美国公共卫生绩效评价工具的研究进展及借鉴意义

评价工具是公共卫生绩效评价研究的重点内容。美国公共卫生学界在公共卫生绩效评价的理论框架和工具开发两个方面取得了较大的进展,形成了以公共卫生体系的概念模型、国家公共卫生绩效标准项目等为代表的重要成果。借鉴美国公共卫生绩效评价工具研究的经验,我国的公共卫生绩效评价研究应加强公共卫生体系研究的理论基础,并推动建立国家公共卫生绩效标准。     

Evidence links increases in public health spending to declines in preventable deaths

Public health encompasses a broad array of programs designed to prevent the occurrence of disease and injury within communities. But policy makers have little evidence to draw on when determining the value of investments in these program activities, which currently account for less than 5 percent of US health spending. We examine whether changes in spending by local public health agencies over a thirteen-year period contributed to changes in rates of community mortality from preventable causes of death, including infant mortality and deaths due to cardiovascular disease, diabetes, and cancer. We found that mortality rates fell between 1.1 percent and 6.9 percent for each 10 percent increase in local public health spending. These results suggest that increased public health investments can produce measurable improvements in health, especially in low-resource communities. However, more money by itself is unlikely to generate significant and sustainable health gains; improvements in public health practices are needed as well.     

Nurses and public health: evolution of missions and trainings

Reflection upon the role of nurses in public health is not something new; however, over the past few years, a questioning and similar reports have sprung up pointing to the difficulty perceived by nurses in reconciling their professional practice and public health. Currently, in light of the evolution of public health, where does the practice of nursing fit into public health practice? What are the potential movements and trends in terms of training? The goal of this paper is to present a number of possible avenues for thought on the subject, namely concerning the training and the allocation of competencies. It would be undoubtedly a pity to conceive of public health training today being intended only for nurses. It is rather preferable that post-graduate public health training is aimed at a variety of professional categories, regardless of their initial training or degree course. The development of schools of public health to which nurses could have access in the same way that other health professionals or from the social and educational fields do is critical. Above and beyond what is at stake for specialisation, and even independent of the implication of nurses in public health work, the current trend to re-balance the work and tasks of both nurses and doctors constitutes a significant challenge for public health.     

A perspective on non-traditional academic programs in the health sciences.

In the 1970s, non-traditional academic programs began to gain impetus, aided by studies and recommendations by such groups as the Carnegie Commission on Higher Education and the Commission on Non-Traditional study. Schools of public health have taken the lead in implementing non-traditional, off-campus programs which are relevant to personnel in health service agencies. Reported in this monograph are three programs representing alternative approaches to off-campus public health programs. As our data base increases and new programs are reported, we may see rapid growth in non-traditional programs, resulting in significant changes in academic programs preparing public health practitioners.     

Maximizing the contribution of the public health workforce: the English experience

In the United Kingdom, until the 1990s, specialist practice of public health was dominated by the medical profession. During the past decade, the contributions to specialist public health practice of people from diverse disciplines have become recognized, respected and valued. In parallel to this paradigm shift in culture in the specialist workforce, recognition is growing of the importance to health improvement of the routine activities of people in other jobs, whose daily work can have a significant impact on population health. These people include public health practitioners, such as environmental health officials, but also others in a very wide range of occupations, from local government chief executive officers to catering assistants, who, although their actions can have a substantial influence on public health, would not traditionally have been viewed as part of the public health workforce. Transforming opportunities for training and professional development to meet the diverse needs of these different groups within the public health workforce for them to recognize and fulfil their potential for health improvement is an important challenge, if we are to achieve continuing improvements in public health. Presenting England's attempts to address the challenges of recruiting and training the range of people needed to deliver effective intersectoral public health may offer insights for those facing similar challenges in other countries.     

关于我国公共卫生人才核心能力的思考

在我国各级公共卫生机构“硬件”建设得到明显改善情况下,作为“软件”之一的公共卫生人才队伍素质已经成为制约公共卫生事业发展的关键因素。本文从核心能力入手,介绍了国际上有关的理论和实践进展,分析了我国在专业技术资格(职称)、继续医学教育和岗位聘任各环节中对公共卫生人才能力标准的相关界定。最后,就提升我国公共卫生人才核心能力提出四点建议:一是从战略高度重视发展公共卫生核心能力,二是以现有管理系统为基础建立公共卫生核心能力传递链,三是根据公共卫生人才结构确定核心能力的适宜能级,四是以制度作保障持之以恒地提高公共卫生人才核心能力。     

Treatment patterns for childhood diarrhoea: evidence from demographic and health surveys.

