of Nursing and Health Care in North Carolina on April 11, 2011. This article summarizes the summit and lays out the way ahead for implementing, in North Carolina, recommendations from the report on the future of nursing recently published by the Institute of Medicine of the National Academies (IOM). A synopsis of the commentaries composing the policy forum of this issue of the NCMJ follows, linking them to the IOM report.     

Psych NP-NC: a benchmark graduate nurse practitioner program for meeting the mental health needs in North Carolina

UNC-Chapel Hill's Psych NP-NC program prepares clinically and culturally proficient nurse practitioners to provide psychiatric and mental health care in North Carolina areas that are medically underserved and have a greater number of health disparities. This article reviews the program and the role of its graduates and makes policy recommendations for improving mental health care in the state.     

Regional extension coordinators: use of practice support and electronic health records to improve quality and efficiency

The North Carolina Regional Extension Center for Health Information Technology provides onsite consultation to primary care practices to help them implement electronic health records then use these systems to optimize care through measurement, rapid cycle quality improvement, and application of medical home functionalities. Services are available from all 9 regional North Carolina Area Health Education Centers.     

Reducing North Carolina's health care costs through environmental disease prevention

At a time of unprecedented pressure on the North Carolina state budget, reducing environmental risks to health may provide opportunities for substantial savings in the proportion of the state budget (24%) that is allocated for medical assistance. Recently, the Research Triangle Environmental Health Collaborative held a summit to identify options for increasing attention to environmental impacts on health in the ongoing health care and budget debates. Summit participants included not only public health and environmental experts, but also individuals (such as transportation planners, developers, and industry representatives) whose decisions can have a significant impact on environmental quality. This article summarizes key recommendations from the summit, as well as commentaries in the policy forum of this issue that further elaborate on why environmental quality matters for public health in North Carolina. Key recommendations from the summit include requiring formal health impact assessments (similar to environmental impact assessments but with an emphasis on health) in state and local transportation and land use planning processes, quantifying the total disease burden attributable to environmental hazards in North Carolina, prioritizing environmental risks to health in North Carolina, providing state technical assistance for communities disproportionately affected by poor environmental quality, establishing a new database system to link existing environmental and public health data by geographic location, undertaking North Carolina case studies to test the hypothesis that improving environmental quality also reduces medical care costs, and developing "environment matters to your health" public awareness campaigns.     

Regionally increasing baccalaureate-prepared nurses in North Carolina: the RIBN Project

A more highly educated nursing workforce is needed to address the increasingly complex health care needs of our citizens and to expand the pool for future faculty and advanced practice nurses. North Carolina must create new partnerships between community colleges and universities to support seamless progression toward a baccalaureate degree. The RIBN model provides one option to meet this goal.     

Building partnerships in a complex academic research environment

信息景观的变化给图书馆员提供了一个寻求新的技能、知识和机遇的机会,以便在需要时能够有效地整合专业知识;尤其是图书馆员已经从信息提供者转变为嵌入式信息创造者、集成者和创新者。如果我们想继续保持作为学术工作中心的地位,我们就必须具备利用自身具体制度环境优势的能力,并能够对信息需求做出迅速反应。介绍了北卡罗莱纳大学教堂山分校的医学图书馆如何寻求机会,并如何成功地建立将图书馆专业知识与卡罗莱纳新的战略框架蓝图的两个核心战略相结合的合作伙伴关系,即面向大众的大众战略以及基础创新战略。这些努力为北卡罗莱纳州带来了更优质的医疗服务和相关保健信息,加快了校园研究企业的发展,并展示了在北卡罗莱纳大学和全球范围以内循证护理学的重要性。通过了解和识别我们各个利益相关者的需求,我们已经能够了解我们需要解决哪些关键问题、需要采取什么样的干预以及图书馆员如何围绕信息合成和批判性思维整合专业知识,以便我们能够在复杂的学术环境中始终处于被认同的有价值的合作伙伴地位。     

