Building a regional health equity movement: the grantmaking model of a local health department

The Boston Public Health Commission's Center for Health Equity and Social Justice provides grant funding, training, and technical assistance to 15 organizations and coalitions across New England to develop, implement, and evaluate community-based policy and systems change strategies that address social determinants of health and reduce racial and ethnic health inequities. This article describes Boston Public Health Commission's health equity framework, theory of change regarding the elimination of racial and ethnic health inequities, and current grantmaking model. To conclude, the authors evaluate the grant model and offer lessons learned from providing multiyear regional grants to promote health equity.     

Occupational allergy in health personnel

BACKGROUND: Health care workers are exposed to many agents that can cause irritant or allergic contact dermatitis. In nurses with eczema of the hands latex sensitivity can play an important role in the occurrence of urticaria, rhinitis and asthma. OBJECTIVES: To determine the prevalence of irritant and allergic contact dermatitis and contact urticaria and the role of skin sensitization to common and occupational haptens and allergens in a group of health care workers with skin problems. METHODS: Retrospective review of 204 health care workers assessed by prick and patch testing in an occupational health clinic. RESULTS: The diagnoses included 35.3% with irritant contact dermatitis, 64.7% with allergic contact dermatitis and 7.3% with contact urticaria to latex. Three workers complained of asthma and 5 complained of rhinitis related to latex sensitization. At present 12.9% of atopic subjects were sensitized to latex by skin prick against 21.9% in 1998, so sensitization showed a decline in the years considered. CONCLUSIONS: Contact dermatitis and sensitization to natural rubber latex is a significant problem and nurses should be tested for both types of hypersensitivity, as well as being patch tested to standard, rubber and disinfectants series. The need is stressed for preventive measures to prevent the onset of contact dermatitis and to avoid latex exposure.     

医疗卫生人员的职业卫生

SARS是 2 1世纪的一场人类灾难。劫难过后 ,带给各行各业的警示虽不尽相同 ,但都刻骨铭心。历史记下SARS肆虐期间的桩桩“大事”,例如 :“截至 2 0 0 3年 2月 9日 ,广东省SARS病例为 30 5例 ,其中医务人员 10 5例 ,患病比例高达 34%” ,令职业卫生学界和社会各界震惊。此后 ,北京、天津、山西、内蒙 ,以至香港特区、台湾地区 ,也都在反复印证同一事实 :医务人员由于职业性密切接触成为SARS高发、群发且“首当其冲”的高危人群。医疗卫生人员的职业特点是 :在日常工作中 ,需面对罹患各种疾病的患者 ,经常暴露于化学、物理和生物学有害…     

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.     

Uncompensated care and emergency department utilization: a local study having national implications

This article provides a comprehensive picture of the manner in which uncompensated care patients utilize the emergency departments (EDs) of two Central Florida hospitals. Specifically, this study assesses the impact of treating uncompensated and primary care patients in ED settings on scarce hospital and community resources. Recommendations are being offered to manage a troubling situation that is occurring with alarming frequency in today's health care system throughout the United States. Special emphasis is placed on recommendations addressing alternative triage and financing models that are considered to be both socially responsible and economically viable. The results of this study suggest strongly that health care organizations must find an alternative to the current trend in ED utilization, in order to meet the primary care needs of patients and not compromise the care provided to those with emergent conditions. The recommendations emanating from this study outline a mechanism that can improve the timeliness of emergency care to those in need, while at the same time, making available primary care resources to those seeking services through an emergency department.     

Evaluation of a model training program for respiratory-protection preparedness at local health departments

Respiratory-protection programs have had limited application in local health departments and have mostly focused on protecting employees against exposure to tuberculosis (TB). The need to provide the public health workforce with effective respiratory protection has, however, been underscored by recent concerns about emerging infectious diseases, bioterrorism attacks, drug-resistant microbes, and environmental exposures to microbial allergens (as in recent hurricane flood waters). Furthermore, OSHA has revoked the TB standard traditionally followed by local health departments, replacing it with a more stringent regulation. The additional OSHA requirements may place increased burdens on health departments with limited resources and time. For these reasons, the North Carolina Office of Public Health Preparedness and Response and industrial hygienists of the Public Health Regional Surveillance Teams have developed a training program to facilitate implementation of respiratory protection programs at local health departments. To date, more than 1,400 North Carolina health department employees have been properly fit-tested for respirator use and have received training in all aspects of respiratory protection. This article gives an overview of the development and evaluation of the program. The training approach presented here can serve as a model that other health departments and organizations can use in implementing similar respiratory-protection programs.     

Privatization and the scope of public health: a national survey of local health department directors

OBJECTIVES: This study sought to obtain and analyze nationally representative data on (1) privatization of local health department services, (2) local health department directors' beliefs and perspectives on the desirable role and focus of health departments, and (3) the influence of these views on privatization practices. METHODS: A stratified representative national sample of 380 local health department directors was drawn, and 347 directors were interviewed by telephone. Logistic regression established the independent effects of various factors on decisions to privatize. RESULTS: Almost three quarters (73%) of the local health departments privatized public health services of some type. The 12% of the directors who believed that local health departments should be restricted to the core public health functions and move entirely out of direct provision of personal health care were more likely to privatize services. The 77% of the directors who believed that local health departments should be involved in an increasing array of social problems were more likely to privatize. CONCLUSIONS: Privatization has quietly and quickly become commonplace in public health, and privatization practices are intimately related to divergent conceptions of public health and the role of local health departments.     

Perceived outcomes of public health privatization: a national survey of local health department directors

Almost three quarters of the nation's local health departments (LHDs) have privatized some services. About half of LHD directors who privatized services reported cost savings and half reported that privatization had facilitated their performance of the core public health functions. Expanded access to services was the most commonly reported positive outcome. Of those privatizing, over two-fifths of LHDs reported a resulting increase in time devoted to management. Yet, one-third of directors reported difficulty monitoring and controlling services that have been contracted out. Communicable disease services was cited most often as a service that should not be privatized. There is a pervasive concern that by contracting out services, health departments can lose the capacity to respond to disease outbreaks and other crises.