Public Health Renaissance and the Role of Schools of Public Health

In these turbulent times of political, social and economic changesin Europe public health is again coming into focus. Schoolsof public health, for long the basis for education of publichealth leaders will also in the future play a key role in promotingthe ‘new’ public health agenda. Based on ecologicalawareness and public involvement in health their teaching, researchand policy development should make them be seen as Centres ofRelevance and not only as Centres of Excellence, thus gearingtheir activities to the needs of new generations of practitionerswho can be both activists and advocates for health. If trainingand research are made relevant for practice and community service,then schools will be in the centre of public health insteadof in the periphery of medicine. Elements of a strategy to achievethese objectives are discussed.     

Public Health Genomics

Which consequences can be drawn from genome-based knowledge and how can it be responsibly and timely translated into policies and practice? What are recent developments in genetics and molecular biology, what are the challenges, what are the risks of these developments? Which policies can provide an acceptable balance between providing strong protection of individuals'interests and needs while enabling society to benefit from the genomic advances and empowering individuals? How can molecular medicine contribute to more effective and efficient health care services, and what infrastructures and policies can already now be implemented to assure a benefit for population health? Thus, Public Health Genomics (PHG) tries to answer these challenging questions. This integration of genomics into the aims of public health is called Public Health Genomics (PHG) and is defined as "the responsible and effective translation of genome-based knowledge and technologies into public policy and health services for the benefit of population health".     

The participation of Hispanics in US schools of Public Health, 1975-79.

Hispanic student and faculty representation at US Schools of Public Health from 1975-1979 was investigated. Findings indicate a substantial underrepresentation of Hispanic students and faculty members at these schools. Hispanic public health graduates were found to be less likely than other graduates to receive an MPH degree or a doctorate. It appears that the University of Puerto Rico graduates one-half of all Hispanic graduates and employs two-thirds of all Hispanic public health faculty.     

Attitudes of faculty members of schools of public health toward public service

Public service has long been considered one of a traditional triad of academic functions--teaching, research, and service. Yet even in schools of public health, where service is purported to be an integral component of the institution's mission, faculty generally do not accord as high a value to service performance or approach it with the same degree of commitment as they do research and teaching. A study was conducted to examine faculty perceptions and attitudes toward the service function and its relationship to teaching and research within schools of public health. The data were taken from a mailed questionnaire survey of 20-30 faculty members in each of 20 schools of public health in the United States. The response rate was 71 percent, or 387 returned questionnaires. Respondents generally felt that the greatest value of service lies in its potential for enhancing the image and prestige of the school, and in the fulfillment of the community obligation of the institution. The possibility that service might bring about improvements in faculty research and teaching, or improvements in health services and public health, was rated significantly lower. Thus, respondents did not view service as useful for its contribution to their own careers or to public health practice as much as they regarded it as a beneficial contribution to the reputation of the institution. This view undermines the traditionally held notion that public service either benefits a particular constituency outside the school or enhances the professional development of faculty members themselves.     

Perceptions of part-time faculty by chairpersons of undergraduate health education programs

In recent years, it has become commonplace for universities to hire part-time and non-tenure track faculty to save money. This study examined how commonly part-time faculty are used in health education and how they are used to meet program needs. The American Association of Health Education's 2009 "Directory of Institutions Offering Undergraduate and Graduate Degree Programs in Health Education" was used to send a three-wave mailing to programs that were not schools of public health (n = 215). Of the 125 departments (58%) that responded, those that used part-time faculty averaged 7.5 part-time faculty in the previous academic year, teaching on average a total of 10 classes per year. A plurality of departments (38%) were currently using more part-time faculty than 10 years ago and 33% perceived that the number of part-time faculty has resulted in decreases in the number of full-time positions. Although 77% of department chairs claimed they would prefer to replace all of their part-time faculty with one full-time tenure track faculty member. As colleges downsize, many health education programs are using more part-time faculty. Those faculty members who take part-time positions will likely be less involved in academic activities than their full-time peers. Thus, further research is needed on the effects of these changes on the quality of health education training and department productivity.     

