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.     

Final report on public health practice linkages between schools of public health and state health agencies: 1992-1996.

Since 1988 there has been a call for enhanced linkages between schools of public health and public health agencies that has prompted schools of public health to develop public health practice initiatives. The University of Illinois at Chicago School of Public Health conducted surveys of schools of public health and of state public health agencies in 1992 to collect baseline data on practice initiatives undertaken by academe and governmental public health agencies to enhance collaboration; follow-up surveys were undertaken in 1993, 1994 and 1996. This article describes the trends and implications of this survey of practice linkages involving schools of public health and state health agencies.     

Team Epi-Aid: graduate student assistance with urgent public health response

Team Epi-Aid provides graduate students with practical public health experience through participation in outbreak investigations and other applied projects with state and local health departments in North Carolina. It is an initiative of the North Carolina Center for Public Health Preparedness in the North Carolina Institute for Public Health at the University of North Carolina School of Public Health. The program allows state and local health departments access to volunteers and technical expertise from the university when they need assistance. It requires close collaboration with state and county health departments. Team Epi-Aid provides the opportunity for integrated learning with students and faculty within the departments of the School of Public Health, and through recent expansion, within the schools of Medicine and Pharmacy. Orientations are conducted each semester and formal training is provided as needed. Team Epi-Aid has been popular, with 58 active student participants contributing 1,465 hours of service during the initiative's first 21 months.     

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.     

The local public health workforce in rural communities.

This work describes the public health workforce and training needs of rural local public health agencies (LPHAs) in comparison with suburban and metropolitan LPHA jurisdictions. A survey was sent to 1,100 LPHAs nationwide. The rural urban commuting area codes (RUCAs) defined LPHAs as rural or urban, and the Standard Occupational Classification system enumerated the workforce. Most occupational classifications had significantly fewer staff in rural LPHAs. Public health nurses ranked as the most needed staff and serve in various important capacities in rural LPHAs. In terms of training, job-specific or programmatic continuing education was identified as the most important training need. Developing leadership and public health workforce capacity within rural public health is an essential agenda item for rural America. Decision makers may need to consider different organizational structures while balancing the need for local input and control. Regionalization and collaborative approaches to difficult workforce issues may present potential solutions to workforce challenges.     

Public health practice and public health education: a personal view of their current relationship.

In its 1988 report, The Future of Public Health, the Institute of Medicine stated that schools of public health had become "somewhat isolated" for public health practice. Since then a great deal has been done to address this issue by the academic community, state and local public health practice agencies, foundations, and federal health agencies. This commentary reviews their most important actions and identifies some unresolved issues.     

External collaboration and performance: North Carolina local public health departments, 1996

OBJECTIVES: This study examined the extent to which local public health departments in North Carolina collaborated with other groups and organizations, the health problems on which they worked together, and the effect of external collaboration on health departments' performance on core public health functions. METHODS: The author mailed a questionnaire asking about interactions with city and county government agencies, boards of health, schools, nonprofits, physicians/private clinics, community health centers/migrant clinics, community members, citizens' groups, state and federal agencies, and universities to all of the directors of local public health departments in North Carolina. Sixty-four directors returned the questionnaire, for a response rate of 74.4%. RESULTS: Local public health departments most frequently interacted with boards of health, state agencies, community members, schools, city and county government agencies, and nonprofit agencies. Large majorities reported productive relationships with boards of health, state agencies, city and county government agencies, schools, nonprofit agencies, and hospitals. Greater frequency of interaction with several types of partners was associated with better performance. CONCLUSIONS: While questions exist about whether performance on core functions improves the community's health status, the results suggest that it is important for local public health departments to continue to build relationships with other organizations in the community.     

Building an academic tobacco control program while forging links with practice: the University of Washington Tobacco Studies Program

Despite the tremendous impact that tobacco use and tobacco smoke exposure have on morbidity, mortality, and health disparities, few schools of public health in the U.S. offer courses of study on tobacco control or make it a priority in their curricula. An academic concentration in tobacco studies and a master's-level scholarship program were developed at the University of Washington School of Public Health and Community Medicine to support and encourage students to pursue tobacco-related coursework, seminars, internships, and thesis work. This article discusses the goals, strategies, and accomplishments of the programs, emphasizing a collaborative approach between the university and state and local health departments, nongovernmental agencies, and research organizations as instrumental to the program's success and ultimate continuation.     

Academic health departments: from theory to practice.

