Implementing the Public Health Social Work Forward Plan: a research-based prevention curriculum for schools of social work.

In 1985, the Division of Maternal and Child Health of the U.S. Public Health Service funded a major working conference entitled "Public Health Social Work in Maternal and Child Health: A Forward Plan." Curriculum recommendations for schools of social work were made, including a recommendation for the integration of health and mental health content in the education of social workers within a public health conceptual framework. In 1986, the National Institute of Mental Health funded a three-year program to develop and evaluate a research-based prevention training curriculum for dissemination to schools of social work and other primary care professional schools. This article examines the Michigan Prevention Training and Curriculum Development Project from the perspective of the recommendations of the Public Health Social Work Forward Plan.     

Environmental medicine in public health service--a social responsibility and its consequences

The special committee for "Environmental Medicine" established by the Federal Association of Doctors in the German Public Health Service presents its paper entitled "Environmental Medicine in the Public Health Service--A Social Responsibility and its Consequences: Propositions with regard to the situation, aims, strategies, and opportunities for action". The paper includes core ideas and responsibilities in the public health service. It aims at providing a number of guidelines for implementing "Environment and Health" ("Umwelt und Gesundheit"), an action programme by the Federal Ministry of Environmental Protection and the Ministry of Health, as well as "Health 21" ("Gesundheit 21"), the framework concept "Health for all" for the WHO's European Region. The paper also aims at initiating and facilitating steps for joint action by the Public Health Service. These theses were passed on to Mrs. Andrea Fischer, the Federal Minister of Health, during a meeting with the Board of the Association. In Germany, environment-related public health protection is well established in the Public Health Departments and state institutes/departments within the scope of public health provision and disease prevention. Typical responsibilities include environmental hygiene and environment-related medical services which have increased in importance. The range of responsibilities and its current political importance are a result of environment-related public health risks, the social situation of the population, also with regard to health issues, and the scope of responsibilities and competencies by doctors and staff in the public health departments. With the people's demands for health, quality of life and life expectancy, this need for action increases. In this paper, judicial, professional, and personal consequence are presented which arise as public health authorities assume these responsibilities.     

The nationalization of a disease: a paradigm?

The early history of the Federal involvement in Hansen''s Disease reflects the history of the Public Health Service itself. As a young and aggressive institution, the Public Health Service sought out contagious, infectious diseases that threatened the public health. National resources and national coordination were needed to fight the likes of malaria, hookworm, or smallpox. The customary attack would consist of a field study, determination of the etiology, the method of transmission, and, then, perhaps, preventive measures. An eradication campaign would follow. Leprosy fit perfectly into the model--a disease of unknown etiology, an unknown method of transmission, thought to be highly contagious, and no known cure. The United States launched a major investigation in Hawaii, where the disease was prevalent and its victims conveniently segregated. The investigation failed. The Public Health Service then turned toward segregation and isolation as a way to fulfill its public health role. A bureaucracy was established around the idea that victims of leprosy must be incarcerated for the good of the public. The institutionalization of the Public Health Service and the philosophy upon which its treatment of leprosy was based proved difficult to change when researchers in the field made major scientific breakthroughs in the 1940s. The realization that the disease was only feebly contagious, activities of patient organizations, and pressure from the media and the Congress did not achieve as dramatic results as the sulfone drugs did. The Public Health Service moved, but slowly. What are the lessons in all of this?.     

Harnessing genomics to improve health in the Eastern Mediterranean Region - an executive course in genomics policy

