Mass Media, Secular Trends, and the Future of Cardiovascular Disease Health Promotion: An Interpretive Analysis

Mass media roles in promoting cardiovascular health in the context of lessons learned from major U.S. community studies, changing media technology, and emergent models of media-community partnerships are discussed. Three principal issues are explored: (1) implications of the current expansion, convergence, and harmonization of mass media technology;(2) recent trends in media coverage of heart disease and population practices; and (3) implications for the future relationship between the media and public health in cardiovascular health promotion. It is concluded that classic campaign models focusing on individual-level change have evolved to recognize environmental-level influences on behavior. Emergent public health campaign models have moved toward “agenda-building,” in which the focus is on a more unified approach to influencing public and community agendas for social, behavioral, and policy change. Recent developments among the commercial mass media may offer new opportunities for public health partnerships to promote cardiovascular health.     

The impact of the 'aging of America' on children

The continued demographic trend of the "aging of America" has many implications for U.S. society. Although their population has remained relatively constant, children are becoming a smaller proportion of the overall population. The rapidly changing age-related U.S. demographics raises issues we have not yet chosen to address. These changes have important implications for children and will become manifest in the financing of both public programs and private markets for health, education, and social services, whether or not specific political actions are taken. Investment in children's health can affect the health and productivity of the next generation of Americans.     

Funding of North Carolina tobacco control programs through the Master Settlement Agreement

Changing political and economic forces in 1 tobacco-dependent state, North Carolina, demonstrate how the interplay between these forces and public health priorities has shaped current allocation of Master Settlement Agreement funds. Allocation patterns demonstrate lawmakers' changing priorities in response to changes in the economic climate; some of the agreement's funds targeted to tobacco farmers appear to reflect objectives favored by tobacco manufacturers. Funds earmarked for health have underfunded youth tobacco prevention and tobacco control initiatives, and spending for tobacco farmers in North Carolina has not lived up to the rhetoric that accompanied the original agreement. We discuss the implications of these findings for future partnerships between public health advocates and workers as well as tobacco control strategies.     

Applied epidemiology and public health: are we training the future generations appropriately?

To extend the reach and relevance of epidemiology for public health practice, the science needs be broadened beyond etiologic research, to link more strongly with emerging technologies and to acknowledge key societal transformations. This new focus for epidemiology and its implications for epidemiologic training can be considered in the context of macro trends affecting society, including a greater focus on upstream causes of disease, shifting demographics, the Affordable Care Act and health care system reform, globalization, changing health communication environment, growing centrality of team and transdisciplinary science, emergence of translational sciences, greater focus on accountability, big data, informatics, high-throughput technologies (“omics”), privacy changes, and the evolving funding environment. This commentary describes existing approaches to and competencies for training in epidemiology, maps macro trends with competencies, highlights an example of competency-based education in the Epidemic Intelligence Service of Centers for Disease Control and Prevention, and suggests expanded and more dynamic training approaches. A reexamination of current approaches to epidemiologic training is needed.     

Preparing for Climate Change: A Perspective from Local Public Health Officers in California

Background

The most recent scientific findings show that even with significant emission reductions, some amount of climate change is likely inevitable. The magnitude of the climate changes will depend on future emissions and climate sensitivity. These changes will have local impacts, and a significant share of coping with these changes will fall on local governmental agencies. Public health is no exception, because local public health agencies are crucial providers of disease prevention, health care, and emergency preparedness services.

Methods

This article presents the results of a survey of California’s local pubic health officers conducted between August and October 2007. The survey gauged health officers’ concerns about the public health impacts of climate change, programs in place that could help to mitigate these health effects, and information and resource needs for better coping with a changing climate.

Results

The results of this survey show that most public health officers feel that climate change poses a serious threat to public health but that they do not feel well equipped in terms of either resources or information to cope with that threat. Nonetheless, public health agencies currently implement a number of programs that will help these agencies handle some of the challenges posed by a changing climate.

Conclusions

Overall, the results suggest that local public health agencies in California are likely in a better position than they perceive to address the threats associated with climate change but that there is a larger role for them to play in climate policy.     

