Public health practice linkages between schools of public health and state health agencies: results from a three-year survey.

Several recent examinations of the state of public health have called for enhanced linkages between schools of public health and public health agencies, prompting federal health agencies and schools of public health to develop practice initiatives. Surveys of schools of public health and of state public health agencies were conducted in 1992 to collect baseline data on practice links between the two agencies; follow-up surveys were undertaken in 1993 and 1994. Responses reveal that a substantial amount of interaction between schools and agencies has been occurring for some time, but that until recently much of the interaction has been informal and between individuals or departments rather than institution-wide. Both frequency and formalization of such collaborations have increased, reflecting a growing emphasis on public health practice activities at schools of public health together with public health agencies.     

Building bridges between schools of public health and public health practice.

A 1988 Institute of Medicine report, The Future of Public Health, characterized the current public health system as fragmented, particularly with regard to relationships between public health agencies and academic institutions. As one response to the report, the Health Resources and Services Administration established the Center for the Development of Public Health Practice at the University of Illinois to advance linkages between schools of public health and public health agencies. Surveys of schools of public health and of state health agencies were conducted in 1992 to collect baseline data on the practice links between the two. Responses reveal that there is a substantial amount of informal collaboration between them. Formalization of collaborative activities between schools and agencies is beginning to occur and is expected to expand owing to increased focus on public health practice at schools of public health.     

Roles of local public health agencies within the state public health system.

OBJECTIVES: In this study we assessed the structure and function of local and district health agencies throughout the United States. We compared these findings with those from a previous national assessment done a decade earlier. METHODS: We surveyed the state health officers of all 50 states in the summer of 2001 in regard to the structures and functions of their state's local and district health agencies. RESULTS: Forty-seven states completed the survey for a 94 percent response rate. Forty-three percent have a regional or district structure in place. According to more than 80 percent of the respondents, local health departments serve all areas of their state. Local boards of health provide guidance and oversight in two thirds of the states. Most local health departments continue to perform a variety of traditional public health functions, as well as a variety of newly emerging responsibilities. Many local functions varied by geographic regions, population size, and organizational type. CONCLUSIONS: The study identified structural and functional changes in the local and district health agencies of state public health systems over the last decade. The stage is set for future work on the relationship between public health structure and function, and performance in the 21st century.     

Structure and functions of state public health agencies

OBJECTIVES: We assessed the structure and functions of state health departments throughout the United States and compared our findings with those from a previous national assessment conducted in 1990. METHODS: In 2001, we sent a survey to the state health officers of all 50 states. The survey asked about the structure and functions of the state health agency. RESULTS: The survey was completed by state health officers from 47 states (a 94% response rate). More than half of the states responding had a freestanding state public health agency and a state board or council of health. Forty-four percent had a regional or district structure. Although some traditional public health functions have been curtailed, important new public health functions have emerged since 1990. CONCLUSIONS: Our current findings confirm core changes in the structure and functions of state public health systems over the past decade and emphasize the need for more research into these systems to maximize their organizational performance.     

Structure and culture of schools of public health to support academic public health practice.

Schools of public health have been cautioned about producing graduates and research that were disconnected from public interest. Although institutions may implement a variety of strategies to rectify the situation, institutional structural and cultural barriers impede progress. Public health practice coordinators in accredited schools of public health were surveyed to describe the presence of structural and cultural barriers to academic public health practice using the Stevens model. Administrative leadership and faculty reward systems are described as critical to advance academic public health practice.     

Supporting academic public health practice: a survey of organizational structures in public health schools.

A survey was conducted at 28 schools of public health to assess how they allocate responsibility for three kinds of academic practice activity: continuing education, student internships, and technical consultation by faculty. Respondents identified whether these responsibilities were in a central practice unit, in another schoolwide unit, dispersed among several units, or dispersed among individual faculty members. Though all respondents engaged in these activities, responsibility tended to be carried out by individual departments or independent faculty members. This typically decentralized approach raises questions about the sustainability of academic public health practice that call for further inquiry.     

Developing cancer control capacity in state and local public health agencies.

In 1986, the National Cancer Institute began a major grant program to enhance the technical capabilities of public health departments in cancer prevention and control. This effort, commonly referred to as "capacity building" for cancer control, provided funding to support eight State and one local health department. The program focused on developing the knowledge and skills of health department personnel to implement intervention programs in such areas as smoking cessation, diet modification, and breast and cervical cancer screening. The grants ranged from 2 to 5 years in length, with funding of $125,000 to $1.6 million per grant. The total for the program was $7.4 million. While the priorities set for these grants were nominally similar, their capacity building activities in cancer prevention and control evolved into unique interventions reflecting the individual needs and priorities of each State or locality. Their experiences illustrate that technical development for planning, implementing, and evaluating cancer prevention and control programs is a complex process that must occur at multiple levels, regardless of overall approach.(ABSTRACT TRUNCATED AT 250 WORDS)     

Structure and functions of state public health agencies in 2007

We sought to document the structure and functions of state public health agencies throughout the United States in 2007 and compare findings with those from a similar 2001 assessment. In 2007 a survey of the structure and functions of state public health agencies was sent to and completed by senior deputies in all 50 states and the District of Columbia (a 100% response rate). The results of the survey showed that all emerging practice areas in 2001 had expanded by 2007. Also, state health departments generally had greater levels of responsibility in 2007 than they did in 2001, emphasizing the need for continued support of governmental public health systems and research on the operations of those systems.     

