Rebuilding public health on more than thoughts and prayers

Sweeping reviews will be conducted once the COVID-19 pandemic concludes to support public health system strengthening. Unfortunately, these reviews will find what past reviews on public health in Canada have found: limited evidence on the organization, financing, and delivery of public health services. This is due to inattention to the field of public health services and systems research (PHSSR) in Canada. To avoid this pandemic becoming “just another public health crisis,” PHSSR must be prioritized by public health and health service research associations, funders, and scholars.     

Law and public health at CDC

Public health law is an emerging field in U.S. public health practice. The 20th century proved the indispensability of law to public health, as demonstrated by the contribution of law to each of the century's 10 great public health achievements. Former CDC Director Dr. William Foege has suggested that law, along with epidemiology, is an essential tool in public health practice. Public health laws are any laws that have important consequences for the health of defined populations. They derive from federal and state constitutions; statutes, and other legislative enactments; agency rules and regulations; judicial rulings and case law; and policies of public bodies. Government agencies that apply public health laws include agencies officially designated as "public health agencies," as well as health-care, environmental protection, education, and law enforcement agencies, among others.     

New directions in European public health research: report of a workshop

Public health draws from a range of academic disciplines, social, medical and statistical, and answers questions relevant to improving the health of populations. We have initiated a Europe-wide study, Strengthening Public Health Research in Europe, to assess the development and use of public health research in both public policy and local decision making. The contemporary challenge for public health research is to integrate the capabilities of different academic disciplines to address policies for health. We have considered the development of public health research in five fields: political epidemiology, community health, health services, economics, and evaluation evidence and synthesis. The organisation and funding of research in Europe should be able to support new research fields and issues, to contribute to policy development and public health practice.     

Making the Case for Laws That Improve Health: A Framework for Public Health Law Research

Context: Public health law has received considerable attention in recent years and has become an essential field in public health. Public health law research, however, has received less attention.Methods: Expert commentary.Findings: This article explores public health law research, defined as the scientific study of the relation of law and legal practices to population health. The article offers a logic model of public health law research and a typology of approaches to studying the effects of law on public health. Research on the content and prevalence of public health laws, processes of adopting and implementing laws, and the extent to which and mechanisms through which law affects health outcomes can use methods drawn from epidemiology, economics, sociology, and other disciplines. The maturation of public health law research as a field depends on methodological rigor, adequate research funding, access to appropriate data sources, and policymakers’ use of research findings.Conclusions: Public health law research is a young field but holds great promise for supporting evidence-based policymaking that will improve population health.     

Building public health associations in the transition countries of south-eastern Europe: the example of Albania

The Albanian Forum of Public Health (AFPH), an umbrella organization including different public health associations operating in Albania, was established in March 2004 with the support of the European Public Health Association (EUPHA) and the Open Society Institute (OSI). Ever since its establishment the AFPH has been an open arena wherein opinions and options for rational health policies comprising all relevant issues of the New Public Health are discussed, formulated, and documented near the Albanian Ministry of Health. Notwithstanding the laudable mission of the AFPH, there is an emerging need to establish a regional Public Health Forum in south-east Europe as a basic prerequisite for sustainable development of public health in these countries. Most conveniently, this regional umbrella organization should have a supporting Secretariat based in one of the south-east European countries. Nevertheless, there is a clear call for international funding with participation of different agencies and bodies (OSI, EUPHA, Canadian International Development Agency, and the Stability Pact). A regional association in the south-east Europe would enable the organization of annual conferences in the most renowned institutions in the region. Also, a regional collaboration among public health associations would be a suitable start for the development of research in south-east Europe. Furthermore, the existence of a regional public health association would make feasible the establishment of a scientific public health journal for south-east Europe in the English language.     

Cultural animation in health research: An innovative methodology for patient and public involvement and engagement

Background

A significant challenge in Patient and Public Involvement and Engagement (PPIE) in health research is to include a wide range of opinions and experiences, including from those who repeatedly find themselves at the margins of society.