School Nurses' Perceptions and Practices of Assisting Students in Obtaining Public Health Insurance

BACKGROUND: From January through June 2009, 6.1 million children were uninsured in the United States. On average, students with health insurance are healthier and as a result are more likely to be academically successful. Some schools help students obtain health insurance with the help of school nurses. METHODS: This study assessed public school nurses' knowledge and beliefs of the impact of health insurance on students' health and academic success. The study also determined whether public school nurses or their schools were involved in helping students obtain public health insurance, and if so, how they did so. Additionally, the study assessed the public school nurses' perceived benefits of and barriers to helping students obtain public health insurance. A paper-and-pencil survey was sent to a national random sample of 750 public school nurses. The response rate was 56%. RESULTS: Nearly 60% of respondents had helped students enroll in public health insurance. The majority perceived that helping students obtain public health insurance would reduce school absenteeism (90%), improve attention during school (84%), reduce the number of students held back (80%), reduce school dropouts (72%), and increase academic test scores (69%). Although the majority (53%) of nurses thought schools should assist students' parents with filling out public health insurance enrollment forms, some expressed reservations about the process. CONCLUSION: School nurses indicated health insurance is important for the health and academic success of students. These beliefs are congruent with state Child Health Insurance Program (CHIP) directors' perceptions, yet few schools have taken on the role of facilitating student enrollment in public health insurance programs.     

Teaching and research on women's health issues in Schools of Public Health.

Women have been among the students and the faculty in Schools of Public Health since the early days of academic programs in public health. This report provides data on the recent past and current proportions of students and faculty who are women, and on the current quantity and type of teaching and research on women's health issues in the 22 North American Schools of Public Health. Teaching on these subjects is more widespread than research, but one or both are found in all but three of the schools.     

Divorce between theory and practice: the system of public health training in the United States

Many analysts have complained about the severe disconnect between public health as it is taught in schools of public health and public health as it is practiced in health departments. At least in the United States, few faculty members teaching in schools of public health have ever worked in public health departments. By the same token, few of those working in public health departments have degrees from schools of public health; most receive on-the-job training. This history traces the roots of this disconnect or "divorce between theory and practice." It finds that the 1930s were the prime years of community-based public health education, when the pressure of the Depression and the funding newly made available from the federal government by New Deal legislation encouraged practical training programs linked to local communities and health departments. The "divorce" began in the post-war period as an unintended consequence of the system for funding medical education and research at a time of general unpopularity of public health during the McCarthy era. Schools of public health were generally ignored in the 1950s and they began to adapt the strategy that continues today, of using research grants, primarily from the National Institutes of Health, to grow their faculty and facilities.     

Teaching the nursing process at undergraduate nursing programs in the State of Sao Paulo

The goal of this study was to describe the teaching of the nursing process at undergraduate nursing programs in the state of S?o Paulo. The sample was formed by 247 faculty members. With respect to the study methodology, authors elaborated a questionnaire that was sent to 899 faculty members from 32 public and private nursing schools in the state of S?o Paulo. Results showed regarding the teaching of the nursing process that, from the total of 147 faculty members who taught the content, 66 (44.9%) were from 19 private schools and 81 (55.1%) from 8 public schools.     

Public Health Law and the Prevention and Control of Obesity

Context: Obesity constitutes a major public health challenge in the United States. Obesogenic environments have increased owing to the consumption of calorie-dense foods of low nutritional value and the reduction of daily physical activity (e.g., increased portion sizes of meals eaten in and out of the home and fewer physical activity requirements in schools). Policymakers and public health practitioners need to know the best practices and have the competencies to use laws and legal authorities to reverse the obesity epidemic. For instance, statutes and regulations at the federal, state, and local levels of government have been implemented to improve nutritional choices and access to healthy foods, encourage physical activity, and educate consumers about adopting healthy lifestyles.Methods: In an effort to understand the application of laws and legal authorities for obesity prevention and control, in June 2008 the Centers for Disease Control and Prevention convened the National Summit on Legal Preparedness for Obesity Prevention and Control. An outcome of this summit will be the publication of the proceeding''s white papers written by eight law and subject-matter experts with substantive contributions from summit participants, which will identify actionable options that sectors and organizations at various jurisdictional levels can consider adopting.Findings: Law has played a critical role in the control of chronic diseases and the behaviors that lead to them. The use of a systematic legal framework—the use of legislation, regulation, and policy to address the multiple factors that contribute to obesogenic environments—can assist in the development, implementation, and evaluation of a variety of legal approaches for obesity prevention and control.Conclusions: Although public health–focused legal interventions are in an early stage and the direct and indirect impact they may have on the obesity epidemic is not yet understood, efforts such as the summit and white papers should help determine potentially viable legal interventions and assess their impact on population-level change.     