BACKGROUND: While innovations in medicine, science and technology have resulted in improved health and quality of life for many people, the benefits of modern medicine continue to elude millions of people in many parts of the world. To assess the potential of genomics to address health needs in EMR, the World Health Organization's Eastern Mediterranean Regional Office and the University of Toronto Joint Centre for Bioethics jointly organized a Genomics and Public Health Policy Executive Course, held September 20th-23rd, 2003, in Muscat, Oman. The 4-day course was sponsored by WHO-EMRO with additional support from the Canadian Program in Genomics and Global Health. The overall objective of the course was to collectively explore how to best harness genomics to improve health in the region. This article presents the course findings and recommendations for genomics policy in EMR. METHODS: The course brought together senior representatives from academia, biotechnology companies, regulatory bodies, media, voluntary, and legal organizations to engage in discussion. Topics covered included scientific advances in genomics, followed by innovations in business models, public sector perspectives, ethics, legal issues and national innovation systems. RESULTS: A set of recommendations, summarized below, was formulated for the Regional Office, the Member States and for individuals.* Advocacy for genomics and biotechnology for political leadership;* Networking between member states to share information, expertise, training, and regional cooperation in biotechnology; coordination of national surveys for assessment of health biotechnology innovation systems, science capacity, government policies, legislation and regulations, intellectual property policies, private sector activity;* Creation in each member country of an effective National Body on genomics, biotechnology and health to:- formulate national biotechnology strategies- raise biotechnology awareness- encourage teaching and training of biotechnology- devise integration of biotechnology within national health systems. CONCLUSION: The recommendations provide the basis for a road map for EMR to take steps to harness biotechnology for better and more equitable health. As a result of these recommendations, health ministers from the region, at the 50th Regional Committee Meeting held in October 2003, have urged Member States to establish national bodies of biotechnology to formulate a strategic vision for developing biotechnology in the service of the region's health. These efforts promise to raise the profile of genomics in EMR and increase regional cooperation in this exciting new field.     

Assessment of validity of the national public health performance standards: the local public health performance assessment instrument

The National Public Health Performance Standards Program (NPHPSP) has developed performance standards measurement instruments, based on the 10 "Essential Services of Public Health" that are being tested in several states. This article is a report on the face and content validity of the instrument designed for local public health systems. Judgments about the face validity of the standards were obtained in a survey of local public health systems that had used the instrument in a test state. The validity of each standard was addressed along the following dimensions: the importance of the standard as a measure of the 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 of that service. Respondents judged the standards to be highly valid measures of local public health system performance. Some respondents had reservations about whether standards related to "enforcing laws and regulations" were achievable. Holding local public health systems accountable for the activities of other agencies was a factor mentioned in conjunction with those standards. The NPHPSP standards have face and content validity for measuring local public health system performance. Further testing of their validity and reliability is continuing.     

Predictors of Perceived Ambiguity About Cancer Prevention Recommendations: Sociodemographic Factors and Mass Media Exposures

Cancer prevention recommendations reaching the public today are often ambiguous—that is, of uncertain reliability, credibility, or adequacy—yet little is known about the factors that influence public perceptions of this ambiguity. We used data from the 2005 Health Information National Trends Survey, conducted by the U.S. National Cancer Institute, to explore how sociodemographic characteristics and self-reported mass media exposures relate to perceptions of ambiguity regarding recommendations for the prevention of colon, skin, and lung cancer. Various sociodemographic characteristics (age, education, race) and mass media exposures (television, radio, Internet, health news) were found to be associated with perceived ambiguity about cancer prevention recommendations, and many of these associations varied by cancer type. These findings have important implications for future health communication research and practice.     

History of the Public Health Institute of Semmelweis Medical University, Budapest

The science of public health of the XVIIIth century named politia medica together with medicina forensis became an independent obligatory subject in 1793 at the Medical Faculty of the Hungarian Royal University of Science. The independent Public Health Institute of the Medical Faculty was established in 1874. The first professor of public health was József Fodor who attained international reputation during his professorship. He organized training for school physicians and health teachers first in Europe and he organized courses for medical officers and for military doctors. He held courses for law-, engineer- and architect-students. He promoted all fields of the public health. His research on the bactericide effect of serum places him among the founders of immunology. Fodor's successors at the Chair of Public Health were Leó Liebermann whose research activities included physico-chemistry, biochemistry, microbiology and social hygiene; Gusztáv Rigler who focused on the epidemiology of communicable diseases, on the health effects of spa treatment and mineral waters. The next famous professor was Gyula Darányi. His scientific field was public health bacteriology and public health chemistry. They were followed by József Melly and László Dabis (Scheff). After the Second World War fundamental changes took place in the life of the university. The Faculty of Medicine was separated from the University of Science on February 1, 1951 and became an independent university under the control of the Ministry of Health. In 1953 the Institute of Public Health was cut into two separate institutes: Institute of Public Health and Institute for the Organization of Health Service. The Institute of Public Health was transformed to Institute of Public Health and Epidemiology in 1973. The Institute for the Organization of Health Service was transformed into Institute of Social Medicine and History of Medicine in 1985 and later into Institute of History of Medicine and Social Medicine in 1991. The Institute of Public Health and Epidemiology and The Institute of History of Medicine and Social Medicine were reunited as Institute of Public Health in 1997. The Institute teaches public health to medical, dental and pharmacy students in Hungarian, in English and in German.     