Objective

To contribute to the debate around PPIE by introducing a bottom‐up methodology: cultural animation (CA). Cultural Animation is an arts‐based methodology of knowledge co‐production and community engagement which employs a variety of creative and participatory exercises to help build trusting relationships between diverse participants (expert and non‐experts) and democratize the process of research.

Design

Three CA full‐day workshops for the research project “A Picture of Health.”

Participants

Each workshop was attended by 20‐25 participants including 4 academics, 5 retired health professionals who volunteered in the local community and 15 community members. Participants ranged in age from 25 to 75 years, and 80% of the participants were women over the age of 60.

Results

The CA workshops unearthed a diversity of hidden assets, increased human connectivity, led to rethinking of and co‐creating new health indicators and enabled participants to think of community health in a positive way and to consider what can be developed.

Discussion

Cultural animation encourages participants to imagine and create ideal pictures of health by experimenting with new ways of working together.

Conclusion

We conclude by highlighting the main advantages to PPIE as follows: CA provides a route to co‐produce research agendas, empowers the public to engage actively with health professionals and make a positive contribution to their community.     

Health researchers' attitudes towards public involvement in health research

Objective  To investigate health researchers' attitudes to involving the public in research.
Background  Public involvement in research is encouraged by the Department of Health in the UK. Despite this, the number of health researchers actively involving the public in research appears to be limited. There is little research specifically addressing the attitudes of health researchers towards involving the public: how they interpret the policy, what motivates and de-motivates them and what their experiences have been to date.
Design  A qualitative research design, using semi-structured telephone interviews.
Setting and participants  Fifteen purposively sampled UK-based University health researchers were the participants. Interviews were conducted over the telephone.
Findings  The participants suggested varying constructions of public involvement in research. Arguments based on moral and political principles and consequentialist arguments for involving the public in research were offered and most participants highlighted the potential benefits of involving the public. However, feelings of apprehension expressed by some participants imply that a number of researchers may still be uncomfortable with involving the public, as it presents a different way of working.     

The public health implications of HIV criminalization: past,current, and future research directions

While public health remains the primary site of authority for preventing HIV transmission, recent shifts in the biopolitics of HIV have heightened tensions in the institutional and discursive relations through which the sexual lives of people living with HIV and broader HIV epidemics are regulated. Most notably, over the past decade, criminal justice responses to HIV have gained considerable traction. The growing use of the criminal law to regulate perceived HIV transmission risks has occasioned considerable controversy among people living with HIV, community-based AIDS organizations, health-care providers, public health authorities, prosecutors, judges, and the legal community. This article introduces a special section of Critical Public Health focused on the public health implications of HIV criminalization. The article reviews past and current work on the topic, situates the contributions made by the articles published in the special section, and outlines directions for future inquiry.     

Ethics in public health research: privacy and public health at risk: public health confidentiality in the digital age

Public health agencies increasingly use electronic means to acquire, use, maintain, and store personal health information. Electronic data formats can improve performance of core public health functions, but potentially threaten privacy because they can be easily duplicated and transmitted to unauthorized people. Although such security breaches do occur, electronic data can be better secured than paper records, because authentication, authorization, auditing, and accountability can be facilitated. Public health professionals should collaborate with law and information technology colleagues to assess possible threats, implement updated policies, train staff, and develop preventive engineering measures to protect information. Tightened physical and electronic controls can prevent misuse of data, minimize the risk of security breaches, and help maintain the reputation and integrity of public health agencies.     

Building bridges between schools of public health and public health practice.

A 1988 Institute of Medicine report, The Future of Public Health, characterized the current public health system as fragmented, particularly with regard to relationships between public health agencies and academic institutions. As one response to the report, the Health Resources and Services Administration established the Center for the Development of Public Health Practice at the University of Illinois to advance linkages between schools of public health and public health agencies. Surveys of schools of public health and of state health agencies were conducted in 1992 to collect baseline data on the practice links between the two. Responses reveal that there is a substantial amount of informal collaboration between them. Formalization of collaborative activities between schools and agencies is beginning to occur and is expected to expand owing to increased focus on public health practice at schools of public health.     