The impact of globalization on public health: implications for the UK Faculty of Public Health Medicine

BACKGROUND: There has been substantial discussion of globalization in the scholarly and popular press yet limited attention so far among public health professionals. This is so despite the many potential impacts of globalization on public health. Defining public health broadly, as focused on the collective health of populations requiring a range of intersectoral activities, globalization can be seen to have particular relevance. Globalization, in turn, can be defined as a process that is changing the nature of human interaction across a wide range of spheres and along at least three dimensions. Understanding public health and globalization in these ways suggests the urgent need for research to better understand the linkages between the two, and effective policy responses by a range of public health institutions, including the UK Faculty of Public Health Medicine. METHODS: The paper is based on a review of secondary literature on globalization that led to the development of a conceptual framework for understanding potential impacts on the determinants of health and public health. The paper then discusses major areas of public health in relation to these potential impacts. It concludes with recommendations on how the UK Faculty of Public Health Medicine might contribute to addressing these impacts through its various activities. RESULTS: Although there is growing attention to the importance of globalization to public health, there has been limited research and policy development in the United Kingdom. The UK Faculty of Public Health Medicine needs to play an active role in bringing relevant issues to the attention of policy makers, and encourage its members to take up research, teaching and policy initiatives. CONCLUSIONS: The potential impacts of globalization support a broader understanding and practice of public health that embraces a wide range of health determinants.     

Systems Thinking as a Framework for Analyzing Commercial Determinants of Health

Policy Points:

• Worldwide, more than 70% of all deaths are attributable to noncommunicable diseases (NCDs), nearly half of which are premature and apply to individuals of working age. Although such deaths are largely preventable, effective solutions continue to elude the public health community.
• One reason is the considerable influence of the “commercial determinants of health”: NCDs are the product of a system that includes powerful corporate actors, who are often involved in public health policymaking.
• This article shows how a complex systems perspective may be used to analyze the commercial determinants of NCDs, and it explains how this can help with (1) conceptualizing the problem of NCDs and (2) developing effective policy interventions.

Context

The high burden of noncommunicable diseases (NCDs) is politically salient and eminently preventable. However, effective solutions largely continue to elude the public health community. Two pressing issues heighten this challenge: the first is the public health community's narrow approach to addressing NCDs, and the second is the involvement of corporate actors in policymaking. While NCDs are often conceptualized in terms of individual‐level risk factors, we argue that they should be reframed as products of a complex system. This article explores the value of a systems approach to understanding NCDs as an emergent property of a complex system, with a focus on commercial actors.

Methods

Drawing on Donella Meadows's systems thinking framework, this article examines how a systems perspective may be used to analyze the commercial determinants of NCDs and, specifically, how unhealthy commodity industries influence public health policy.

Findings

Unhealthy commodity industries actively design and shape the NCD policy system, intervene at different levels of the system to gain agency over policy and politics, and legitimize their presence in public health policy decisions.

Conclusions

It should be possible to apply the principles of systems thinking to other complex public health issues, not just NCDs. Such an approach should be tested and refined for other complex public health challenges.     

27起学校传染病突发公共卫生事件信息分析

目的了解济南市学校传染病突发公共卫生事件的流行病学规律,为预防控制学校突发公共卫生事件提供科学依据。方法应用描述流行病学方法,对济南市2006-2008年学校传染病突发公共卫生事件数据、资料进行统计分析。结果 2006-2008年济南市报告学校传染病突发公共卫生事件相关信息27起,以呼吸道传染病为主,发生起数较多的为水痘(9起)、流感样病例(6起)、流行性腮腺炎(6起);3～5月为报告发病高峰;乡中小学和县中小学是突发公共卫生事件好发场所;学校突发事件信息主要来源于属地医疗机构,占66.67%。结论应加强对各类学校、托幼机构人员培训和督查,提高突发公共卫生事件的报告、处理水平。     

Public health at a crossroads: assessing teaching on economic globalization as a social determinant of health

This article examines how public health faculty prepare students to respond to economic globalization, and more broadly considers the response of public health academics to structural challenges that fall within the realm of global economics, politics, and policy. At this moment, public health is at a crossroads of formalizing its education through graduate competencies and certifications. This research undertook in-depth interviews with public health faculty from across the US to explore how students are prepared to critically consider root causes and respond to political and economic trends shaping health. These interviews reveal a general dearth of attention to globalization, as well as several factors shaping public health academic knowledge production. These include the deep influence and shortcomings of funding resources; a general lack of critical perspective in public health; and both methodological and faculty competence deficiencies. Interviewees also discuss political influences and conflicting student demands, as well the strength of public health as an interdisciplinary profession and potential opportunities for improving public health's responsiveness. Interestingly, while there was near unanimity regarding public health's role and obligation to advocate for change on these issues, there was also uncertainty about how to appropriately model and teach advocacy skills, and tension over public health's role in politics and policy. While public health has a rich history of addressing structural and political factors shaping health, this research reveals an ongoing need to define public health's role in contemporary politics and policy, and in advocating for change at the global policy level.     

