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.     

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.     

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.     

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.     

Performing public health functions: the perceived contribution of public health and other community agencies

As public health struggles to define its role within health care reform, the need to examine carefully the component organizations providing and/or supporting health care for the public appears critical. This article identifies the nature and extent of involvement by agencies other than the official local public health department in performing public health practices and functions within 63 local public health jurisdictions. Adequacy of overall public health performance is significantly related to the extent of participation of outside agencies. Outside agencies contribute over 26 percent to the total public health performance for the jurisdictions surveyed. Other agencies of government, both at the state and local level, are the predominant outside contributors to public health practice. Private and voluntary agencies are perceived as minor contributors. Little variation exists among communities in which outside agencies tend to perform particular public health activities. Findings suggest that local public health departments can maximize their impact by understanding better the nature of working relationships within multi-institutional arrangements, encouraging greater levels of collaboration and integration and acting as catalysts for increased support of public health activities.     

Competitive health policies and community health

Since 1992 there have been fundamental changes in health care policy in Victoria, Australia, as the state government moves to competitive market models of service delivery and the measurement of service provision through output based funding. The introduction of competitive relationships to the public health system has had a major impact in the primary health care sector, particularly on community health centres. Most community health centres in Victoria have traditionally been semi-independent agencies controlled by community based committees of management. Such policies have had huge implications for the management and organisation of these agencies, as they have led to different patterns of service delivery and different models of management practice, often devaluing traditional philosophical perspectives of 'primary health care practice'. Although many agencies have embraced change as providing opportunities for growth and development and to have more influence in the provision of mainstream public health care, primary health care models of practice should be supported for their intrinsic and increasing value.     

Preparing currently employed public health nurses for changes in the health system

OBJECTIVES: This article describes a core public health nursing curriculum, part of a larger project designed to identify the skills needed by practicing public health workers if they are to successfully fill roles in the current and emerging public health system. METHODS: Two focus groups of key informants, representing state and local public health nursing practice, public health nursing education, organizations interested in public health and nursing education, federal agencies, and academia, synthesized material from multiple sources and outlined the key content for a continuing education curriculum appropriate to the current public health nursing workforce. RESULTS: The skills identified as most needed were those required for analyzing data, practicing epidemiology, measuring health status and organizational change, connecting people to organizations, bringing about change in organizations, building strength in diversity, conducting population-based intervention, building coalitions, strengthening environmental health, developing interdisciplinary teams, developing and advocating policy, evaluating programs, and devising approaches to quality improvement. CONCLUSIONS: Collaboration between public health nursing practice and education and partnerships with other public health agencies will be essential for public health nurses to achieve the required skills to enhance public health infrastructure.     

The value of microgrants for community-based health promotion: two models for practice and policy.

In 2001, the Office of Disease Prevention and Health Promotion in the US Department of Health and Human Services announced its intention to (1) identify innovative ways to increase public awareness and focus on Healthy People 2010 objectives and (2) broaden the participation of community-based organizations, including agencies new to public health. The mechanism selected, microfinancing, was modeled after small venture loans for economic stimulus in developing countries. The Office of Disease Prevention and Health Promotion selected one state health department and one academic research organization from 80 applicants to test models of awarding "microgrants" of 2,010 dollars to community agencies. This article describes the two models, the types of agencies that were funded, the primary Healthy People 2010 objectives targeted, examples of how the monies were used and leveraged by grantees, and the implications of microgrants for public health practice and policy.     

Provider turnover in public sector managed mental health care

The present study examines the extent of turnover in mental health provider networks within public sector managed mental health care over a 1-year period and its association to provider and practice characteristics. Telephone interviews were conducted with a sample of mental health services providers listed the previous year in the networks of the 3 public sector managed mental health care organizations operating in Puerto Rico. Thirty-one percent of respondents had dropped out of networks. The drop-out rate was significantly associated (P.05) with increasing number of years in practice and decreasing years under contract. A nonsignificant trend was observed, suggesting that providers with subspecialty training are less likely to drop out. The results may be signaling an emerging problem in public sector managed mental health care. Stability of provider networks should be monitored by state agencies contracting out mental health care.     

Implementing and assessing organizational practices in local health departments.

One of the most difficult forms of public health practice to characterize involves governmental public health agencies, especially at the local level. A lack of consensus within the public health community as to the purpose and content of organizational public health practice inhibits efforts to increase the capability of public health to address effectively its core functions of assessment, policy development, and assurance. Meaningful capacity building efforts must establish both benchmarks and expectations for the organizational practice of public health. Those markers must be established so that the impact of practice on outcomes and health status can be examined. A model identifying 10 organizational practices was established through the work of the Centers for Disease Control and Prevention (CDC) in collaboration with national practice organizations. Early applications of the model to public health capacity building activities have been effective. Among the applications have been approaches to surveillance of health department practice, certification of local health departments using practice guidelines, and development of leadership within the public health enterprise. Although results are promising, use of the model requires additional external examination and validation, as well as acceptance and consensus within the public health community. The development of organizational practice guidelines for public health agencies may be useful in further efforts to characterize and measure public health practice and its impact on the public''s health.     