Addressing the dearth of critical gender analysis in public health and medical pedagogy: an interdisciplinary seminar to generate student-created teaching examples

Gender-based analysis in public health is a systematic examination of how population health is shaped by systems of gender relations, involving policies and laws, programs and services, research priorities, social norms and practices, and public discourse. To address the paucity of critical gender-based analysis training in most public health, medical, and health policy courses, we designed the capstone course in the Women, Gender, and Health (WGH) Interdisciplinary Concentration at the Harvard T.H. Chan School of Public Health. This course enables students to develop brief teaching examples to expose students in non-WGH courses to gender-based analysis (e.g. challenging simplistic conflations of gender and sex). The assignment has yielded 26 teaching examples (several available online at no cost) and offers a model that can be used to address analogous curriculum gaps in relation to other social determinants of health, including racism, social class, sexuality, and immigration.     

The Public Health Statute Modernization National Collaborative: developing a model state public health law.

It is through laws that state governments set forth the policy statements describing their responsibilities and authorities for promoting and protecting the public's health. A number of Turning Point states identified the need for strengthening the legal foundation for their public health systems. The Public Health Statute Modernization National Collaborative is working to address this need by providing a tool for public health law reform in the form of a Model Public Health Act for states.     

Health departments' implementation of public health's core functions: an assessment of health impacts

OBJECTIVES: The purpose of this article was to investigate the relationship between state health agencies' adherence to the recommendations of the United State's Institute of Medicine's (IOM) report, "The Future of Public Health", and changes in their populations' health. STUDY DESIGN: Data were abstracted from agencies' plans, budgets, annual reports, etc. spanning a 5-year period. A comprehensive change in population health measure over the same period was drawn from the UnitedHealth Group's annual survey. METHODS: Configurations, based on public health core functions, were established using linear regression and qualitative comparative analysis. The dependent variable was a holistic measure of change in a state population's health status. RESULTS: State agencies that most completely adopted a public health model emphasizing assessment, assurance and policy development also experienced significant improvements in their population health measures. CONCLUSIONS: State agencies that more completely adopted the IOM's public health core functions had a concomitant improvement in their populations' health statuses. Further research to explore if there is a causal link between adoption of the core functions and positive health impacts is warranted.     

Demonstrating excellence in practice-based research for public health

This document explores the opportunity for scholarship to enhance the evidence base for academic public health practice and practice-based research. Demonstrating Excellence in Practice-Based Research for Public Health defines practice-based research; describes its various approaches, models, and methods; explores ways to overcome its challenges; and recommends actions for its stakeholders in both academic and practice communities. It is hoped that this document will lead to new partnership opportunities between public health researchers and public health practitioners to strengthen the infrastructure of public health and add new dimensions to the science of public health practice. Demonstrating Excellence in Practice-Based Research for Public Health is intended for those who produce, participate in, and use practice-based research. This includes academic researchers and educators, public health administrators and field staff, clinical health professionals, community-based organizations and professionals, and interested members of the public.     

State public health laws: an expression of constituency expectations.

One expression by the body politic about public health in any jurisdiction is the law under which the public health agency practices. The degree of congruence between a widely used model of public health and current statutes can be a measure of that opinion. This study identified the extent to which the statements of purpose expressed in state laws are consistent with Public Health in America (PHA); the published mission statements of state health agencies are consistent with either statute or PHA; and which concepts from PHA are most underrepresented and what additional concepts are included.     

Forty years of federal support for public health research through the Department of National Health and Welfare

This paper traces: (a) the development, to the present day, of federal support for public health research in Canada, from its early beginnings under the Public Health Research Grant in 1948, and since 1975 through the National Health Research and Development Program (NHRDP); and (b) the influence that "New Perspectives" (1974) and "Achieving Health For All" (1986) have had on the evolution of the program. Other initiatives taken by the federal government during the past 40 years related to health/medical research in Canada are also indicated. Current NHRDP programs and policies are described, as are the mechanisms used by the NHRDP to fulfill its mandate for stimulating research in areas related to national health objectives.     