Introduction: The provision of animal health services in a changing world

In the future, animal health services in developing countries will need to operate in a continuously changing policy, institutional and commercial environment. Firstly, the changing policies and priorities of national policy-makers regarding public and private sector roles, reinforced in Africa by the donors, have reduced funding and support for the large number of tasks that animal health services have traditionally performed, and there is continuing pressure from policy-makers to focus on what the public sector can do best. Secondly, poverty reduction has become one of the main criteria guiding the allocation of official development assistance, which has major implications for the main target clientele of veterinary services. Thirdly, population growth, increasing income and urbanisation are causing a marked increase in demand for livestock products in the developing world. As a result, the entire livestock commodity chain is undergoing major structural changes, which has significant implications for the definition and control of food safety standards. Fourthly, globalisation, and increasing trade and travel have greatly increased the risk of disease transmission between different countries and continents. Veterinary institutions in the developing world need to adapt to these challenges. They will have to be able to focus on the essential public sector roles. At the same time they must deliver those essential services to the poor, and provide the policy framework to ensure that the inevitable structural changes in the commodity chain take place in an equitable and sustainable fashion, with an acceptable level of health risk for the consumer. According to the weight given to these different objectives, changes in the institutional set-up need to be considered. This issue of the Scientific and Technical Review addresses these challenges. It begins by reviewing the basic economic characteristics underlying the provision of animal health services, and then examines the alternative delivery systems that are emerging in the developing world and their strengths and weaknesses. The implications for food safety and trade are specifically highlighted. Also included are the practical experiences of countries, from all along the development continuum, that have introduced alternative systems. This paper deals with implications for the future, and while the growing importance of veterinary care for companion animals is acknowledged, the focus is on veterinary services for food animals.     

Reflections on expert consensus: a case study of the social trends contributing to obesity

BACKGROUND: In Australia, as elsewhere in the developed world, researchers and policy makers have expressed concern about rising rates of obesity. Explanations for the increasing weight of the Australian population have focused on both declining levels of physical activity and changes in food consumption patterns. METHODS: The primary aim of our study was to determine the views of obesity, dietary and physical activity experts, about the most important social trends that have contributed to Australia's obesogenic environment over the last 50 years. We used a modified Delphi technique to successfully contact 50 such experts to obtain their views on this topic. The process involved a semi-structured interview with each expert to identify the trends and then a round of ranking of the trends by these experts. A second aim was to comment on the utility of expert opinion in public policy. RESULTS: The experts identified the most important social trends as 'escalating car reliance', 'increasing "busy-ness" and lack of time' and 'rising use of convenience and pre-prepared food'. Because we asked experts to explain their responses, a diversity of opinion emerged on both the aetiology of these trends and how the environment is embodied to produce rising levels of obesity. CONCLUSION: We reflect on the implications of this dissensus for the utility of expert opinion in public policy and argue that one way through the smorgasboard of competing expert explanations for health differentials, including obesity levels, is practice-based evidence gathered through community level action research.     

Public health care under pressure in sub-Saharan Africa

Taking as point of departure the need for a strong public health care sector in developing countries the article firstly outlines how in sub-Saharan Africa enhanced scarcity has characterized the content and quality of health care in the public sector. This has eroded the trust among the public in the government as provider of health care and guardian of public health. Secondly, it describes how workers in the public health domain have dealt with the implications of scarcity by etching out a "puvate" zone in health care provision and how these informal activities need to be interpreted as "muddling through". It also points out what are reactions of clients to a decline in public health care provision. Thirdly, it discusses the changing relation between the state as provider of health care and private sector health care provision at a time of emerging public-private partnerships. The article emphasizes the need for strong health services at basic health centre level. It is at that level that the state has to address problems of scarcity and regain public trust. It also is at that level where major long-term health policies like the imminent large-scale delivery of antiretrovirals (3by5) have to be accomplished.     

The 'graying' of group health insurance

We examine differential declines in private insurance by income and age. We show that older, higher-income people in working families are more likely to retain private coverage as premiums rise, and we project these effects on future coverage rates. The analysis suggests that trends are leading to the "graying" of the employment-based health insurance system, where older, higher-income people get private health insurance, and others increasingly have public coverage or go without. These changes raise questions about the private health care system's ability to pool health risks. Population aging could interact with rising premiums and place additional pressure on an already strained employment-based health insurance system.     

The changing managerial role of physician executives

A survey of tasks performed by a sample of 517 physician executives from the AMA Masterfile was carried out to determine the role played by this group of administrators in health care organizations. In contrast to the findings of previous studies, physician executives appear to have responsibilities in general management as well as clinical management and do not focus primarily on physician and medical staff issues. No significant differences were found among respondents from hospitals, government, academic organizations, group practices/HMOs, and physician executives who spend more than 90 percent of their time in administration. Tasks identified as important for the future but not currently being done were primarily in the category of external activities such as "changing regulations and legislation" and "communicating goals to the public." These results identify an important boundary-spanning role for physician executives in balancing managerial and professional issues of cost, quality, and access in health care organizations. The implications of these findings for the educational needs of physician executives are discussed.     

Peer Reviewed: Assessing the Professional Development Needs of Public Health Educators in Light of Changing Competencies

Introduction

Because of the need for a well-trained public health workforce, professional competencies have been recently revised by the Institute of Medicine and the National Health Educator Competencies Update Project. This study compared the self-identified training needs of public health educators with the updated competencies and assessed employer support for continuing education.

