Public health nurses in Quebec: an essential contribution that remains to be known

Public health nurses in Quebec are essential although little is known about their role. Generally trained at the undergraduate level, with additional qualifications in community health, they essentially work in CLSCs in maternal and child health programs, youth clinics or occupational health. In regional public health departments, they also work in the field of infectious disease prevention or other programs. Like their colleagues, they are confronted to the profession's challenges, the most notable being current and future shortage of nurses. However, they can now count on a new. As nurses further develop their practice and orient it even more towards primary prevention and health promotion, they will significantly contribute to the National Public Health Program and to the improvement of population health and wellbeing.     

The course of specialization in public health in Rio de Janeiro, Brazil, from 1926 to 2006: lessons and challenges

Background  

Public health, as a field of knowledge, depends on its professionals. Their education and training, therefore, is considered to be an important factor for the quality of health services. In Brazil, the Course of Specialization in Public Health of the National School of Public Health is one of the oldest in the country. The course has existed for over 80 years, during which it has had an eventful history, with modifications in its organization, interruptions in its delivery, threats to its survival and changes in the institutions hosting it, reflecting the wider transformation in Brazilian society and public life over that period.     

The Local Public Health System Assessment of MAPP/The National Public Health Performance Standards Local Tool: a community-based, public health practice and academic collaborative approach to implementation.

The Local Public Health System Assessment (LPHSA) in Mobilizing for Action through Planning and Partnerships (MAPP), and the Local Tool of the National Public Health Performance Standards Program (LT/NPHPSP)--which are one in the same-attempt to assess the capacity to provide the essential public health services. Both tools have been utilized in various public health practice settings; however, users have been challenged with the complexity of the tools and time and human resource investment necessary to complete them. The recent Journal of Public Health Management and Practice issue focus on MAPP provided several examples of LPHSA implementation, both as a component of MAPP and as a stand-alone activity in the context of performance standards. The uniqueness in our approach involved a collaborative between a community-based organization, a public health academic program, and a governmental public health agency which conducted the LPHSA in a manner that did not require actual modification of the tool itself, was practical and feasible, and was of benefit and value to all partners.     

Developing knowledge translation capacity in public health: the role of the National Collaborating Centres

This paper outlines the history and rationale of the six National Collaborating Centres for Public Health program, established by the Public Health Agency of Canada in 2004. The Centres are not focused on primary research, but rather on synthesizing the global scientific evidence relevant to public health policies, programs and practices--and its translation into useful "knowledge products" for public health professionals, policy-makers and community groups to inform public health decision-making. The broad principles of knowledge synthesis and translation/exchange (KSTE) for public health applications are reviewed, as are recent publications and websites describing international projects in this burgeoning field. Finally, some best practices for public-health-oriented KSTE derived from experiences in Canada and elsewhere are described.     

Local public health agency capacity and its relationship to public health system performance.

he study described in this article identifies local public health agency capacity characteristics that are related to their local public health systems' performance scores on the CDC's National Public Health Performance Standards Program assessment instrument. Public health system performance scores from a test version of the National Public Health Performance Standards instrument (5b) from county and city/county jurisdictions in three states were matched to organizational capacity data from the 1997 National Association of County and City Health Officials profile of health departments, resulting in a sample of 152 jurisdictions. Twenty-eight capacity variables from the profile and all 10 scores on the Essential Public Health Services plus the total performance score were analyzed in 11 separate multivariate regression models. Public health agency capacities in the areas of funding, organizational leadership, and certain nonprovider partnerships were found to be significantly related to public health system performance. Further study is needed to determine if these relationships between agency capacities and system performance are found, with data from other states now using the nationally released performance assessment instruments and with capacity measures that are more specific for evaluating public health system performance.     

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.     

Public Health’s Falling Share of US Health Spending

We examined trends in US public health expenditures by analyzing historical and projected National Health Expenditure Accounts data. Per-capita public health spending (inflation-adjusted) rose from $39 in 1960 to $281 in 2008, and has fallen by 9.3% since then. Public health’s share of total health expenditures rose from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014; it is projected to fall to 2.40% in 2023. Public health spending has declined, potentially undermining prevention and weakening responses to health inequalities and new health threats.Despite widespread rhetorical endorsement of prevention, public health programs have received less attention and far less funding than personal medical services.1 The 2010 Affordable Care Act (Pub L No. 111–148) mandated insurance coverage of clinical preventive services such as colon cancer screening and contraception. In addition, it earmarked funding for a new Prevention and Public Health Fund, buoying hopes for an expansion of public health spending.In this brief report, we analyze trends in public health spending over the past 53 years, as well as projected trends in the coming decade.     