To integrate or deintegrate?: Fitting public health into New Zealand's reforming health system

The relationship between public health and clinical medicinehas been the subject of international debate. In New Zealandsuccessive restructurings of the health sector have seen significantchanges in this relationship and the status of public health.The paper traces these changes over a decade of public sectorrestructuring (1984–1993) and shows how public healthpolicy and the purchasing and delivery of public health serviceshave been subject to integration, deintegration and reintegrationwith clinical and treatment services. Some advantages flowedfrom integrating policy, purchasing and delivery, includinga comprehensive approach to tackling problems through nationalhealth goals and targets. On the other hand, there is evidencethat public health was financially disadvantaged by this association.A separate public health structure, set up in 1992 and led byan independent Public Health Commission, brought some benefits.These included a specific budget and a high profile for publichealth. It also created tensions between competing policy agencies,a fragmented purchasing system for public health and exposedpublic health to political interference. This led to the abolitionof the Commission in 1995 and the reintegration of policy makingat the national level and purchasing at the regional level.At the end of 1996 a new coalition government formally abandonedthe commercial elements of its predecessor's health reforms.The new policy requires the main providers of hospital and relatedservices, which continue to include public health, to focuson health gains for their defined populations. With the integrationof policy and purchasing this should lead to the promotion ofbetter integration at the service delivery level.     

History of public health research in Estonia: A review

The University of Tartu (which was founded In 1632) and itsDepartment of Public Health (Hygiene) have been the centre ofpublic health research in Estonia. Environmental factors suchas living conditions, water, soil, air and food have been thetraditional topics. The study on blind people and people sufferingfrom eye diseases among the rural population of Livonia conductedby Professor Himmelstiern in 1856–1859 proved to be thefirst epidemlological study in Russia. Professor Körber,a supporter of a statistical approach in research, founded thelocal school of demographers in 1890s. Professor Khlopin's stayin Tartu (1895–1903) was a very fruitful period. He andhis students paid much attention to communal hygiene. ProfessorRammul, the head of the department in 1920–1940, initiatedand supervised an extensive medicogeographical study of overallEstonia. The Second World War and post-war years caused a standstillin research. A revival occurred in the end of 1950s when ProfessorKask returned to the department. After his death (1968), AssociateProfessor Ulbo and Professor Jannus continued his work. Theirmain study areas were concerned with public health aspects ofthe water supply, nutrition of pre-school children and theirprovision with vitamins, work conditions and health risks ofsome occupations. During resent years the area of research hasenlarged to comprise health risks due to lifestyle factors,health economics and health care management topics. After thewar special medical research institutes were established. Theyhave made a considerable contribution to public health researchin Estonia.     

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。     

Mapping transgender policies in the US 2017–2021: The role of geography and implications for health equity

Transgender individuals globally face varying policy contexts that can influence their health. In the United States (US), a patchwork of exclusionary and inclusive policies exists, creating potentially different social and political contexts that shape transgender health depending on the state. In this article, we consider how recent legislation introduced in US states focused on transgender people may be a political determinant of health and affect health equity goals. To advance this aim, we employed the perspective of legal epidemiology to systematically search a US legal database (Westlaw) for policies focused on transgender individuals proposed between January of 2017 and September of 2021.698 policies were analyzed as affirming or exclusionary of transgender identities and categorized by content. We calculated a ratio of affirming versus exclusionary bills to create “exclusionary density” and “affirming density” measures. Those measures were used to calculate an inclusivity score and corresponding maps of inclusivity and exclusionary contexts by US state. Exclusionary and affirming density measures showed deeply polarized policy responses to transgender individuals depending on US state. Further, we observed differences in magnitude regarding the laws being proposed. Exclusionary laws largely focused on criminalization while inclusionary laws focused on representation in government agencies. These findings highlight that transgender individuals in the US can experience vastly different political contexts depending on where they live.