The changing face of local public health: a case example.

Local public health agencies are looking for new ways to position themselves within the rapidly changing health care environment. This article provides background on one community's process for developing an innovative, collaborative organizational model for delivering public health and primary care services. Challenges and opportunities, key stakeholders, and transition issues are highlighted.     

Examining the views of key stakeholders regarding the provision of occupational influenza vaccination for healthcare workers in Australia

Annual vaccination of hospital healthcare workers (HCWs) may be an effective measure to reduce the transmission of healthcare associated influenza. However, vaccine coverage rates among HCWs in most public Australian hospitals are below satisfactory for a number of reasons. This study aimed to examine the opinions of key health stakeholders on current issues regarding HCW influenza vaccination.     

Improving the Quality of Health Information on the Internet

Abstract

The Internet Healthcare Coalition (IHC), a nonprofit organization, believes it is possible to improve the quality of health information on the Internet without imposing new regulations and laws that limit the freedom of information providers or consumers. This article traces the history of the grass-roots development of the IHC beginning with an October 1996 FDA-sponsored public meeting. An online call to action led to the creation of the MEDWEB-MASTERS-L e-mail discussion group where important issues were debated and a community of interest developed. Subscribers felt it was important to meet in person during June 1997. At that time, it was resolved to create a coalition of health professionals, patients, industry, publishers, and Web developers with a common goal of promoting improved Internet health resources through education and self-regulation. The IHC is currently involved with efforts to help consumers and governments control health fraud on the Internet without destroying the Internet's ability to provide useful and legitimate health information. The Coalition plans to be an educational resource to support many independent efforts by members to improve the quality of health information on the Internet. In October 1998, it plans to hold its first annual meeting.     

Assessment of newspaper reporting of public health and the medical model: a methodological case study

A case study over a 4-week period reviewed health items reportedin the Australian newspaper, The [Brisbane] Courier Mail, underthe two broad categories of public health and the medical model.Content analysis was utilized to assess 19 criteria which measuredprominence, content, stakeholders, orientation of reportingand tone of items. The findings suggest that public health,including health promotion, is presented less often, less prominentlyand less positively than medical model issues (Westwood, 1995).No comparable review of press reporting of these two modelswas identified in extensive international literature searchesand this study is considered to break new ground. The potentialinfluence of the print media in the education of the populationon public health issues is presented. It is proposed that agreater understanding of the dynamics of health reporting andparticularly the relationship between public health and themedical model may lead to more constructive and informativereporting.     

Summary of the workshop on methodologies for environmental public health tracking of air pollution effects

The US Centers for Disease Control and Prevention established the Environmental Public Health Tracking (EPHT) program to support state and local projects that characterize the impact of the environment on health. The projects involve compiling, linking, analyzing, and disseminating environmental and health surveillance information, thereby engaging stakeholders and guiding actions to improve public health. One of the EPHT objectives is to track the public health impact of ambient air pollution with analyses that are timely and relevant to state and local stakeholders. To address methodological issues relevant to this objective, in January 2008, government officials and researchers from the USA, Canada, and Europe gathered in Baltimore, Maryland for a 2-day workshop. Using commissioned papers and presentations on key methodological issues as well as examples of previous air pollution impact assessments, work group discussions produced a set of consensus recommendations for the EPHT program. These recommendations noted the need for data that will encourage local stakeholders to support continued progress in air pollution control. The limitations of using only local data for analyses were also noted. To improve local estimates of air pollution health impacts, methods were recommended that “borrow strength” from other evidence. An incremental approach to implementing such methods was recommended. The importance and difficulty of communicating uncertainties in local health impact assessments was emphasized, as was the need for coordination among different agencies conducting health impact assessments.     

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.     

Pediatric CT research elevates public health concerns: low-dose radiation issues are highly politicized.

This article presents an analysis of issues related to low-dose radiation, with a focus on pediatric computed tomography (CT). It references several early studies that are seldom quoted in radiation research papers, then quantifies the excess lifetime fatal cancer yield attributable to an estimated 6.5 million pediatric abdominal CT scans. The authors highlight an important policy document issued jointly by the National Cancer Institute and the Society for Pediatric Radiology--specifically, its conclusion that a small dose from CT represents "a public health concern." Finally, the article identifies several contentious issues and proposes policy initiatives that, if implemented, could result in significant reductions of future radiogenic cancers and chronic injuries. The authors call for discussions between professional radiology societies and public interest health organizations, thereby involving all stakeholders.     

Priorities and strategies for promoting community-based prevention policies.

The public health community faces major choices in priorities for its mission in a rapidly changing environment. One option is to place greater emphasis on public health policy development. Policy making requires a grasp of the interplay among stakeholders, policy makers, the press, and the public. A framework for gathering relevant information and guiding strategic action is a useful tool for participation in community, state, and national arenas in the interests of population health. Organization-targeted approaches can make policy advocacy, community mobilization, and public education about policy issues more effective. This requires investment in public health infrastructure.     