The role of states in ensuring essential public health services: development of state-level performance measures.

The Association of State and Territorial Health Officials (ASTHO) has worked with other public health partners across the country to develop National Public Health Performance Standards, nationally recognized measures by which state public health systems can compare themselves with similar systems across the country. The lead federal agency is the Centers for Disease Control and Prevention (CDC), and other partners include the Public Health Foundation, the American Public Health Association, the National Association of City and County Health Officials, and the National Association of Local Boards of Health. Both challenges and opportunities emerged during the development of the state public health system standards.     

Experiences from the Swedish determinants-based public health policy

A comprehensive Swedish public health policy was adopted by the Swedish Parliament, the Riksdag, in April 2003. It pushes health up on the political agenda and affords equity in health high priority. The first phase of implementation of the policy, 2003-5, is described in the 2005 Public Health Policy Report published by the Swedish National Institute of Public Health (SNIPH). For the purpose of investigating the implementation, SNIPH has monitored the development of 42 determinants and used reports from 22 central agencies and eight county administrative boards together with interviews with all Sweden's county councils (21) and a questionnaire sent out to all municipalities (290). The experiences from the implementation of the policy are that: the determinants approach - focusing on structural factors in society, people's living conditions and health behaviours that affect health - is in general well understood and emphasises the role of other sectors in public health; the use of indicators to follow up exposures to determinants is of key importance; the support to actors outside the health service is needed to identify their public health role; a continuous steering from the government and other political bodies is of vital importance; public health promotion on the regional level needs a higher level of co-ordination; municipalities need more skills development; Sweden has a new government that was elected in September 2006; the new government has retracted the former government's public health policy communication submitted to the Riksdag in the spring of 2006, but does not intend to change the public health policy.     

Public health guidance and the role of new NICE

This paper describes the operating and methods for the newly established centre for Public Health Excellence in the National Institute of Health and Clinical Excellence (NICE). The origins of the establishment of this organisation are described and the types of public health guidance which will be produced are outlined. The Advisory Committee Structure for the new organisation is also presented. The importance of the application of evidence based guidance in public health is considered.     

国家基本公共卫生服务项目实施现状及问题分析*

通过对国家基本公共卫生服务项目进行面上调查和典型地区调查发现,国家基本公共卫生服务项目已经建立了完善的组织管理体系、明确的分工协作机制和稳定的筹资增长机制,服务内容不断丰富,服务提供更加精细化,居民获得感得到提升。建议进一步完善相关政策,建立以需求为导向的基本公共卫生服务项目动态调整机制;研究以成本为基础的服务标准测算方法并制定操作手册;提供精细化与个性化服务;加快发挥智慧化手段的助力作用。     

Recommendations from testing of the National Public Health Performance Standards instruments.

The National Public Health performance Standards Program (NPHPSP) has developed assessment instruments based on the ten essential public health services (EPHS) for state and local health departments. The article reviews validity testing of the state and local instruments. The study employed multiple approaches to validity testing with state and local health departments in Florida, Hawaii, Minnesota, Mississippi, and New York. The New York State validity checks included the judgments of community partners. The study found that the EPHS have content and face validity as a basis for measuring public health system performance. The article includes recommendations for continued development of the NPHPS.     

An Instrument for Assessing Public Health System Performance: Validity in Rural Settings

PURPOSE: This study evaluated the validity and utility of the Local Public Health System Assessment Instrument (Local Instrument) of the National Public Health Performance Standards Program in rural settings. METHODS: The study compared the Local Instrument scores of 6 rural local public health systems to external assessments of those public health systems. The 6 public health systems represented 3 states in which 1 of the 2 local jurisdictions had scored well below and the other well above the state median in a pilot test of the Local Instrument. The study design featured a case study approach consisting of an iterative and integrated combination of semistructured individual and focus group interviews along with the collection of archival materials provided by the 6 public health systems. FINDINGS: Despite differences in Local Instrument scores, the representative public health systems in each state provided roughly the same levels of public health services. Sites varied tremendously in the percentage of survey items rated highly or less relevant. CONCLUSIONS: The National Public Health Performance Standards Program Local Instrument can provide a useful structure and process for assessing public health system performance at the local level. Key informants provided several recommendations to improve the Local Instrument, including clarification of difficult terminology and acronyms, and development of multiple instruments structured around subsets of survey items.     

