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.     

Fear of bioterrorism and implications for public health preparedness

After the human anthrax cases and exposures in 2001, the Illinois Department of Public Health received an increasing number of environmental and human samples (1,496 environmental submissions, all negative for Bacillus anthracis). These data demonstrate increased volume of submissions to a public health laboratory resulting from fear of bioterrorism.     

Bioterrorism risk perceptions and educational needs of public health professionals before and after September 11, 2001: a national needs assessment survey.

The study objectives were to compare local public health professionals' bioterrorism risk perceptions, the extent of bioterrorism preparedness training, and to describe preferred methods for delivery of preparedness education in the United States. National needs assessments were conducted via a mailed survey to 3,074 local public health departments in October 2000 and November 2001. Compared to a survey conducted in October 2000, the perceived risk of a bioterrorism attack in the United States increased dramatically after September 11 (p < 0.0001); however, 57% of respondents believed one was unlikely to occur within their own community. Public health professionals perceive their own communities to be at low risk for a bioterrorism event. Ongoing, updated, standardized bioterrorism preparedness education is needed.     

Bioterrorism surveillance and privacy: intersection of HIPAA, the Common Rule, and public health law

The threat of bioterrorism in the wake of the September 11, 2001, terrorist attacks cannot be ignored. Syndromic surveillance, the practice of electronically monitoring and reporting real-time medical data to proactively identify unusual disease patterns, highlights the conflict between safeguarding public health while protecting individual privacy. Both the Health Insurance Portability and Accountability Act and the Common Rule (which promulgates protections for individuals in federally sponsored medical research programs) safeguard individuals. Public health law protects the entire populace; uneven state-level implementation lacks adequate privacy protections. We propose 3 models for a nationwide bioterrorism surveillance review process: a nationally coordinated systems approach to using protected health information, creating public health information privacy boards, expanding institutional review boards, or some combination of these.     

Strategic orientation of public health in transition: an overview of South Eastern Europe

Two recent developments have redirected the course of Public Health in Europe - the Public Health Mandate of the European Commission and the conceptualization of a New Public Health. For the transition, countries in South Eastern Europe, particularly Serbia, provide support to essential public health reforms in four areas: strategic management, public health information, public health legislation, and public health training and research. The roles of the Dubrovnik Pledge (2001) and the Stability Pact, which has international support, have been central.     

Building academic-practice partnerships: the Center for Public Health Preparedness at the Columbia University Mailman School of Public Health, before and after 9/11.

The Center for Public Health Preparedness at the Columbia University Mailman School of Public Health is part of a national network of academic centers established by the Centers for Disease Control and Prevention to strengthen links between public health practice and academe, especially for public health workforce development. Since its inception in Fall 2000, the Center has been working in partnership with the New York City Department of Health & Mental Hygiene (DOHMH) on planning and competency-based training in emergency preparedness (including bioterrorism and infectious diseases) and evaluation. Initial programs with DOHMH included development of a 3-hour orientation to basic emergency preparedness for their workforce. In the wake of 9/11 and the anthrax events, Center members gave over two dozen presentations at community forums, seminars, and clinical rounds, and over 100 press interviews, provided lay language information through community forum presentations and the School's Web site, and developed a database of volunteers for surge capacity. Subsequent programs include bioterrorism response training for clinicians and emergency medical services personnel, incident command for public health, and a study of evacuation from the World Trade Center on 9/11.     

The Management Academy for Public Health: the South Carolina experience.

In the late 1990s, the South Carolina Department of Health and Environmental Control (SCDHEC) was faced with the challenges of a workforce that was not prepared in public health; the impending loss of significant agency expertise, leadership, and institutional knowledge through retirement; the lack of available and accessible training; and continuing state budget cuts. Preparedness for bioterrorism and other public health emergencies was also of concern, a need made more urgent after 2001. To respond to current and emerging public health challenges, the SCDHEC had to have a workforce with the knowledge and skills necessary for the delivery of essential public health services. To address these challenges, the department partnered with the University of North Carolina in the pilot of the Management Academy for Public Health. The Management Academy is now integrated into the South Carolina workforce development strategy, and 199 staff members and 22 community partners have graduated from the program. Along with increased knowledge, skills, and abilities of individual staff and increased organizational and community capacity, a significant result of South Carolina's experience with the Management Academy for Public Health is the development of a training program for emergency preparedness modeled on the Management Academy. This highly successful program illustrates the replicability of the Management Academy model.     

Integration of academia and practice in preparedness training: the Harvard School of Public Health experience

Given the need for public health professionals well trained in emergency preparedness and response, students in public health programs require ample practical training to prepare them for careers in public health practice. The Harvard School of Public Health Center for Public Health Preparedness has been instrumental in the creation and implementation of a course entitled, "Bioterrorism: Public Health Preparedness and Response." This course features lectures on specific applications of public health practice in emergency preparedness and response. In addition, it provides students the opportunity to operationalize and apply their knowledge during an interactive tabletop exercise. In light of their university affiliations and expertise in providing preparedness training, other Academic Centers for Public Health Preparedness have the opportunity to be instrumental in providing similar training to graduate students of public health.     