In August of 2003, 23 institutions submitted proposals to build closer ties between state and local public health departments and schools of public health in response to a solicitation from the Association of Schools of Public Health supported by the Centers for Disease Control and Prevention. This article describes the strategies proposed to build collaboration between public health academia and practice. Qualitative analysis discerned five principal approaches: the development of comprehensive planning processes; reform of the way practica are planned and implemented; the identification and nurturing of boundary-spanning individuals in academia and health agencies; the fostering of new approaches to joint research; and workforce development programs. Major themes that emerged included the importance of achieving a balance of power between academic and health department partners; the need to address cultural differences between institutions; a conviction that efforts at institutional change require both strong leadership and the cultivation of boundary spanners farther down the chain of command; and the idea that prospects for success may be improved if faculty and practitioners have tangible incentives to collaborate.     

Petroleum scarcity and public health: considerations for local health departments

Recognition of petroleum as a finite global resource has spurred increasing interest in the intersection between petroleum scarcity and public health. Local health departments represent a critical yet highly vulnerable component of the public health infrastructure. These frontline agencies currently face daunting resource constraints and rely heavily on petroleum for vital population-based health services. Against this backdrop, petroleum scarcity may necessitate reconfiguring local public health service approaches. We describe the anticipated impacts of petroleum scarcity on local health departments, recommend the use of the 10 Essential Public Health Services as a framework for examining attendant operational challenges and potential responses to them, and describe approaches that local health departments and their stakeholders could consider as part of timely planning efforts.     

Public health practice linkages between schools of public health and state health agencies: results from a three-year survey.

Several recent examinations of the state of public health have called for enhanced linkages between schools of public health and public health agencies, prompting federal health agencies and schools of public health to develop practice initiatives. Surveys of schools of public health and of state public health agencies were conducted in 1992 to collect baseline data on practice links between the two agencies; follow-up surveys were undertaken in 1993 and 1994. Responses reveal that a substantial amount of interaction between schools and agencies has been occurring for some time, but that until recently much of the interaction has been informal and between individuals or departments rather than institution-wide. Both frequency and formalization of such collaborations have increased, reflecting a growing emphasis on public health practice activities at schools of public health together with public health agencies.     

Assessing relationships between state and local public health organizations: evidence from the NACCHO 2008 profile of local health departments

Public health systems vary by degree of centralization, reflecting the distribution of authority, responsibility, and effort between state and local public health agencies. We analyzed data from the 2008 National Association of City and County Health Officials Profile of Local Health Departments survey, and propose an improved composite measure of centralization that can be computed for all local health departments within a state, as opposed to a single state respondent, as done in 1998. While most states' structures (79.5%) are decentralized, the new measure presents a continuum from highly decentralized to highly centralized. The measure was internally consistent (Cronbach α = .87) and correlated somewhat strongly with the centralization classification from the 1998 survey (Kendall's τ correlation = .62, P < .001), suggesting that a stable centralization construct can be reliably determined. This new centralization variable can facilitate more nuanced studies of public health systems, and inform policy design and implementation.     

Environmental health services in primary care centers

Primary Health care centers supported by the Public Health Service through the Community Health Center and Migrant Health Centers programs are now required to provide environmental hazards directly related to clinical findings, but correcting community and occupational environmental problems may be pursued through appropriate agencies. State and local health departments will play key roles in the program in providing professional expertise in environmental health, assisting patients in taking corrective action, and assisting in the coordination with state, local, federal and voluntary agencies. Some primary care centers in areas of great need and limited resources will have their own environmental health professionals, but most will depend on local health departments for this specialty.     

Content and criterion validity evaluation of National Public Health Performance Standards measurement instruments

OBJECTIVE: The Centers for Disease Control and Prevention's National Public Health Performance Standards Program (NPHPSP) has developed instruments to measure the performance of local and state public health departments on the 10 "Essential Services of Public Health," which have been tested in several states. This article is a report of the evaluation of the content and criterion validity of the local public health performance assessment instrument, and the content validity of the state public health performance assessment instrument. METHODS: Health department performance is measured using a set of indicators developed for the 10 Essential Services of Public Health and a model standard for each indicator. Content validity of each model standard in the local instrument was addressed by community partners along the following dimensions: the importance of each standard as a measure of the associated Essential Service, its completeness as a measure, and its reasonableness for achievement. All standards for each Essential Service were then judged in terms of their completeness in measuring performance in that service. Content validity of the state instrument was evaluated in a group interview of health department staff members from three states. Criterion validity of the local instrument was assessed for a sample of eight public health departments in Florida and six in New York by examining documentary evidence for selected responses. Criterion validity was also evaluated for a sample of Florida local public health departments and one Hawaii public health department by comparing state health department staffs' judgments of performance against the instrument score. RESULTS: Criterion validity was upheld for a summary performance score on the local instrument, but was not upheld for performance judgments on individual Essential Services. The NPHPSP standards based on the Essential Services have validity for measuring local public health system performance, according to community partners. The model standards are valid measures of state performance, according to state public health departments in three states. CONCLUSIONS: Within the scope of the validity evaluations completed, the NPHPSP state and local performance assessment instruments were found to be valid measures of public health performance.     