Recommendations to improve health risk communication: lessons learned from the U.S. Public Health Service

The growth in the public's concern over a variety of environmental health risks has placed new requirements and demands on U.S. Public Health Service (PHS) agencies for information that describes and explains the nature of risk in clear and comprehensible terms. Experience has shown, however, that merely disseminating information without reliance on communication principles can lead to ineffective health messages and public health actions. This article presents the findings of a study conducted by the Subcommittee on Risk Communication and Education of the Environmental Health Policy Committee (EHPC), PHS, on how PHS agencies are communicating information about health risk; how effective these communications have been; and what specific principles, strategies, and practices best promote effective health risk communication. The purpose of the Subcommittee's study was to develop specific recommendations that would help PHS decision makers and health risk communicators improve the effectiveness of health information provided to, and received from, the public. The study suggests fundamental principles drawn from a series of case studies from PHS agencies about how best to plan and carry out risk communication activities.     

Public health week: marketing the concept of public health.

The Public Health Programs and Services (PHP&S) Branch of the Los Angeles County Department of Health Services began a strategic planning effort in January 1986 to meet new disease trends, curb rising health care costs, consolidate limited resources, and handle shifting demographics. A strategic plan was designed to assess the opportunities and challenges facing the agency over a 5-year horizon. Priority areas were recognized, and seven strategic directives were formulated to guide PHP&S in expanding public health services to a changing community. Health promotion was acknowledged as a critical target of the strategic planning process. Among the most significant results of the health promotion directive was the establishment of an annual Public Health Week in Los Angeles County. Beginning in 1988, 1 week per year was selected to enhance the community's awareness of public health programs and the leadership role PHP&S plays in providing these programs to nearly 9 million residents of Los Angeles County. Events in Public Health Week include a professional lecture series and the honoring of an outstanding public health activist and a media personality who has fostered health promotion. Other free community activities such as mobile clinics, screenings, and health fairs are held throughout the county. With intensive media coverage of Public Health Week, PHP&S has been aggressive in promoting its own services and accomplishments while also educating the community on vital wellness issues. The strategic methodology employed by PHP&S, with its emphasis on long-range proactive planning, is receiving national recognition and could be adopted by similar agencies wishing to enhance their image and develop unique health promotion projects in their communities.     

Recommendations to Improve Health Risk Communication: Lessons Learned from the U.S. Public Health Service

The growth in the public's concern over a variety of environmental health risks has placed new requirements and demands on U.S. Public Health Service (PHS) agencies for information that describes and explains the nature of risk in clear and comprehensible terms. Experience has shown, however, that merely disseminating information without reliance on communication principles can lead to ineffective health messages and public health actions. This article presents the findings of a study conducted by the Subcommittee on Risk Communication and Education of the Environmental Health Policy Committee (EHPC), PHS, on how PHS agencies are communicating information about health risk; how effective these communications have been; and what specific principles, strategies, and practices best promote effective health risk communication. The purpose of the Subcommittee's study was to develop specific recommendations that would help PHS decision makers and health risk communicators improve the effectiveness of health information provided to, and received from, the public. The study suggests fundamental principles drawn from a series of case studies from PHS agencies abouthow bestto plan and carry outrisk communication activities.     