Methods

A convenience sample of public health educators was recruited from an e-mail list of San Jose State University master of public health alumni. Respondents completed a Web-based survey that elicited information on emerging trends in public health education, training needs, and employer support for continuing education.

Results

Concerns about funding cuts and privatization of resources emerged as a theme. Key trends reported were an increase in information technology, the need for policy advocacy skills, and the importance of a lifespan approach to health issues. Primary areas for training were organization development, evaluation, and management. Although most employers were reported to support continuing education, less than two-thirds of respondents were reimbursed for expenses.

Conclusion

These findings have implications for both research and practice. Innovative technologies should be developed to address health education professionals'' training needs, and emerging themes should be incorporated into curricula for students.     

Whence and whither health insurance? A revisionist history

Throughout the postwar era in federal health policy, policymakers have sought to expand both public and private insurance coverage, while wrestling with the cost consequences of the demand generated by the insurance-financing mechanisms thus created. This essay advances the view that the limits to insurance expansion have been reached and that public and private plan sponsors will henceforth continually "thin out" the coverage they offer. In this environment, policymakers seeking to mitigate access concerns may need to consider strategies that promote direct service delivery. This emerging regime, it is argued, will have important implications for the future of innovation in health care.     

Reshaping the state from above,from within,from below: implications for public health

The modern state is being reshaped by multiple forces acting simultaneously. From above, the state is actively constrained by agreements promoted by international agencies and by the power of multinational corporations. From within, the state is being reshaped by increasing trends toward marketization and by problems of corruption. From below, the state's role is being diminished by the expansion of decentralization and by the rising influence of non-governmental organizations. This article explores these three sets of processes--from above, from within, and from below--and suggests some implications for public health. Public health professionals require an understanding of the changing nature of the state, because of the consequences for thinking about the metaphors, solutions, and strategies for public health.     

Using Functional Data Analysis Models to Estimate Future Time Trends in Age-Specific Breast Cancer Mortality for the United States and England–Wales

Background

Mortality/incidence predictions are used for allocating public health resources and should accurately reflect age-related changes through time. We present a new forecasting model for estimating future trends in age-related breast cancer mortality for the United States and England–Wales.

Methods

We used functional data analysis techniques both to model breast cancer mortality-age relationships in the United States from 1950 through 2001 and England–Wales from 1950 through 2003 and to estimate 20-year predictions using a new forecasting method.

Results

In the United States, trends for women aged 45 to 54 years have continued to decline since 1980. In contrast, trends in women aged 60 to 84 years increased in the 1980s and declined in the 1990s. For England–Wales, trends for women aged 45 to 74 years slightly increased before 1980, but declined thereafter. The greatest age-related changes for both regions were during the 1990s. For both the United States and England–Wales, trends are expected to decline and then stabilize, with the greatest decline in women aged 60 to 70 years. Forecasts suggest relatively stable trends for women older than 75 years.

Conclusions

Prediction of age-related changes in mortality/incidence can be used for planning and targeting programs for specific age groups. Currently, these models are being extended to incorporate other variables that may influence age-related changes in mortality/incidence trends. In their current form, these models will be most useful for modeling and projecting future trends of diseases for which there has been very little advancement in treatment and minimal cohort effects (eg. lethal cancers).Key words: breast cancer, forecasting, functional-data-analysis models, mortality trends     

Challenges and options for animal and public health services in the next two decades

Trade in livestock and livestock products makes up approximately one sixth of global agriculture trade. This trade is demand driven, primarily by growing human populations, changing economies, and consumer preferences in developing countries. Different rates of population growth, economic growth, urbanisation, environmental sustainability, and technology transfer will determine which countries will reap the greatest benefits. Global trends in demand and supply for food, not terrorism, will drive the future of animal and public health service delivery. To benefit the greatest number of people and countries, animal and public health services should support policies that temper growing disparities among rich and poor countries, city and rural populations, and the sexes. Economic growth is critical to overcoming disparities between countries and best supported by integrated animal health, public health, labour, and foreign policies. Opportunities for job growth will be the greatest along the value added chain of food production and will require significant investments in science- (risk-) based education.     

Mental Health News: How Frames Influence Support for Policy and Civic Engagement Intentions

Depression accounts for nearly 400 million disability days per year, and has been identified as the definitive public health priority in the decades to come (Greenberg et al., 2015). Despite the passage of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, which requires coverage of mental health services, behavioral health and substance-use disorders to be equal to physical health coverage, individuals face numerous barriers when seeking help for depression. This research tests whether changing the way stories frame depression affects how audience members attribute responsibility for depression and their intentions to participate in civic engagement activities supporting policy solutions. Findings from this study contradict earlier scholarship and have implications for how information about depression and policy solutions are framed for the public including how to develop health policy messaging when working with the news media. Suggestions for future research are included.     

The Changing Nature of Public Schools: Implications for Teacher Preparation

The changing nature of public schools in America reflects an increasing demand for accountability in public institutions. One outgrowth of this change is the "agency" orientation of the school. This orientation requires schools to participate fully in the larger social service network supporting many of America's students. The teacher's role in this new school environment is discussed and strengths and weaknesses of current training of teachers is highlighted. Particular emphasis is placed on the changing nature of the entering teaching major. Teacher thinking styles that promote success in general, and success in health teaching in particular, are identified. The need to make incoming teachers aware of the "realities" of the teaching environment is discussed. Person-environment fit issues are reviewed in terms of their implications for teacher training. The importance of the teaching minor is discussed focusing on the new demands of health educators in schools, and recommendations are offered to increase the potential success of the health educator as a change agent.     

Preparing public health nutritionists to meet the future

Public health nutrition personnel have been defined as those specialized nutrition professionals and paraprofessionals who provide nutrition services through agencies whose mandate is health protection and promotion, disease prevention, and/or primary care to people in the community. Educators preparing graduate level nutritionists for future demands of federal, state, and local public health programs must read the scientific, technological, and societal trends, including changes in demographics, health delivery systems, communications technologies, and consumer demands. As research more clearly defines the role of nutrition and diet in human health, nutritionists should be educated to monitor trends and be proactive in seeking emerging opportunities. It is nutritionists' responsibility to assure that scientific findings in nutrition, dietetics, and food science are considered in policy formulation as well as in the technical input into agency and community programs. The nutritionist who understands the changing values and life-styles of diverse populations uses acceptable techniques to motivate any necessary behavior changes. To be effective in the community, he/she uses community assessment, epidemiological, and program planning skills basic to public health practice. In the current climate of cost containment, the public health nutritionist will successfully compete for dwindling funds by managing programs with skill and documenting cost benefits and cost-effectiveness.     

Global environmental change: preventive measures to reduce the impact on human health

Awareness of the magnitude of worldwide climate change and theloss of biological diversity that may occur as the result ofpresent human activities is increasing. However, much needsto be done to reverse current trends and prevent unprecedentedglobal environmental changes which are expected to produce irreversibleresults, and to have profound implications for the health ofindividuals. This paper briefly reviews what is known aboutthe global environmental changes that are taking place and theirpredicted impact on human health. Some of the preventive measuresand activities in which public health professionals need toassume leadership roles in the critical years ahead are discussed.Our hope is to enliven a much needed dialogue among health professionalson the crucial issue of environmental survival in which preventionmay be the only viable solution.     

A Ride in the Time Machine: Information Management Capabilities Health Departments Will Need

We have proposed needed information management capabilities for future US health departments predicated on trends in health care reform and health information technology.Regardless of whether health departments provide direct clinical services (and many will), they will manage unprecedented quantities of sensitive information for the public health core functions of assurance and assessment, including population-level health surveillance and metrics. Absent improved capabilities, health departments risk vestigial status, with consequences for vulnerable populations. Developments in electronic health records, interoperability and information exchange, public information sharing, decision support, and cloud technologies can support information management if health departments have appropriate capabilities.The need for national engagement in and consensus on these capabilities and their importance to health department sustainability make them appropriate for consideration in the context of accreditation.What information management capabilities will be needed by tomorrow’s US health departments? The Public Health Accreditation Board establishes standards and provides accreditation to US local, tribal, and state health departments. Because we are experienced in local, state, and federal public health informatics (the systematic application of information and computer science and technology to improve public health practice, research, or education),1 a Public Health Accreditation Board think tank asked us to predict the effects of emerging trends on requirements for future accreditation standards.The Patient Protection and Affordable Care Act (ACA) may radically change the functions of US health departments. New developments in health information technology (technology standards, applications, and hardware for health data) will profoundly change how information is managed and exchanged. Different predictions about these changes may produce markedly different predictions of required health department capabilities.Some have asserted that ACA reforms (more people insured, preventive services covered, and provider incentives) may lead health departments to stop delivering individual services, such as immunizations.2 Meanwhile, some predict that digitization and the exchange of health care data will produce “distributed access to information without exposing the details of the underlying data . . . collect[ing] only summarized data . . . or key results.”3 Taken together, these trends suggest that health departments may eliminate direct services and consume rather than create health information products, thus minimizing their management of sensitive health information.We predict, rather, that health departments will struggle with managing more information to improve service cost efficiency, collaborate on prevention with a leaner health care system, and meet demands for unbiased population health statistics. Competitive pressures will emerge rapidly over the next 5 years. Health departments that cannot manage information appropriately may become vestigial—to the detriment of their communities (and especially to vulnerable underserved populations). The pace of change will challenge many health departments. Emerging advances in health information technology can help meet these challenges, but only if health departments develop needed capabilities.