Development and implementation of a public health workforce training needs assessment survey in North Carolina

Assessing the training needs of local public health workers is an important step toward providing appropriate training programs in emergency preparedness and core public health competencies. The North Carolina Public Health Workforce Training Needs Assessment survey was implemented through the collaboration of several organizations, including the North Carolina Center for Public Health Preparedness at the North Carolina Institute for Public Health, the outreach and service unit of the University of North Carolina School of Public Health, the Office of Public Health Preparedness and Response in the North Carolina Division of Public Health Epidemiology Section, and local health departments across the state.     

The future of public health: a local health department view

This is an examination of factors responsible for the "disarray" in public health activities as described in the Institute of Medicine report on The Future of Public Health. It approaches the problem primarily from the viewpoint of the local health agency. Three contributing factors are discussed: disproportionate national expenditures for medical care as compared to public health funding; structural flaws in organization leading to functional difficulties; and medical profession opposition to an expanded role for local health departments. The problem of inadequately sized local governmental jurisdictions which are unable to supply sufficient resources for their health departments is discussed, and the complexities of remedial mergers across political boundaries are explored. Suggestions for improving the functions of local health departments include the provision of medical care services, not as a last resort as the Institute of Medicine report suggests, but as equal and perhaps superior competitors in the marketplace; increased state financial and technical support; and a proposed new federal program, The Health Objectives 2000 Act, S.2056, which will make specific provision to greatly strengthen health departments, facilitate the incorporation of missing skills and expertise in local health units, and enhance their capabilities to function as front-line agencies which are essential for achieving effective public health action.     

The quest for an accurate accounting of public health expenditures.

This article describes one effort to develop management tools that will help public health administrators and policy makers implement comprehensive public health strategies. It recounts the ongoing development of a methodology through which the Essential Public Health Services can be related to public health budgets, appropriations, and expenditures. Through three pilot projects involving: (1) nine state health agencies, (2) three local health agencies, and (3) all local jurisdictions and the state health agency in one state, a workable methodology for identifying public expenditures for comprehensive public health programming has been identified.     

Public health expenditures: developing estimates for improved policy making.

The Public Health Foundation (PHF), under contract to the U.S. Department of Health and Human Services, Public Health Service (PHS), worked with federal, state, and local public health, mental health, substance abuse, and environmental agencies in nine states to develop and successfully test a methodology for estimating investments in essential public health services. Estimates from the nine-state sample revealed the predominance of personal health expenditures in the public health system. Of total state health care dollars, only 1 percent was spent on population-based health services by participating agencies. This pilot provides a rational starting point toward a uniform methodology for highlighting public health expenditures that may be critical in revealing the effects of a changing health care environment on the nation's health. In combination with other data, results are expected to lead to a more informed policy-making process.     

The south central center for public health preparedness training system model: a comprehensive approach

The South Central Center for Public Health Preparedness (SCCPHP) is a collaboration among the schools of public health at Tulane University and the University of Alabama at Birmingham and the state health departments in Alabama, Arkansas, Louisiana, and Mississippi. The SCCPHP provides competency-based training via distant delivery methods to prepare public health workers to plan for and rapidly respond to public health threats and emergency events. This article presents the training system model used by the SCCPHP to assess, design, develop, implement, and evaluate training that is both competency driven and practice based. The SCCPHP training system model ensures a standardized process is used across public health occupations and geographic regions, while allowing for tailoring of the content to meet the specific training needs of the workforce in the respective state and local health departments. Further, the SCCPHP training system model provides evidence of the reciprocal nature between research and practice needed to advance the area of emergency preparedness training and workforce development initiatives in public health.     

The healthy afterschool activity and nutrition documentation instrument

Health department accreditation is one of the most important initiatives in the field of public health today. The Public Health Accreditation Board (PHAB) is establishing a voluntary accreditation system for more than 3000 state, tribal, territorial, and local health departments using domains, standards, and measures with which to evaluate public health department performance. In addition, public health department accreditation has a focus on continuous quality improvement to enhance capacity and performance of health departments in order to advance the health of the population. In the accreditation effort, a practice-based research agenda is essential to build the scientific base and advance public health department accreditation as well as health department effectiveness. This paper provides an overview of public health accreditation and identifies the research questions raised by this accreditation initiative, including how the research agenda will contribute to better understanding of processes underlying the delivery of services by public health departments and how voluntary accreditation may help improve performance of public health departments.