以全健康理论提升我国应对突发公共卫生事件的能力

随着全球化进程和交通技术发展,突发公共卫生事件的影响范围可以在短时间内从发生地突破国家界限,并对其他国家形成健康威胁。突发公共卫生事件不仅累及人类-动植物-环境健康,对于社会发展也有长远影响,因此其应对方法已经超越了一般卫生问题,需要以整体和综合的策略进行应对。本文以全健康视角剖析了我国目前突发公共卫生事件应对体系存在的问题和短板,应用全健康相关理念,从整体、联动、发展、可持续的角度提出了相关建议,为我国进一步优化突发公共卫生事件应对体系提供参考依据。     

Using national news events to stimulate local awareness of public policy issues

Community leaders in Atlanta, GA, the Detroit and Lansing, MI, areas, and San Francisco, CA, participated in a demonstration of techniques to disseminate information and increase public awareness of the recommendations from the Surgeon General's Workshop on Drunk Driving, held in December 1988. Local officials worked with the Public Health Service's Office for Substance Abuse Prevention, of the Alcohol, Drug Abuse, and Mental Health Administration, to educate and inform the public about the workshop recommendations as well as other alcohol-related concerns, and to encourage public involvement in their communities with the issue of alcohol-impaired driving and other alcohol-related concerns. With minimal assistance from Federal agencies and Washington-based health and public interest groups, the communities developed unique approaches to generating local television, radio, and newspaper coverage of an event that had originated as national news. The events demonstrated that, with minimal Federal resources and support, local groups can create media attention in conjunction with national news, and local media events can lead to successful community activism. The techniques can be applied by other community groups to gain sufficient news media attention to encourage the public to organize around issues of common concern.     

Guidelines for public health management of meningococcal disease in the UK

Following changes in the epidemiology of meningococcal disease, the advent of new vaccines, and with new evidence on risk and control measures, the Public Health Laboratory Service Meningococcus Forum set up a Working Group to review the guidance for control measures in the UK. This review is based on available evidence, and recommendations are graded according to the level of evidence on which they are based. These guidelines cover pre-admission management, investigation of suspected cases, the role of public health, public health action after a single case, prophylaxis in healthcare settings, and management of clusters. Detailed revised recommendations are presented on the use of antibiotics before admission to hospital, the rationale and indications for chemoprophylaxis, and the use of new vaccines. Links to relevant websites are included.     

New guidelines issued for occupational exposures

New recommendations have been issued by the U.S. Public Health Service for health care workers who are occupationally exposed to HIV. The post-exposure prophylaxis recommendations have been modified to include a basic four-week regimen of AZT and 3TC and an expanded regimen to include a protease inhibitor for higher-risk cases. Copies of the guidelines, "Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Post-Exposure Prophylaxis", are available from the Centers for Disease Control and Prevention (CDC).     

Ortsnahe Koordinierung der gesundheitlichen Versorgung in Nordrhein-Westfalen

In January 1998, the Public Health Service Act (OGDG) was put into force by North Rhine-Westphalia's state parliament as Article 3 of the Act on the Strengthening of the Efficiency of Districts, Cities and Municipalities. The objective of the Public Health Service Act is the performance of functions through the public health service in a way which corresponds to problems, ambitions and priorities at the local level. The effects of the Act have been documented over a period of 5 years. The authors describe the method of evaluation and the most important results. As well as describing traditional tasks, they focus in particular on process and structural data of the local health conferences. These have been introduced as a consequence of the Public Health Service Act in all 54 districts and self-administered cities in North Rhine-Westphalia. Another task which has become obligatory as a result of the Public Health Service Act is health reporting. Here, the authors report on the state of affairs with regard to implementation, major topics and differences in concept. Based on the state of development at the end of 2002, the authors describe present developments and prospects. They expect continuous need for support, particularly in the fields of health conferences and health reporting.     

Developing the academic institution's role in response to bioterrorism: the Iowa Center for Public Health Preparedness.

The terrorist acts during the fall of 2001 triggered renewed concern about the capacity of the nation's public health system to deal with crisis. A critical element of the response ability of the public health system is a prepared workforce. Based on a pre-existing concern about emerging infectious disease, the Centers for Disease Control (CDC), working with the Association of Schools of Public Health, had established a network of university-based Centers for Public Health Preparedness. The events of September 11 accelerated, expanded, and focused this effort. This article discusses this national program, details the activities of the based Center for Public Health Preparedness located at the University of Iowa, and suggests preparedness issues deserving future development.     