Survey of nutritionists in state and local public health agencies

A spring 1985 survey of 50 state and four territorial public health nutrition directors identified 2,931 budgeted positions for public health nutritionists--1,128 in state agencies and 1,803 in local health departments. To achieve the recommended staffing ratio of one public health nutritionist per 50,000 population, an estimated 1,827 more public health nutritionists are needed nationwide with more needed in some states than in others. About half of the state personnel systems require registration or registration eligibility to assure expertise of public health nutrition personnel; about one-third also require graduate training in public health for leadership, planning, and policymaking positions. Sixty-two percent of the funding for state and local health agency nutritionist positions is from the Special Supplemental Food Program for Women, Infants, and Children (WIC). When that is added to the 11% of funds from the Maternal and Child Health Block Grant, 73% of the public health nutritionist positions are federally supported to serve women of childbearing age, infants, and children. That leaves the remaining state and local funding sources and the federal Prevention Block Grant (2%) to pay salaries of nutritionists to serve the general public, including men, postmenopausal women, and the elderly.     

New partnerships between animal health services and public health agencies

As Veterinary Services and animal health organisations attempt to respond to a new era of emerging and re-emerging zoonotic diseases, their ability and skill in forming new strategic partnerships will be paramount. While these new partnerships are likely to include many relationships outside traditional Veterinary Services and animal agriculture, none will become more important than the formation of new animal health and public health partnerships. Episodes of emerging zoonoses are being increasingly recognised around the world and the confluence of people, animals and animal products today is unprecedented. Concurrently, a wide array of complex factors are also converging that will not only ensure the continuous emergence of zoonoses, but are also likely to drive the further increase and expansion of these diseases. This article discusses the need for the creation of more effective and co-operative partnerships in the face of new microbial threats, the complexity of both the formation and expansion of zoonoses, and the collective abilities of both human and animal health services to respond to them. Lessons learned from recent zoonotic epidemics supportthe need for co-ordinated research, interdisciplinary centres, integrated surveillance systems, response systems and infrastructures, and workforce development strategies. While there are some excellent examples of collaborative animal and public health relationships, there is no question that more and stronger partnerships among national and international organisations, both academic and private, will be necessary to meet the future challenges of emerging zoonoses and to manage their profound implications.     

A model for mapping linkages between health and education agencies to improve school health

Efforts to develop effective and sustainable school health programs evolved in sophistication the past 20 years through research and practical experience. This paper reviews these developments, arguing they were significantly driven by public health priorities, and have not adequately accounted for educational perspectives and priorities. To better understand the differences in perspective, a model is presented which illustrates linkages between different school-based inputs and strategies, and long-term health and educational outcomes. The model describes similarities and differences between the two perspectives. A significant coincidence exists in factors that determine educational attainment and improved health outcomes for students. A more holistic and integrated approach to school health is emerging, and at these interfaces our implementation and research efforts for the 21st century should be concentrated.     

Communication between public health agencies and their external stakeholders

Effective communication between public health agencies and their external stakeholders is vital to the agencies, as well as to those they serve. Agency leaders must obtain information from stakeholders and provide information to them. A process is described whereby agencies can systematically obtain necessary information from external stakeholders, and three of the most important forms of communications are described through which an agency provides information to stakeholders: promotion of the agency, advocacy, and social marketing. Barriers to effective communication of the interpersonal, personality, organizational, operational, skill/knowledge, attitude, and nature-of-information types are described, and guidelines are provided for minimizing the impact of these barriers.     

Post-maternity outcomes following health care reform in Alberta: 1992-1996

OBJECTIVE: The effect of Alberta's health reform on length of stay for maternity cases and on subsequent mothers' rehospitalization was examined in the present study. METHODS: The data set included all Alberta acute care hospital separation records from 1991/92 to 1996/97 inclusive. A logistic regression was applied to the data in order to examine the effects of prepartum condition, type of delivery, length of stay, maternal age, and year on the likelihood of readmission. RESULTS: Health reform proved to be associated with a dramatic decrease in length of stay for maternity cases; from 3.8 to 2.4 days on average. This was accompanied by very little variation in the 90-day readmission rate for mothers over the same time period (notably, a slight decrease). Higher readmission rates were associated with the existence of difficulties during the pregnancy and other prenatal conditions, maternal age, and with the type of delivery. There were no dramatic changes in the rates for prepartum diagnoses, nor for the type of delivery. DISCUSSION: The data suggest that the reduction in the length of maternity stay has had no discernible negative health effects on new mothers, perhaps because of the home visiting programs that were put in place. Furthermore, there may still be room to improve outcomes by focussing on those with prepartum conditions and cases involving complicated births.     

Public health practice in schools of public health: is there a fit?

Public health practice has been a part of schools of public health for a long time and yet it is still an emerging field of scholarship. Practice faculty often are isolated in their schools and not part of the mainstream. This article explores the elements of culture that are necessary to support a practice focus in a school of public health.     

泰安市不同性质学校中学生心理健康状况调查

目的 了解山东省泰安市公立学校与私立学校中学生心理健康状况之间的差异.方法 采用便利整群抽样方法,抽取泰安市2所公立学校和2所私立学校的中学生,采用症状自评量表 (SCL-90)进行匿名自填式问卷调查.结果 共发放问卷1232份,收回1232份,有效问卷1221份;公立学校学生579人,私立学校学生642人;公立学校、私立学校中学生轻度心理健康问题检出率分别为27.8%,53.4%,差异有统计学意义 (P<0.01);公立学校、私立学校学生中度以上的心理健康问题检出率分别为5.2%,15.4%,差异有统计学意义 (P<0.01);除了恐怖因子外,私立学校女生在其余8个因子得分均高于公立学校女生,且差异均有统计学意义 (P<0.01);私立与公立学校男生仅在抑郁因子分上差异有统计学意义 (P<0.01).结论 与公立学校比较,私立学校中学生心理问题更加突出,尤其是女生的心理问题更明显.