Treatment patterns for childhood diarrhoea among providers in public and private settings have been examined using data from 28 surveys in the Demographic and Health Surveys programme. In the majority of surveys, at least 50% of the children with diarrhoea who sought care from a health provider (public or private) received treatment that included oral rehydration salts (ORS). Private providers are a significant source of care for children with diarrhoea, but they are less likely to use ORS and more likely to prescribe unneeded drugs than providers in public settings. In countries where data are available, bloody diarrhoea appears to be undertreated. The results indicate that national public health programmes must continue to improve their strategies to ensure correct treatment of childhood diarrhoea by all health providers.     

Effects of cognitive overweight status on food choice

ABSTRACT

Obesity is a serious concern from a personal and public health perspective. This research examines the effects of consumer cognitive overweight status (COS) on food choice. The results show that COS is a significant predictor of consumer food choices, and gender, age, and education differences are found. While the literature shows that many years of efforts by the public and private sectors do have positive influences on consumer food choices, more efforts should be made to help the public engage in weight control behaviors. Managerial and public health policy implications are provided.     

Nutrition services in State and local public health agencies. Special supplement: revision of the 1955 guide by the Nutrition Services Project Committee.

The contribution of nutrition in preventing disease, prolonging life, and promoting health through organized community effort is well recognized. While many gains have been made in public health nutrition, it is clear that the American population continues to exhibit nutrition problems. Rene Dubos has said that no community will find it possible to deal simultaneously with all of the health problems inherited from the past and with those brought about by modernization and change. The challenge lies in determining priorities and making difficult choices in the face of shifting responsibilities among levels of government, reduced resources, and increased competition. The purpose of this guide is to help public health officials appreciate the important role nutrition services play in meeting the health needs of their communities. The recommendations for nutrition programs are sensitive to the social, economic, and political forces that are shaping the future of public health. How well public health officials meet the challenge of providing nutrition services in their communities will be a significant factor influencing the health status of the American population in the 1980s and beyond.     

Enumeration and Composition of the Public Health Workforce: Challenges and Strategies

The field of public health needs a comprehensive classification data system that provides a better assessment of the size and composition of its workforce. Such a data system is necessary for understanding the capacity, trend projections, and policy development critical to the future workforce.Previous enumeration and composition studies on the public health workforce have been helpful, but the methodology used needs further improvements in standardization, specificity, data storage, and data availability. Resolving this issue should follow a consensus-based course of action that includes public and private stakeholders at the national, state, and local level.This prime issue should be addressed now, particularly in the current environment of comprehensive health care reform.THE FIELD OF PUBLIC HEALTH and its workforce have been persistently challenged by an unclear definition of boundaries of knowledge, expertise, and practice. These attributes lead to a corresponding lack of clarity of the public health workforce size (enumeration) and composition. Furthermore, other information on the public health workforce such as education and training, wages, turnover rates, and mobility across states is not regularly collected and available for comprehensive and comparative analysis and policy development.Central to this issue is the lack of a consensus-based, comprehensive, standardized classification (taxonomic) data system that provides a relevant and validated characterization of the public health workforce.1–4 Although there have been significant efforts to enumerate and garner a better characterization of the public health workforce, multiple gaps remain in specificity of the public health workforce and in the placement of this information in a suitable data repository for common use. Moreover, current circumstances—that is, alerts of workforce shortages in public health and other health professions (some based on limited estimated data), fears surrounding formidable rising health care costs, and recent passage by Congress of comprehensive health care reform initiatives—are provoking an escalating need to examine the public health apparatus and, in particular, the supply and needs or demands of the public health workforce.I examine these challenges in developing a valid classification data system that could be a significant tool to understand, monitor, and provide direction to the workforce. An underlying purpose is to stimulate a sense of urgency and call for leadership to bring consensual action to bear in this matter.     

Health interventions and the persistence of rumour: The circulation of sterility stories in African public health campaigns

Public health programmes have done enormous good in Africa and elsewhere in the global south, but have also been met with skepticism. This skepticism often takes the form of rumours about the motives or the results of the public health intervention. One recurrent theme in such rumours is the centrality of reproductive bodies (both male and female), and the perception that these bodies are being rendered sterile by toxic compounds given under the guise of improving health. Public health operations research has identified these rumours as significant obstacles to programme delivery, but they have been treated primarily as failures in communication, to be rectified by the provision of more accurate information. Using reports of such rumours from public health interventions in Africa, with emphasis on vaccines, I argue that these rumours are more than simply stories which are not true. The widespread rumour of sterility is a way of articulating broadly shared understandings about reproductive bodies, collective survival, and global asymmetries of power. I use Foucault's notion of biopolitics to theorize international public health programmes, and introduce the concept of counter-epistemic convergence to account for the ubiquity and persistence of sterility rumours.     

The state's role in promoting population health: public health concerns in Canada, USA, UK, and Sweden

Despite the expanding literature on the importance role public policy plays in influencing the broader determinants of the public's health, profound differences exist among jurisdictions in the attention placed by the State - as represented by public health authorities and agencies - upon such activities. In this paper we examine the dominant public health models of Canada, USA, UK, and Sweden. The Canadian and USA public health communities are focused upon individualized approaches to risk management. In contrast, the UK and Swedish public health scenes are more oriented toward broader approaches to health determinants. We argue that the extent to which governments, public health agencies and public health workers concern themselves with public policy approaches to address broader determinants of health depends upon the particular model of health adhered to within each jurisdiction. And whether a health model is adopted depends upon the ideological and political context within which a nation is situated. Canada represents a situation where concerted effort to influence governmental policy directions by the public health community could reap significant benefits.     

Behavior therapy as a new procedure in health education--recommendation for introducing behavior science into personal health services]

Recent efforts to integrate biomedical and behavioral science perspectives and techniques have revealed the creativity and efficacy of behavioral health approaches to health enhancement and disease prevention. There are expectations that behavioral medicine and behavioral health will be significant in approaches toward changing life style, improving patient's compliance with medical advice, and in rehabilitation. Three examples of actual practice of behavioral procedures in a public health center are studied-behavior therapies for obesity and hypercholesterolemia, and prompting of patient clinic utilization behavior by a letter of introduction. The importance of proper selection of target problems, staff training is emphasized. In conclusion, it is recommended that behavioral science and its techniques of assessment and treatment are incorporated into public health activities, especially in the field of health education.     

上海金山区基层公共卫生协管员能力现状调查

目的了解金山区公共卫生协管员基本情况,分析基层卫生监督人员能力现状,为完善基层卫生监督网络提供借鉴。方法对涉及对象开展普查,采用专家咨询、问卷调查方法。结果在11个社区卫生服务中心的32名协管员中年龄50岁以上者占40.6%,具有中级职称人员占25.0%。他们的工作需要掌握的卫生知识与所学的不符,还要对他们进行国家卫生标准、卫生管理知识等培训。不同能力自评有显著性差异,沟通协调及社交的能力和掌握管理相对人基本情况、卫生现状自评较好,法律法规、卫生规范学习与运用能力和调查取证、资料收集的能力自评较低。结论人员构成和知识培训是金山区公共卫生协管员能力建设的薄弱环节,应当采取措施予以优化。     

Rationing influenza vaccine: Legal strategies and considerations for local health officials.

Despite the fact that influenza vaccine is an important health resource, the structure and organization of the US vaccine manufacturing system has produced influenza vaccine shortages or distribution delays in five out of the last six influenza seasons. These shortages have produced the need for local public health officials to develop protocols for rationing and redistributing influenza vaccine at the local community level. In so doing, local health officials are confronted with significant practical and legal constraints associated with allocating a resource that is largely not under direct government control. In the face of an impending influenza vaccine shortage, local public health departments endeavor to do three things: (1) assess the local supply of vaccine, (2) assess the local demand from high-risk community members, and (3) ensure that to the greatest extent, the limited local supply of vaccine is used exclusively by those at highest risk within the local jurisdiction. There are a number of legal tools and strategies that local health officials have at their disposal to carry out these functions. This article will attempt to outline some of the significant legal impediments and practical constraints that local public health officials face in managing influenza vaccine supply-demand issues and will offer some suggestions for strengthening their ability to effectively manage these increasingly common situations.     

Public health campaign funds provide a "safety net" for indigent tuberculosis patients at the Mount Sinai Hospital.

This article describes the development of a partnership between a voluntary health care institution and a state agency for a focused public health program providing vital clinical, public health, and social supportive services. In addition to the historical development of this alliance, the article illustrates joint problem-solving processes to address complex issues. Since its inception in 1992, this collaboration has resulted in significant improvements in the health status of a high-risk, difficult-to-serve, indigent population that would otherwise pose a public health threat to the community. Demographics of 17 indigent patients are described. Nine have completed treatment for tuberculosis under directly observed therapy and completion is in sight for six others. None have been lost to follow-up.     

Barriers of mistrust: public and private health sectors' perceptions of each other in Madhya Pradesh, India

India has one of the most highly privatized health care systems in the world. The dominant private health sector functions alongside a traditional tiered public health sector. There has been an overall lack of collaboration between the two sectors despite international policy recommendations and local initiatives. It has been postulated that "conflicting perceptions" might contribute to the uncooperative attitude between the two sectors. But there has been little empirical exploration of the existing perceptions that the private and public health sectors have of each other. We explored these perceptions among key stakeholders (who influence the direction of health policy) in the public and private health sectors in the province of Madhya Pradesh, India. The barriers of mistrust, which hinder true dialogue, are complex, and have social, moral, and economic bases. They can be best addressed by necessary structural change before any significant long-term partnership between the two sectors is possible.     

Has public health messaging during the COVID-19 pandemic reflected local risks to health?: A content analysis of tweeting practices across Canadian geographies

During the COVID-19 pandemic, public health agencies and decision-makers have used social media to disseminate information, encourage changes to behaviour and promote community supports and resources. Their communications have served to educate the public on risks and initiate the widespread adoption of public health measures to ‘flatten the curve’. We conducted a content analysis of COVID-19 Tweets by Canadian public health accounts during the first 6 months of the pandemic to explore differences in Tweeting practices by geography and identify opportunities to improve risk communication. We found that Canadian public health accounts in particular geographic settings did not always apply best practices for health communication. Tweeting practices differed considerably between jurisdictions with varying burdens of COVID-19. Going forward, Tweets authored by public health accounts that promote behaviour change and community-building ought to be utilized whenever risks to health are high to reflect an increase in disease transmission requiring intervention. Our study highlights the need for public health communicators to deliver messaging that is relevant for the levels of risk that their audiences are encountering in a given geographic context.     

Epidemiology and the macrosocial determinants of health

In the past two decades, public health researchers have taken renewed interest in investigating the role of social factors in health. This holds substantial promise in terms of identifying manipulable social factors that are amenable to policy intervention. Most existing empirical and conceptual epidemiologic work, however, has focused on the more proximal social determinants, such as interpersonal relations. These factors, although perhaps easier to study epidemiologically, are much less relevant to policy makers than more "macrosocial" factors such as taxation policies. Limited epidemiologic attention to macrosocial determinants of health is ironic given that macrosocial factors such as the rapid industrialization and urbanization in the 19th century contributed to the organization of public health practice and, tangentially, to academic public health research. We suggest here that greater investment in the study of macrosocial determinants has the potential to make a significant and unique contribution to the greater public health agenda and should be a prominent aspect of social epidemiologic inquiry in the coming decades.     

A Multi-Tiered Approach to Addressing the Mental Health Issues Surrounding Obesity in Children and Youth

ABSTRACT

Obesity in children and youth is a major public health concern known to have a significant impact on physical and mental health. Although traditional approaches to obesity have emphasized diet and exercise at the individual level, broader attention to the mental health consequences of obesity is crucial. Individuals who are obese live in a world where they are often less accepted resulting in social exclusion and discrimination. A public health multi-tiered approach to obesity focusing on mental health promotion, prevention, and individualized intervention is presented.