Developing national performance standards for local public health systems.

Since the beginning of the 1990s, public health has struggled to measure its performance and capacity to carry out the core functions of public health practice, while facing increasing challenges within the ever-changing landscape of healthcare delivery, bioterrorism response, emerging infections, and other threats to the public's health. The article describes the development of a set of national performance standards for measuring how effectively public health systems deliver the 10 Essential Public Health Services. The standards were developed through a practice-driven approach that incorporated comprehensive field testing and iterative revisions. The standards represent a national consensus framework for measuring important aspects of public health practice.     

Educating health professionals to respond to bioterrorism

In September 2003, a consortium of bioterrorism and health education experts from the University of Louisville, the University of Kentucky, the Kentucky Department for Public Health, and the Louisville Metro Health Department received funding from the Health Resources and Services Administration (HRSA) to develop a broadly based bioterrorism education program for health professionals in the Commonwealth of Kentucky and the surrounding region. This grant will fund a series of presentations tailored to the needs of professionals in medicine, dentistry, public health, nursing, behavioral medicine, allied health, pharmacy, veterinary medicine, and agriculture, providing coordinated training both on site and through distance learning technology. This article outlines the major grant-funded activities envisioned for the grant years 2003 through 2005, focusing on the use of standardized patients and computerized biosimulators, the transdisciplinary partnerships of the universities involved, and the essential collaboration provided by the state and local health departments.     

健康中国背景下《公共卫生综合实践技能》课程建设的探索

在大健康背景下,培养高质量的公共卫生与预防医学类专业人才是健康中国建设的重要内容之一。在公共卫生人才培养过程中,强化公共卫生实践技能并提升其实践应用能力,是保障其与公共卫生事业工作岗位有效衔接,更是提升其岗位胜任力的关键。本文对《公共卫生综合实践技能》课程建设的前期准备、课程内容及设置、课程建设后期的完善三个方面进行了探索和讨论,为共建《公共卫生综合实践技能》课程提供经验参考。     

An innovation in partnership among first responders and public health: bridging the gap

To properly prepare for and respond to bioterrorism and other urgent public health threats and emergencies, response disciplines must work together in well coordinated efforts to address the preparedness needs of their communities and the nation. Traditional public health workforce and first responder roles have been challenged and new partnerships have emerged, increasing the need for innovative education and training. This article provides a review of an approach the Heartland Center for Public Health Preparedness took to foster these partnerships and increase the provision of competency-based, integrated responder education and training in the St. Louis, MO, metropolitan area.     

Teaching Public Health Practitioners about Health Communication: The MPH Curriculum Experience

The dissemination of health information to the public often occurs through the mass media. Media strategies as a component of behavior change assume knowledge of communication theories and methods by public health practitioners. We surveyed the curricula of 52 accredited graduate programs leading to the Master's in Public Health (MPH) degree to assess their communication component. Graduate bulletins for admission year 1996 were examined for public health mission statement, goals and objectives of the MPH training program, and for course titles. Courses were identified as having a communication focus if the terms communication, information, marketing or media were used in the title. There were a total of 82 communication courses offered, with 65 courses in 26 Schools of Public Health (SPH), 13 courses in 18 Community Health and Preventive Medicine departments (CHPM), and 4 courses in 8 Community Health Education departments (CHE). The difference in mean number of health communication courses was significant by type of MPH program (p < 0.003) with SPH offering an average of 3 courses, CHPM departments offering an average of 1 course, and CHE offering an average of 0.5 course. The distribution of communication courses ranged from 10 courses to 0 courses per program. Seven SPH offered 3 or more communication courses, whereas 5 SPH offered no health communication courses in the MPH curriculum. These data point to a shortcoming in the training of MPH students in health communication theory and skills as ascertained by course titles in graduate bulletins.     

Developing Academic–Practice Partnerships to Enhance the Integration of Genomics Into Public Health

The sequencing of the human genome has provided tools to gain a better understanding of the role of genes and their interaction with environmental factors in the development of disease. However, much work remains in translating discoveries into new opportunities for disease prevention and health promotion. Both public health academia and practice have important roles to play in bridging the gap between the growth in knowledge stemming from the Human Genome Project and its application in public health. Recognizing this, the Centers for Disease Control and Prevention, through the Association of Schools of Public Health, established Centers for Genomics and Public Health at three schools of public health in 2001: the University of Michigan, the University of North Carolina, and the University of Washington. This paper describes the experience of the University of Washington Center for Genomics and Public Health in forging partnerships with public health practitioners to translate genomic advances into public health practice.     

