Weighing in on obesity: America's growing health epidemic

On October 31, 2001, Grantmakers In Health (GIH) convened an Issue Dialogue in Washington, DC, on the problem of obesity and its implications for personal and public health. The purpose of this meeting was to help the staff and trustees of health foundations and corporate giving programs understand the nature of today's epidemic and explore ways in which they could play a role in identifying and promoting effective solutions. In addition to discussing the scope and implications of overweight and obesity in the United States, presenters and discussants provided insights into the strategies that grantmakers might want to consider to address this serious health problem. This Issue Brief incorporates the information and ideas shared during the meeting into the background paper which was prepared for participants at the Issue Dialogue. It offers detailed data on the prevalence and growth of overweight and obesity in various populations, discusses their impact on health and the costs of care, reviews the major causes, and suggests strategies for both prevention and treatment. In the context of those strategies, this report also profiles a number of efforts by both grantmakers and government agencies to tackle some of the root causes of this important public health issue.     

Turning the tide: preserving community mental health services

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of experts from the fields of philanthropy, research, government, and health care on September 19, 2002 to examine the status of community-based services for people with mental disorders. This Issue Dialogue, "Turning the Tide: Preserving Community Mental Health Services," explored how health grantmakers can support community programs that provide critical mental health intervention and treatment services to children and adults. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It includes quantitative and qualitative information on mental health, as well as profiles of public sector, private sector, and grantmaker strategies for promoting improvements.     

Positive youth development: a pathway to healthy teens

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of experts from the fields of philanthropy, research, government, and health care to examine recent research on youth development and effective approaches for promoting healthy decision making by adolescents. This Issue Dialogue, Positive Youth Development: A Pathway to Healthy Teens-held June 13, 2002 in Washington, DC-provided an opportunity for grantmakers to explore how they can apply youth development principles and asset-based strategies to their grantmaking to promote healthy development and healthy decision making by the adolescents in their communities. This Issue Brief incorporates the information and ideas shared during the meeting into a background paper prepared for participants at the Issue Dialogue. It provides an introduction to positive youth development; describes the characteristics of effective services and programs; reviews the research in this area; and provides examples of programs sponsored by the government, national organizations, and foundations that are intended to support and promote positive youth development.     

Nevada's academic-practice collaboration: public health preparedness possibilities outside an academic center

The Nevada State Health Division developed a local academic-practice partnership with the University of Nevada Reno's Master of Public Health Program to assess the bioterrorism risk communication, information, response, and training needs of professional and public stakeholder groups throughout Nevada. Between October 16, 2002, and April 13, 2004, 22 needs assessment focus groups and 125 key informant interviews were conducted to gather information on the diverse needs of the stakeholders. The themes that emerged from these activities included the need for effective pre-event education and training; a coordinated and responsive public health preparedness infrastructure; honest, accurate, and timely communication in the event of a bioterrorism situation; and appropriate information dissemination methods and technology. The data collected through this needs assessment gave the Nevada State Health Division vital information to plan public health preparedness initiatives. The establishment of local academic-practice partnerships for states without a Centers for Disease Control and Prevention-funded Academic Center for Public Health Preparedness is an effective way for health departments to develop their public health preparedness infrastructure while simultaneously training the future public health workforce.     

How can performance standards enhance accountability for public health?

This article focuses on how a national system of measuring public health performance can help enhance accountability for public health. It describes the trend toward increased accountability in public health; provides an overview of the issues and challenges public health practitioners face in demonstrating how the resources they spend and programs they operate contribute to improved community health status and suggests how the results of participating in the National Public Health Performance Standards Program can help.     

Refining estimates of public health spending as measured in national health expenditures accounts: the United States experience.

Providing for the delivery of public health services and understanding the funding mechanisms for these services are topics of great currency in the United States. In 2002, the Department of Homeland Security was created and the responsibility for providing public health services was realigned among federal agencies. State and local public health agencies are under increased financial pressures even as they shoulder more responsibilities as the vital first link in the provision of public health services. Recent events, such as hurricanes Katrina and Rita, served to highlight the need to accurately access the public health delivery system at all levels of government. The National Health Expenditure Accounts (NHEA), prepared by the National Health Statistics Group, measure expenditures on healthcare goods and services in the United States. Government public health activity constitutes an important service category in the NHEA. In the most recent set of estimates, Government Public Health Activity expenditures totaled $56.1 billion in 2004, or 3.0 percent of total US health spending. Accurately measuring expenditures for public health services in the United States presents many challenges. Among these challenges is the difficult task of defining what types of government activity constitute public health services. There is no clear-cut, universally accepted definition of government public health care services, and the definitions in the proposed International Classification for Health Accounts are difficult to apply to an individual country's unique delivery systems. Other challenges include the definitional issues associated with the boundaries of healthcare as well as the requirement that census and survey data collected from government(s) be compliant with the Classification of Functions of Government (COFOG), an internationally recognized classification system developed by the United Nations.     

The promise of public health: ethical reflections

Public health is in the spotlight of public and political concern, providing a unique window of opportunity for its revitalization and restoration as a pillar of the Canadian health care system. The establishment of a Federal Public Health Agency is a critical first step. The public health community has identified key challenges toward this renewal. However, public health ethics have received little attention and, when addressed, have focussed almost exclusively on communicable diseases. The ethical issues inherent in public health transcend infectious diseases and are distinct from clinical and research ethics. Identifying and addressing ethical issues at the heart of public health, including the public interest and the common good, as well as fundamental issues related to the core functions of public health will be essential if this revitalization of public health is to be achieved. While legal and regulatory reforms are necessary, they will not be sufficient to adequately address fundamental questions of the valuing of public health or the ethical issues in public health. Elements of a research agenda on the ethical foundations of public health reform are identified here.     

Design Principles in the Development of (Public) Health Information Infrastructures

In this article the author outlines the key issues in the development of a regional health information infrastructure suitable for public health data collections. A set of 10 basic design and development principles as used and validated in the development of the successful New Zealand National Health Information Infrastructure in 1993 are put forward as a basis for future developments. The article emphasises the importance of securing clinical input into any health data that is collected, and suggests strategies whereby this may be achieved, including creating an information economy alongside the care economy.It is suggested that the role of government in such developments is to demonstrate leadership, to work with the sector to develop data, messaging and security standards, to establish key online indexes, to develop data warehouses and to create financial incentives for adoption of the infrastructure and the services it delivers to users. However experience suggests that government should refrain from getting involved in local care services data infrastructure, technology and management issues.     

Relationship between water supply,sanitation, public health,and environment: elements for the formulation of a sanitary infrastructure planning model

The understanding of sanitation infrastructure, public health, and environmental relations is a fundamental assumption for planning sanitation infrastructure in urban areas. This article thus suggests elements for developing a planning model for sanitation infrastructure. The authors performed a historical survey of environmental and public health issues related to the sector, an analysis of the conceptual frameworks involving public health and sanitation systems, and a systematization of the various effects that water supply and sanitation have on public health and the environment. Evaluation of these effects should guarantee the correct analysis of possible alternatives, deal with environmental and public health objectives (the main purpose of sanitation infrastructure), and provide the most reasonable indication of actions. The suggested systematization of the sanitation systems effects in each step of their implementation is an advance considering the association between the fundamental elements for formulating a planning model for sanitation infrastructure.     

Special Considerations for Prophylaxis for and Treatment of Anthrax in Pregnant and Postpartum Women

In August 2012, the Centers for Disease Control and Prevention, in partnership with the Association of Maternal and Child Health Programs, convened a meeting of national subject matter experts to review key clinical elements of anthrax prevention and treatment for pregnant, postpartum, and lactating (P/PP/L) women. National experts in infectious disease, obstetrics, maternal fetal medicine, neonatology, pediatrics, and pharmacy attended the meeting, as did representatives from professional organizations and national, federal, state, and local agencies. The meeting addressed general principles of prevention and treatment for P/PP/L women, vaccines, antimicrobial prophylaxis and treatment, clinical considerations and critical care issues, antitoxin, delivery concerns, infection control measures, and communication. The purpose of this meeting summary is to provide updated clinical information to health care providers and public health professionals caring for P/PP/L women in the setting of a bioterrorist event involving anthrax.     

Ethical issues in public health: a qualitative study of public health practice in Scotland

STUDY OBJECTIVE: To identify ethical issues encountered by staff in the development and implementation of public health activities at two sites in Scotland. DESIGN: Qualitative research study involving face to face semi-structured interviews with participants. SETTING: A public health directorate in a National Health Service Trust, and a public health demonstration project in child health. PARTICIPANTS: Health promotion specialists, managers, nurses, public health consultants and specialists, researchers, trainees, and other public health staff. MAIN RESULTS: Three main categories of ethical issues were identified: paternalism, responsibilities, and ethical decision making. Consulting with the community and sharing information raised issues of paternalism and honesty. Participants identified multiple and sometimes conflicting responsibilities. Barriers to fulfilling responsibilities included meeting targets, working with partners, and political influences. Defining the limits of responsibilities posed challenges. Participants identified values for ideal decision making, but lack of time often led to a more pragmatic approach. CONCLUSION: These empirical findings complement and extend existing discussions of public health ethics, emphasising the complex nature of ethical issues in public health. The implications for public health policy and future research are discussed.     

Training the health workforce of tomorrow

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a small group of grantmakers and national experts concerned about health workforce issues. This roundtable - held on October 31, 2001, in Washington, DC - explored various issues related to the supply, composition, and competency of the health workforce, and the role that these factors play in maintaining and improving the health status of individual patients and broader populations. The session also highlighted the current activities of and future opportunities for foundations.This Issue Brief synthesizes key points from the day's discussion with a background paper prepared for roundtable participants. It includes quantitative and qualitative information on workforce issues and profiles public sector and grantmaker strategies for addressing workforce problems.     

'Knowledge Infrastructure for Public Health': an advisory report from the Advisory Council on Health Research

Social, scientific and technological developments are forcing health care systems to shift the focus from disease to health and from cure to prevention. The Advisory Council on Health Research (RGO) has published an advisory report about the knowledge infrastructure serving the needs of public health in the Netherlands. The Council's concept of public health also includes aspects such as policy and health management. The Council concludes that more research is needed on the following determinants of health: environmental issues, social factors, unhealthy behaviour and genetic factors. Intervention research must focus on health protection, health promotion and disease prevention. The public health infrastructure can be improved by amalgamating research groups, establishing departments of public health at every academic medical centre, and linking service, education and research.     

The Health Care Home Model: Primary Health Care Meeting Public Health Goals

In November 2010, the American Public Health Association endorsed the health care home model as an important way that primary care may contribute to meeting the public health goals of increasing access to care, reducing health disparities, and better integrating health care with public health systems. Here we summarize the elements of the health care home (also called the medical home) model, evidence for its clinical and public health efficacy, and its place within the context of health care reform legislation. The model also has limitations, especially with regard to its degree of involvement with the communities in which care is delivered. Several actions could be undertaken to further develop, implement, and sustain the health care home.THE AMERICAN PUBLIC HEALTH Association (APHA) has 3 overarching policy priorities: rebuild the public health infrastructure, ensure access to care, and reduce health disparities.1,2 The health care home model contributes to these goals by improving health care delivery at the patient level through redesigning and expanding the scope of primary health care services and improving the interface between primary care practices and public health agencies.In November 2010, APHA endorsed the health care home model of primary care for its public health value. Health care home, a term used by the National Association of Community Health Centers, is a model also referred to as the medical home.3,4 The health care home is a vehicle by which patient- and family-level care at the point of delivery may contribute to meeting population-level goals of improving access to care, reducing health disparities, increasing preventive service delivery, and improving chronic disease management.5 Here we summarize the APHA health care home policy statement and suggest next steps for moving the model forward.     

Financing adolescent health care: the role of Medicaid and CHIP

Financing health care for adolescents involves a combination of public and private sources of payment and, in the public sector, a combination of insurance coverage and categorical programs. In recent years, the importance of health insurance coverage has increased along with the potential for insuring more adolescents. Medicaid and the new State Children's Health Insurance Program (CHIP) offer numerous options for reducing the proportion of uninsured adolescents and for increasing adolescents' access to necessary health care. This article explores the potential of Medicaid and CHIP for meeting adolescents' needs, the extent to which they have done so already, and the gaps or missing links that remain. It also reviews issues that cut across funding sources related to managed care, consent, and confidentiality.     