Academic public health and managed care.

Health care delivery is going through revolutionary changes. There is a shift toward providing care under the auspices of managed care organizations (MCOs). These MCOs are becoming larger and more comprehensive while increasingly focused on preventive and public health issues. Quality of care, health economics, health services research, data and information systems, quantitative analysis, and the social and behavioral sciences are all becoming important areas of expertise for MCOs and are vital to their successful operation. Thus schools of public health can contribute considerably to MCOs by making their curricula relevant to a managed care environment and having faculty members and research programs that recognize the public health overlap with managed care.     

Future directions for AUPHA (Association of University Programs in Health Administration)? Results of a survey of faculty members.

As part of its strategic planning process, the Association of University Programs in Health Administration (AUPHA) conducted a survey of individual faculty members in health administration programs. The objective of the survey was to assess the faculty development needs of individual faculty members in terms of their professional association affiliations, and to identify what, if any, additional roles might be filled by AUPHA. The findings supported a role for AUPHA beyond its historical role of serving the needs of health administration programs primarily through program directors. Of particular importance to faculty members were exchanges with faculty in other health administration programs around research and teaching issues. While these views were held by those of all academic ranks and educational levels, the importance of these activities was judged higher by those respondents with doctorates and those of assistant professor rank. A specific role indicated for AUPHA is one of creating opportunities for exchange among individual faculty members in health administration programs. Furthermore, the data suggest that those faculty members of assistant professor rank should be a major focus for AUPHA faculty development activities. Roles for AUPHA in the areas of revising curricula and exploring new methods of instruction, developing closer linkages with management practitioners and discussions of ways to facilitate multidisciplinary exchange and research were outlined in this study.     

新疆卫生监督机构卫生监督人员现况调查

目的了解新疆卫生监督机构卫生监督人员现状。方法对新疆各级卫生监督机构人员编制、数量、学历和年龄构成进行调查分析。结果全疆卫生监督机构编制性质不统一。卫生监督人员配置不足。人员学历集中于大专、中专及以下学历，年龄较年轻化，南、北、东疆三大区域卫生监督员学历、年龄构成存在差异。结论建议出台统一政策，制定科学、合理的编制方案，明确卫生监督机构性质、人员编制。严把人员聘用关，提高卫生监督员学历层次。     

Health planning in the United States and the decline of public-interest policymaking

In the 1960s and 1970s, health planning formed a major theme of American health policy. Planners aimed to improve health services and make them broadly available while using resources efficiently. This article provides a history, both intellectual and political, of the origins of planning, its rise, and--in the face of mounting problems--its decline. The story also illustrates broader changes in the culture of policymaking in American health care. From the Progressive Era through the 1960s, reform-minded experts in health worked to advance the public interest. Thereafter, they increasingly left behind public-interest ideals and their underlying extramarket values in favor of organizing and improving health care markets. Whatever the deficiencies of traditional policymaking may be, this study suggests the need to resurrect extramarket values in health policy.     

The Oregon Public Health Policy Institute: Building Competencies for Public Health Practice

The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013.The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts.Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall.Innovative policy solutions to address public health problems are becoming increasingly important, particularly because chronic diseases constitute a growing share of the disease burden in the United States. Public health policies increasingly aim to shape an environment that encourages healthy behaviors, such as physical activity or healthy eating.1,2Although traditional public health programs often target smaller groups, such as those infected with or at elevated risk of particular infectious diseases, public health policies can influence the behavior or environment of large populations. Such policies, which include laws, regulations, rules, or operational decisions intended to improve population health, can help jurisdictions meet population health goals because they work “upstream” of heath care services and even many traditional health promotion programs.The Public Health Division (PHD) of the Oregon Health Authority (OHA) is working to enhance the competencies of the state and local health agencies in Oregon to develop, implement, and evaluate public health policies; these competencies receive limited attention in existing degree programs or in-service training. The PHD funded Oregon State University (OSU) to develop a Public Health Policy Institute (PHPI) tailored to the state’s institutional and political environment, and designed to train public health professionals to address public health problems with upstream policy solutions. We describe the existing public health policy background and training resources nationwide and in Oregon, and outline the structure and content of the PHPI curriculum. We present the results from the evaluation of the first offering of PHPI and reflections on lessons for other states.