A life cycle model of public policy issues in health care: the importance of strategic issues management

Public policy affects health and social services organizations. Senior management has a responsibility to prevent inappropriate demands of stakeholders from predominating and to influence the outcome of public policy to the benefit of their organization through the strategic issues management process. This article presents a public policy issue life cycle model, life-cycle stages and suggested strategies, paths issues can take in the life cycle, and factors that affect issue paths. An understanding of these dynamics can aid senior managers in shaping and changing public policy issues and lessening external environment threats to their organization.     

Mapping the key issues shaping the landscape of global public health

Abstract A survey of global health experts attending an invited meeting provided a means to map key issues perceived to be shaping emerging global public health agendas. Eighty-five participants proposed three major issues likely to have the most significant impact on the field of global health in the coming years. Six raters grouped the resultant items, with multi-dimensional scaling (MDS) analysis producing a composite two-dimensional map depicting the overall patterning of items. Thematic clusters were incorporated within four major domains: changing health and prevention needs (15% of items), globalisation and global health governance (33% of items), transforming health systems (30% of items) and innovations in science and technology (7% of items). The remaining 15% of items addressed forms of environmental change. The distribution of items across domains was not significantly influenced by the current professional role of participants, their current location in the 'global north' or 'global south' or their region of focus (although the latter approached threshold significance). The constraints on interpretation imposed by the biases influencing participation in the survey are noted. However, the exercise suggests the potential for coherently defining shared agendas for diverse stakeholders to address emerging priorities. The closer integration of environmental concerns with other global public issues is clearly warranted.     

Australian letters to the editor on tobacco: triggers, rhetoric, and claims of legitimate voice

News coverage of tobacco issues influences both individual behavior change and policy progression. Thus, media advocacy is increasingly recognized as important for promoting public health. Letters to the editor (LTE) are a basic form of media advocacy, serving to demonstrate community sentiment on a given issue. Such letters are yet to receive systematic analytic consideration. The authors conducted an ethnographic content analysis of LTE on tobacco issues from a sample of 11 Australian daily newspapers over a 3-year period (2001 to 2003, N=361). They argue that letters are artifacts of active engagement in a public debate and note that various stakeholders adopt similar strategies to pursue their objectives. They illustrate how identifying personal and collective identities is crucial in the assertion of legitimacy of voice in LTEs. Better understanding is needed of both the particular issues that spark public engagement, and the salient rhetoric employed by advocates of disparate positions.     

Changing Policy Framing as a Deliberate Strategy for Public Health Advocacy: A Qualitative Policy Case Study of Minimum Unit Pricing of Alcohol

Context

Scotland is the first country in the world to pass legislation introducing a minimum unit price (MUP) for alcohol in an attempt to reduce consumption and associated harms by increasing the price of the cheapest alcohol. We investigated the competing ways in which policy stakeholders presented the debate. We then established whether a change in framing helped explain the policy''s emergence.

Methods

We conducted a detailed policy case study through analysis of evidence submitted to the Scottish parliament, and in-depth, one-to-one interviews (n = 36) with politicians, civil servants, advocates, researchers, and industry representatives.

Findings

Public- and voluntary-sector stakeholders tended to support MUP, while industry representatives were more divided. Two markedly different ways of presenting alcohol as a policy problem were evident. Critics of MUP (all of whom were related to industry) emphasized social disorder issues, particularly among young people, and hence argued for targeted approaches. In contrast, advocates for MUP (with the exception of those in industry) focused on alcohol as a health issue arising from overconsumption at a population level, thus suggesting that population-based interventions were necessary. Industry stakeholders favoring MUP adopted a hybrid framing, maintaining several aspects of the critical framing. Our interview data showed that public health advocates worked hard to redefine the policy issue by deliberately presenting a consistent alternative framing.

Conclusions

Framing alcohol policy as a broad, multisectoral, public health issue that requires a whole-population approach has been crucial to enabling policymakers to seriously consider MUP, and public health advocates intentionally presented alcohol policy in this way. This reframing helped prioritize public health considerations in the policy debate and represents a deliberate strategy for consideration by those advocating for policy change around the world and in other public health areas.     