Advertising health: the case for counter-ads.

Public service advertisements have been used by many in hopes of "selling" good health behaviors. But selling good behavior--even if it could be done more effectively--is not the best goal for using mass media to prevent health problems. Personal behavior is only part of what determines health status. Social conditions and the physical environment are important determinants of health that are usually ignored by health promotion advertising. Public service advertising may be doing more harm than good if it is diverting attention from more effective socially based health promotion strategies. Counter-ads are one communications strategy that could be used to promote a broader responsibility for rectifying health problems. In the tradition of advocacy advertising directly promoting policy rather than products, counter-ads promote views consistent with a public health perspective. Counter-ads set the agenda for health issues, conferring status on policy-oriented strategies for addressing health problems. The primary purpose of counter-ads is to challenge the dominant view that public health problems reflect personal health habits. They are controversial because they place health issues in a social and political context. Advertising strategies for health promotion range over a spectrum from individually oriented public service advertising to socially oriented counter-advertising. The recent anti-tobacco campaign from the California Department of Health Services represents advertisements across the spectrum. Counter-ads that focus on a politically controversial definition for health problems are an appropriate and necessary alternative to public service advertising.     

Use of Big Data and Ethical Issues for Populations With Substance Use Disorder

With expanding data availability and computing power, health research is increasingly relying on big data from a variety of sources. We describe a state-level effort to address aspects of the opioid epidemic through public health research, which has resulted in an expansive data resource combining dozens of administrative data sources in Massachusetts. The Massachusetts Public Health Data Warehouse is a public health innovation that serves as an example of how to address the complexities of balancing data privacy and access to data for public health and health services research. We discuss issues of data protection and data access, and provide recommendations for ethical data governance. Keeping these issues in mind, the use of this data resource has the potential to allow for transformative research on critical public health issues.     

Study of seniors identifies attitudes, barriers to promoting their health

What information and skills do older persons need in order to enhance their health? What obstacles stand in the way of promoting their health? One way to find out is simply to ask them, as the Office of Disease Prevention and Health Promotion (ODPHP), U.S. Department of Health and Human Services, did in a study undertaken as part of the Health Promotion and Aging Initiative sponsored by th Public Health Service nd Administration on Aging. Following are excerpts from an executive summary of "Aging and Health Promotion: Market Research for Public Education," a report of a research study that involved 15 focus groups of persons aged 58 and over, as well as a review of data on the media habits and the demographic characteristics of older Americans. The study, which was undertaken to serve as the basis for recommendations for national action, also offers insights that should be useful to program planners interested in meeting the needs and capturing the interest of older persons.     

Good governance and corruption in the health sector: lessons from the Karnataka experience

Strengthening good governance and preventing corruption in health care are universal challenges. The Karnataka Lokayukta (KLA), a public complaints agency in Karnataka state (India), was created in 1986 but played a prominent role controlling systemic corruption only after a change of leadership in 2001 with a new Lokayukta (ombudsman) and Vigilance Director for Health (VDH). This case study of the KLA (2001-06) analysed the:Scope and level of poor governance in the health sector; KLA objectives and its strategy; Factors which affected public health sector governance and the operation of the KLA. We used a participatory and opportunistic evaluation design, examined documents about KLA activities, conducted three site visits, two key informant and 44 semi-structured interviews and used a force field model to analyse the governance findings. The Lokayukta and his VDH were both proactive and economically independent with an extended social network, technical expertise in both jurisdiction and health care, and were widely perceived to be acting for the common good. They mobilized media and the public about governance issues which were affected by factors at the individual, organizational and societal levels. Their investigations revealed systemic corruption within the public health sector at all levels as well as in public/private collaborations and the political and justice systems. However, wider contextual issues limited their effectiveness in intervening. The departure of the Lokayukta, upon completing his term, was due to a lack of continued political support for controlling corruption. Governance in the health sector is affected by positive and negative forces. A key positive factor was the combined social, cultural and symbolic capital of the two leaders which empowered them to challenge corrupt behaviour and promote good governance. Although change was possible, it was precarious and requires continuous political support to be sustained.