Developing academic-practice partnerships to enhance the integration of genomics into public health

The sequencing of the human genome has provided tools to gain a better understanding of the role of genes and their interaction with environmental factors in the development of disease. However, much work remains in translating discoveries into new opportunities for disease prevention and health promotion. Both public health academia and practice have important roles to play in bridging the gap between the growth in knowledge stemming from the Human Genome Project and its application in public health. Recognizing this, the Centers for Disease Control and Prevention, through the Association of Schools of Public Health, established Centers for Genomics and Public Health at three schools of public health in 2001: the University of Michigan, the University of North Carolina, and the University of Washington. This paper describes the experience of the University of Washington Center for Genomics and Public Health in forging partnerships with public health practitioners to translate genomic advances into public health practice.     

Regional public health emergency preparedness: the experience of Massachusetts Region 4b

Historically, local public health in Massachusetts has been largely decentralized, with each town responsible for providing local public health services. After 9/11, the Massachusetts Department of Public Health (MDPH) began to plan for bioterrorism and other possible public health emergencies and found that having 351 separate departments made emergency planning difficult and dispersing of funds a challenge. To facilitate this process, MDPH created seven emergency preparedness regions and asked local public health departments to engage in joint planning. This article describes the formation of Region 4b and how the region came together to work on emergency preparedness issues. It also examines the organizational, financial, and planning challenges associated with organizing these towns as a unified entity.     

Lalonde's paradigm, World Health Organization and new public health

The authors present the origins and evolution of the New Public Health idea assuming the fundamental significance of Lalonde's health field concept in this process. The other crucial events which contributed to it was the formulation and implementation of WHO strategy HFA 2000, publication of Ottawa Charter, defining by WHO the essential public health functions and concepts of Gro Harlem Bruntland from 1998-1999 when she was the Director General of WHO. Authors present for discussion their working definition of New Public Health, which is based of the public health definition of J. Nosko et al. from 2001.     

Through the glass ceiling - and back again: the experiences of two of the first non-medical directors of public health in England

In 2001, the English Department of Health announced a radical re-organisation of the NHS under the banner of 'shifting the balance of power'. As part of this re-organisation health authorities were abolished and the main NHS public health responsibilities devolved to the new primary care trusts (PCTs) from April 2002. Following several years of campaigning by the Multidisciplinary Public Health Forum (MPHF), in November 2001 the Acting Minister for Public Health, Lord Hunt, announced that PCT director of public health (DPH) posts would be open to 'suitably qualified' candidates from any discipline. From April 2002 a number of new DsPH from backgrounds other than medicine were appointed. This paper reports on the experiences of two such DsPH who shared a commitment to multidisciplinary public health, but who did not wholly share the objectives of the MPHF. We place the opening of PCT DPH posts in the context of tensions within NHS public health between a focus on health services versus the wider determinants of health, and the development of multidisciplinary public health. The paper reflects on both the degree of change this opening represented and the limitations and tensions such appointments exposed.     

Strengthening the public health system for a healthier future

On November 6, 2002, Grantmakers In Health (GIH) convened a group of experts from the fields of philanthropy, research, government, and policy to examine the nation's public health infrastructure and explore opportunities for grantmakers to strengthen and sustain this fragile and troubled system. During the course of this meeting, representatives from the Institute of Medicine, which recently released a report on this topic, and the Centers for Disease Control and Prevention (CDC) discussed the role of the national public health system and reviewed weaknesses in its infrastructure. Elaborating on these points, local public health leaders offered an on-the-ground perspective of the challenges they face as they struggle to maintain and improve the health of the public at the same time as they prepare for the possibility of bioterrorism. Finally, several foundations with experience in this area shared their strategies for helping to buttress the infrastructure so vital to the health of the nation. This Issue Brief builds on a paper prepared in advance of the meeting by incorporating the highlights from presentations and discussions that took place at GIH's Issue Dialogue. It also incorporates comments and discussion from GIH's 2002 Fall Forum intensive breakout session Worst Case Public Health Scenario: Can Philanthropy Respond? Following a brief introduction to the public health system and its evolution over the past several decades, the Issue Brief discusses essential elements of the public health infrastructure, reviews the issues confronting each of these elements, and profiles various philanthropic initiatives aimed at repairing and improving the public health infrastructure. It concludes with an in-depth look at the infrastructure issues involved in emergency preparedness.     

Legal and public policy responses of states to bioterrorism

In late 2001, during the aftermath of the anthrax letter attacks, model legislation was proposed to relevant state agencies to update their states' public health laws to meet the threat of bioterrorism. This legislation was the Model State Emergency Health Powers Act. A concern underlying this and related efforts to address future bioterrorism threats was the perceived inadequacy of state laws to respond effectively when such threats occur. We evaluated how 4 states--Utah, Maine, South Dakota, and Indiana--addressed this concern in the context of the model legislation. The conclusion is that the model legislation generally served as an important catalyst for state action in the field of bioterrorism preparation.