Environmental medicine in public health service--a social responsibility and its consequences

The special committee for "Environmental Medicine" established by the Federal Association of Doctors in the German Public Health Service presents its paper entitled "Environmental Medicine in the Public Health Service--A Social Responsibility and its Consequences: Propositions with regard to the situation, aims, strategies, and opportunities for action". The paper includes core ideas and responsibilities in the public health service. It aims at providing a number of guidelines for implementing "Environment and Health" ("Umwelt und Gesundheit"), an action programme by the Federal Ministry of Environmental Protection and the Ministry of Health, as well as "Health 21" ("Gesundheit 21"), the framework concept "Health for all" for the WHO's European Region. The paper also aims at initiating and facilitating steps for joint action by the Public Health Service. These theses were passed on to Mrs. Andrea Fischer, the Federal Minister of Health, during a meeting with the Board of the Association. In Germany, environment-related public health protection is well established in the Public Health Departments and state institutes/departments within the scope of public health provision and disease prevention. Typical responsibilities include environmental hygiene and environment-related medical services which have increased in importance. The range of responsibilities and its current political importance are a result of environment-related public health risks, the social situation of the population, also with regard to health issues, and the scope of responsibilities and competencies by doctors and staff in the public health departments. With the people's demands for health, quality of life and life expectancy, this need for action increases. In this paper, judicial, professional, and personal consequence are presented which arise as public health authorities assume these responsibilities.     

The New Hampshire public health network: creating local public health infrastructure through community-driven partnerships.

In 1997, under the auspices of the Turning Point program, New Hampshire's public health stakeholders convened a strategic planning process to transform the state public health system. What emerged was a fundamental vision that the public health system could only be improved by strengthening the capacity of local communities to address local health issues. A plan was developed to create regional public health structures, in areas with no local health departments, to deliver essential public health services at the local level. Seven years later, that plan has become the New Hampshire Public Health Network. The network now covers 67% of the New Hampshire population and includes 113 (48%) cities and towns. Pre- and postevaluations to assess local public health infrastructure at the inception of the program and following 2 years of funding and technical assistance showed significant improvement in local public health capacity and performance. This article describes the development of local public health structures in New Hampshire where none had previously existed.     

Public health workforce development: progress, challenges, and opportunities.

The public health workforce is key to strengthening public health infrastructure. National partners have articulated a vision of a sustainable and competent workforce prepared to deliver essential public health services. Six strategic elements provide a framework for action: monitoring workforce composition; identifying competencies and developing related curriculum; designing an integrated life-long learning delivery system; providing individual and organizational incentives to ensure competency development; conducting evaluation and research and assuring financial support. Partners convened in January 2003 to review progress and to re-evaluate strategies in light of the recently released Institute of Medicine reports on infrastructure and workforce issues. Although significant challenges remain, there is convergence on priorities for competency development, research questions to be addressed and next steps in the national dialogue on certification and credentialing in public health.     

Selling health lifestyles: using social marketing to promote change and prevent disease

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) brought together grantmakers, researchers, and public health professionals on May 20, 2004 to discuss the application of social marketing principles to health promotion and chronic disease prevention. As a behavior change technique, social marketing has proven effective in motivating people to make the complex and difficult behavior changes that can improve health and reduce the risk of chronic diseases such as cardiovascular disease, cancer, and diabetes. The Issue Dialogue used the lens of tobacco prevention and cessation, physical activity, and healthy eating to examine how health grantmakers can use social marketing principles and techniques to encourage and support the adoption of healthier behaviors across the lifespan. This Issue Brief incorporates the information and ideas shared at the meeting with a background paper on social marketing that was prepared for participants who attended the Issue Dialogue. It starts with an introduction of social marketing concepts and provides a framework for assessing whether social marketing is an appropriate approach to use in addressing a particular issue. Subsequent sections: (1) describe both the social marketing communications process and techniques, using examples from campaigns developed by health grantmakers and others; (2) describe how social marketing can be used to promote policy change; (3) provide information on communication strategies that can complement social marketing; and (4) present opportunities for grantmakers.