Strengthening public health practice content in public health training.

U.S. schools of public health have recognized the imperative to strengthen the public health practice content of training for future public health practitioners. Five strategies to develop administrative and curriculum programs within schools of public health to address this need are described: (1) institution of centers for public health program evaluation; (2) creation of automated field placement and apprenticeship programs; (3) formalization of linkages with professional management training programs to create a track for future senior managers of community health agencies; (4) establishment of cross-departmental applied public health faculty tracks; and (5) offering applied public health evaluation scholarships for students. These initiatives may provide incentives for the institution of a public health practice focus within schools of public health.     

Public health worker competencies for emergency response.

Emergency preparedness is an expectation of public health organizations and an expectation of individual public health practitioners. Organizational performance standards for public health agencies have been developed during the last several years, providing a foundation for the development of competency statements to guide individual practice in public health program areas, like emergency response. This article provides results from a project that developed emergency preparedness and response competencies for individual public health workers. Documentation of the qualitative research methods used, which include competency validation with the practice community, can be applied to competency development in other areas of public health practice.     

Legal options for achieving public health outcomes.

To achieve desired public health outcomes, state agencies can choose among several legal mechanisms; however, no "best practice" guidelines are available to help them choose the most effective mechanism for a given situation. This article offers such guidance by comparing the relative advantages and disadvantages of laws, regulations, policies, and contracts. Factors compared include flexibility, the need for legislative involvement, the nature of the rulemaking process, enforceability, ability to reach target populations, and generalizability. Contracts, in particular, are described as an effective but underutilized mechanism for achieving successful public health outcomes.     

从医改之争看公共服务的提供主体

在健康的市场环境中,只要政府加强监管,营利机构提供公共服务并不一定会导致行业暴利,由于信息不对称所引起的对消费者的伤害也会大大减少;只要政府最后“兜底”,市场所带来的社会不公也会得到相当程度的弥补。所以,对于可以利用市场机制实现高效运营目标的公共服务,营利机构可以作为提供主体之一。     

Optimizing professional education in public health.

Traditional public health education has lacked required practicums such as are the rule in other health professions. Described is a model professional education program that is built around required course work in all areas of public health and a series of mandatory internships at sites of public health practice, utilizing state and local health departments, other federal and state agencies, and public and private sites where students are supervised in public health rotations similar to those a medical, dental, nursing, or veterinary student would experience in a clinic or ward.     

How to institutionalize health promotion programs

Abstract This article presents six implications for practice that suggest how to optimize the institutionalization of health promotion programs. These six implications were derived from a study of ten health promotion programs funded by the Virginia State Health Department and operated by local schools and community health agencies. Institutionalization refers to the long-term survival of health promotion programs, i.e., survival well beyond an initial grant funding period. To generate the implications for practice, a multiple case design for cross-case comparisons was applied to the ten health promotion programs. In brief, the six practice implications are: 1) cultivating a "program champion"; 2) favoring organizations with mature "subsystems"; 3) favoring organizations in which health promotion "fits" with the organization's mission; 4) avoiding brokering relationships; 5) altering lengths of funding periods; and 6) funding existing worthy programs. The significance of these practice implications for both funding and implementing agencies is briefly discussed.     

Structure and functions of state public health agencies in 2007

We sought to document the structure and functions of state public health agencies throughout the United States in 2007 and compare findings with those from a similar 2001 assessment. In 2007 a survey of the structure and functions of state public health agencies was sent to and completed by senior deputies in all 50 states and the District of Columbia (a 100% response rate). The results of the survey showed that all emerging practice areas in 2001 had expanded by 2007. Also, state health departments generally had greater levels of responsibility in 2007 than they did in 2001, emphasizing the need for continued support of governmental public health systems and research on the operations of those systems.     

The edge of America: struggling for health and justice.

The National Association of County and City Health Officials (NACCHO) is the national organization representing local public health agencies. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.     

A systems approach to public health workforce development.

During the 1990s, several distinct but interrelated efforts to strengthen the public health infrastructure were launched. Defining public health work in terms of core functions and essential services, these efforts focused on the competence of the workforce and the performance of public health agencies. The systems approach offered here highlights the relationships and interdependencies among these three components of public health practice: (1) the work, (2) the worker, and (3) the work setting. The model suggests that advances in public health workforce development may require major public health organizational development efforts.     

Risk communication activities of state health agencies.

Surveys concerning the risk communication practices and needs of state health agencies were completed by agency commissioners and designated staff of 48 states and territories. These data indicate that agencies are expending more effort on responding to requests for information than on initiating dialogues with interested constituencies or alerting the public to risk. The data also suggest a gap between the stated philosophy and practice of the agencies.