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.     

National Rural Health Mission--a critical review

National Rural Health Mission is strategic framework to implement the National Health Policy 2002. The scheme of Accredited Social Health Activist is an improvement over the earlier Community Health Guide Scheme. Integration of various health and family welfare programmes will result in economy and allocation of resources as per needs of the districts. Decentralised planning with the involvement of Panchayati Raj Institutions is likely to make health as people's programme. Converging water supply, sanitation, hygiene and nutrition with health planning is a logical step. The proposal to strenthen institutions of primary health care and Community Health Centres as functional Rural Hospitals alongwith introduction of Indian Public Health Standards and accountability of public health institutions to the public is likely to revolutionise the status of health care in rural India.     

The impact of pensions on health and wellbeing in rural South Africa: Does gender matter?

Unique to Africa, a means-tested non-contributory pension is available to South Africans. In 2006, women over 60 and men over 65 were pension-eligible. To explore the effect of the pension for health and wellbeing indicators of rural South African men and women, we analyze data from the WHO-INDEPTH Study of Global Ageing and Adult Health Survey, carried out in the Agincourt sub-district by the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) in 2006. Because pension receipt was not measured directly, our findings represent intent-to-treat (ITT) rather than treatment-on-the-treated (TOT) effects using age as an indicator for intent-to-treat. Overall, women report poorer wellbeing compared to men. However, women have a "honeymoon" period at ages 60-64, the first years of pension-eligibility, in which they report lower levels of worry and sadness, and higher overall happiness, life satisfaction, and quality of life as compared to younger and older women. For men, in contrast, reports of wellbeing worsen in the pre-pension years, followed by a similar but not as prominent pattern of favorable reports in the five years following pension-eligibility, and a decline in the next five-year period. Thus, while pensions continue to enhance financial wellbeing, our results suggest that their effect on social wellbeing may be gendered and transitory. Further research is needed to improve understanding of these dynamics.     

Powerful connections for public health: the National Library of Medicine and the National Network of Libraries of Medicine.

As incorporated in Healthy People 2010 objectives, data and information systems and a skilled workforce are 2 of the critical components of the public health infrastructure. The National Library of Medicine (NLM) and the National Network of Libraries of Medicine (NN/LM) are important resources for improving Internet access and providing related training to the public health workforce and to those in training for public health careers. The NLM and the NN/LM have joined forces with the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Public Health Foundation. The goal of this collaboration is to improve electronic resources useful in public health practice and increase awareness of them, to train public health professionals to use electronic information services, and to help public health agencies obtain the equipment and Internet connections needed to use these services effectively. The databases, outreach programs, and connection grants available to public health professionals from the NLM, and the training and ongoing support available from the NN/LM for accessing these programs and services, are described.     

A model for public health workforce development using the National Public Health Performance Standards Program.

Workforce development programs in public health should link improvements in workers' performance with improvements in their agencies' performance. The "ten essential services" of public health provide criteria for measuring both individual worker training (as in workforce competency standards) and agency performance (as in the Centers for Disease Control and Prevention's National Public Health Performance Standards Program). This shared foundation was the basis for a model strategic training program developed for use in a 500-employee urban county health department. Full implementation of this model as a foundation for assessment, curriculum development, and evaluation requires careful attention to management issues, confidentiality of employee records, and evaluation methodologies.     

医疗卫生发展方式转变之我见

近十年来,我国医疗卫生事业有了长足发展,但是结构性矛盾日臻显现。对此,医疗卫生事业发展必须转变发展方式,实现＂四化＂——公共卫生服务提供均等化、公立医疗机构运行公益化、基本医疗保险制度高效化、医疗卫生服务信息化,这样才能与经济社会发展相适应并优质、高效、可持续发展。