Positioning North Carolina for leadership in injury control: a call to action

For most types of injury and violence, mortality and morbidity rates in North Carolina are worse than those of the nation. The costs in lives and dollars are enormous. The state has not provided the necessary resources for tackling the problem, devoting barely $6 per death to preventive efforts and failing to ensure that the public health workforce is adequately trained. At the same time, North Carolina has numerous excellent academic and community-based resources that can enable further capacity development. This article suggests the following 6 key steps for moving the state forward to prevent injury: making a serious financial commitment, training practitioners, supporting safety-promotion initiatives, creating a stronger culture of safety, addressing disparities, and improving data systems.     

Opportunities in preventive oral health care for children in North Carolina

Tooth decay affects more children than any other chronic infectious disease, yet it is almost entirely preventable. The Oral Health Section of the North Carolina Division of Public Health stresses the importance of prevention and promotes opportunities for citizens to achieve good oral health as part of total health.     

Lack of basic amenities: indicators of health disparities in low-income minority communities and tribal areas

North Carolina has numerous low-income minority communities and tribal areas where basic public health amenities are lacking. Disparities in clean air, safe drinking water, and toxin-free soil create human exposures that result in poor health, depressed property value, and more contaminated environments than are present in higher income communities.     

Leadership development for rural health

Leadership is the capacity to help transform a vision of the future into reality. Individuals who can and will exercise leadership are like a river's current--a part past where we now stand, a part yet to come. We have an ongoing need to remember and to look toward the next "generation." A key responsibility of those here now, is to mentor and to create structures for mentoring, in order to maximize the flow and effectiveness of tomorrow's leaders. When recruiting organizational leaders, the recruitment and interview process must seek individuals who in addition to technical competence, also have demonstrated leadership in their prior work and activities. To exercise effective leadership, we must work to know who we are, how we relate to others, and the environment around us. "Servant leadership" is a perspective held by many throughout the rural health community and offers a key set attributes of leadership useful to rural health. To implement the Institute of Medicine's recommendations in Through Collaboration: the Future of Rural Health, we must develop leaders skilled in collaboration, both internal to their organization and across organizations. The National Advisory Committee on Rural Health and Human Services had it right when they said to the Secretary and to the rest of us, "the best way to honor Jim is to consciously work to help develop the next generation of rural health leaders." There are, of course, a multitude of leadership institutes, programs, and courses throughout America; this is not a call for yet another separate entity. But it is a call to each of us in rural health to assure that we are deliberate in how we identify "emerging leaders from and for rural communities and provide them with the training and resources to play a lead role in ensuring access to quality healthcare in their states and communities." Let's get started.     

Community outreach, training, and research: the Hawai'i/Pacific Basin area Health Education Center of the University of Hawai'i, John A. Burns SChool of Medicine

The Hawai'i/Pacific Basin AHEC is a federal grant program that utilizes academic/community partnerships to recruit students to health careers, train students in rural and underserved areas, and assist with workforce development across the region. Ongoing activities and programs include 1) Outreach for recruitment to health careers for students from kindergarten through adulthood; 2) Individual and interdisciplinary health professions student training in rural and underserved areas; 3) Community health education using distance learning; 4) Assessment of and efforts to improve recruitment and retention of providers in rural areas including continuing education; and 5) Health disparities research. The AHEC programs reach more than 4,000 individuals annually, helps to train more than 1,000 individuals a year and assist with placement of up to 20 providers a year in rural and underserved healthcare practices. This article describes the existing AHEC programs that are community based, community driven and inclusive of all who choose to participate. Collaboration is invited and necessary for success and future program development. Future areas for collaboration activities include increased statewide community health worker training, an expanded health careers pipeline, ongoing rural and underserved health needs assessments and an expanded training network for students in healthcare. Additional information is available at www.ahec.hawaii.edu.