Creating a public space and dialogue on sexuality and rights: a case study from Bangladesh

This article describes and analyses a research based engagement by a university school of public health in Bangladesh aimed at raising public debate on sexuality and rights and making issues such as discrimination more visible to policy makers and other key stakeholders in a challenging context. The impetus for this work came from participation in an international research programme with a particular interest in bridging international and local understandings of sexual and reproductive rights. The research team worked to create a platform to broaden discussions on sexuality and rights by building on a number of research activities on rural and urban men's and women's sexual health concerns, and on changing concepts of sexuality and understandings of sexual rights among specific population groups in Dhaka city, including sexual minorities. Linked to this on-going process of improving the evidence base, there has been a series of learning and capacity building activities over the last four years consisting of training workshops, meetings, conferences and dialogues. These brought together different configurations of stakeholders - members of sexual minorities, academics, service providers, advocacy organisations, media and policy makers. This process contributed to developing more effective advocacy strategies through challenging representations of sexuality and rights in the public domain. Gradually, these efforts brought visibility to hidden or stigmatised sexuality and rights issues through interim outcomes that have created important steps towards changing attitudes and policies. These included creating safe spaces for sexual minorities to meet and strategise, development of learning materials for university students and engagement with legal rights groups on sexual rights. Through this process, it was found to be possible to create a public space and dialogue on sexuality and rights in a conservative and challenging environment like Bangladesh by bringing together a diverse group of stakeholders to successfully challenge representations of sexuality in the public arena. A further challenge for BRAC University has been to assess its role as a teaching and research organisation, and find a balance between the two roles of research and activism in doing work on sexuality issues in a very sensitive political context.     

Control of mother-to-child transmission of infectious diseases in Brazil: progress in HIV/AIDS and failure in congenital syphilis

In Brazil, syphilis and HIV infection are considered serious public health problems. However, in practice, epidemiological surveillance, prevention measures, and prenatal care seem to be more effective in the control of mother-to-child transmission of the HIV than in the control of transmission of the Treponema pallidum. Here we discuss the differences in surveillance, prenatal care, and care of the newborn. Important differences were identified. It is concluded that there is an urgent need to establish prevention of mother-to-child transmission of syphilis as a public health priority, using an integrated approach including women's health, children's health, primary health care, and STD/AIDS programs on all governmental levels. These issues also need to be discussed with all stakeholders involved. Important aspects related to the problem are the training of public health professionals, as well as the participation of the community. The elimination of congenital syphilis does not require expensive drugs, and diagnostic tools, but a long-term sustainable approach.     

The Washington state "name-to-code" HIV reporting system: a public health perspective.

The advent of highly active anti-retroviral treatment for human immunodeficiency virus (HIV) infection in the mid-1990s, along with other new developments in HIV understanding, epidemiology, and care, led local and state public health officials to recommend to the Washington State Board of Health in 1996 that asymptomatic HIV infection be added to the list of conditions reportable to public health by name. A controversy over reporting followed that lasted over two years. Although a "name-to-code" compromise had been suggested early on, it gained acceptance only after key stakeholders faced substantial public health, medical, and general community opposition to unique identifier reporting. This article describes the processes of adopting HIV reporting in Washington State, the nature of the reporting system, and how the issues were ultimately resolved.     

城市社区卫生服务“收支两条线”运行模式研究

在公益性和预防保健为主的社区卫生服务体系里,目前最值得尝试的方式就是需要政府跨越层级繁长的委托代理链,直接为各利益体中的弱势者提供需要在“收支两条线”运行机制下的社区卫生服务,断绝利益相关者利益博奕中的趋利行为。     

Participatory environmental health research in Aotearoa/New Zealand: constraints and opportunities.

Within the Aotearoa/New Zealand context, this article identifies opportunities for, as well as constraints on, using participatory research to address environmental health concerns. In New Zealand, principles of partnership fundamental to the Treaty of Waitangi, and the requirements for consultation within the Resource Management Act, provide a framework for participatory approaches. Participatory environmental health research integrates knowledge from various scientific and community sources. It also fosters the innovation, evaluation, and sharing of information that new public health approaches demand. As an emerging field in Aotearoa/New Zealand, it must draw on experience from resource management, rural development, and public health research and practice. Water quality is used as an example of the complexity of environmental health issues and of the potential benefits of engaging stakeholders where long-term health and well-being require balancing ecosystem integrity, economic viability, and social processes.     

Mind and Body Reunited: Improving Care at the Behavioral and Primary Healthcare Interface

This paper reviews current models, research, and approaches to improving care on the primary care/behavioral health interface in the USA. We focus on care in the public sector where high rates of comorbidity, regulatory burdens, and lack of resources create particular challenges to collaboration and coordination. To achieve the goals of improved coordination and collaboration, it will be critical to address key financing, workforce, information technology, performance assessment, and research issues. It will also be critical to engage multiple stakeholders including consumers, mental health and health providers, and policymakers and public sector funders.     

Public strategies for improving eHealth integration and long‐term sustainability in public health care systems: Findings from an Italian case study

eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long‐term sustainability. In a public health care system, the public actor is among the main “buyers” eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a “buyer”) improve long‐term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win‐win strategies should be followed. Investments should take into account the need to long‐term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the “platform approach” emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitoring. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes.