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The continued recognition process of dental public health as a specialty of dentistry served as an opportunity for the specialty to rediscover and reevaluate itself. What it found was a discipline that has evolved for 38 years to address the issues of a dynamic society. Dr. Abraham Kobren, ADA past-president has stated that public health dentistry stands as the dental conscience of the nation. The changes in dental public health mirror both changes in society and the technical changes occurring in dentistry. Identifying diseases in children is giving way to identifying diseases in adults. Prevention for adults is taking on as much importance as is prevention in children. Access to dental care for the poor and homeless is as much a problem as is access to care for people with infectious diseases. Infection control, technology transfer, national oral health objectives, and a myriad of new financing mechanisms are some areas of change. What has remained constant is the specialty's goal to improve the oral health of the public, and its commitment to work through "organized community efforts" to achieve this goal.
The discipline of environment-related health protection lacks continuously recorded data. Therefore, a three-year pilot project "Sentinel Public Health Offices" was initiated by the Ministry of Labour, Health and Social Welfare of Baden-Württemberg in 1992. Selected public health offices were instructed to conduct a series of three cross-sectional surveys of biological and effect monitoring among children attending the fourth grade of primary schools. The surveys were coordinated by the Provincial Public Health Office. During the pilot project the system of " Sentinel Public Health Offices" has proved successful not only in the continuous recording of data relevant to health. Its continuation as a permanent institution is contemplated.
Community involvement with public health planning and implementation are vital to improving community health. There are a variety of community health models that are available. We describe these four models from the perspective of how they involve the broader community. These models are evaluated from a different perspective about linking the community and politics and agencies, that involves naming issues, framing options, public deliberation and public acting. We suggest ways that these models can be further refined to connect citizens to the processes that we use for community health improvement.
This rule sets forth requirements for programs for Grants for Traineeships in Health Administration, Hospital Administration, or Health Policy Analysis and Planning at Public or Nonprofit Private Educational Institutions Other Than Schools of Public Health under Section 749 of the Public Health Service Act (42 U.S.C 294s).
Due to extensive government funding, public health research in Germany presently goes through times of revival and relative prosperity. The multiprofessionality of its background, its nearly disrupted scientific tradition in Germany, and the idiosyncrasies in their understanding of "health" among different professions impede the development of a common scientific identity. This paper underscores the importance of semantic precision and the avoidance of pretentious, overstrained theories in favour of pragmatic scientific approaches. Complementary to its action-oriented rationale, the German public health community should more than ever devote itself to health objectives and outcomes.
Corporations have long influenced environmental and occupational health in agriculture, doing a great deal of damage, making substantial profits, and shaping public debate to make it appear that environmental misfortunes are accidents of an otherwise well-functioning system, rather than systemic. The debate over the genetically modified (GM) crops is an example. The largest producer of commercial GM seeds, Monsanto, exemplifies the industry's strategies: the invocation of poor people as beneficiaries, characterization of opposition as technophobic or anti-progress, and portrayal of their products as environmentally beneficial in the absence of or despite the evidence. This strategy is endemic to contemporary market capitalism, with its incentives to companies to externalize health and environmental costs to increase profits.
The story of the Department of Health and Human Services (DHHS), its United States Public Health Service (US PHS), and the US PHS Commissioned Corps is comprised of people and programs aimed at protecting and promoting the nation's health, including oral health. The federal precursors of these organizations focused on clinical services for federal beneficiaries, and with time grew to include federal support for community and state programs for underserved and institutionalized populations; biomedical and behavioral research conduct: drug, device, and food regulatory activities; and, most recently, an enhanced response to biodefense and emergency readiness, among other activities. An essential component of the workforce addressing these activities is the US PHS Commissioned Corps, directed by the Surgeon General of the US PHS. This corps is a mobile, uniformed health service assigned to programs throughout the DHHS, as well as to other departments and agencies as needed. Dentistry has been a critical part of these programs and of the corps since their inception.
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A letter of inquiry from a fictious dentist, requesting applications and information regarding training in dental public health, was sent to each of the 19 accredited Schools of Public Health. The purpose of the survey was to determine the manner in which the schools respond to a letter of inquiry from a dentist and to determine, from the material included in the response, what type of program in dental public health, if any, each school had. All 19 schools responded, but the type and quality of the responses varied greatly. Some schools answered the questions fully and others ignored them. From the bulletins of the schools and other material contained in the responses, seven schools were determined to have what could be termed viable programs in dental public health. Two of the seven programs are administratively independent with full-time faculty as directors of their programs; three of the programs receive their major input in dental public health from an affiliated dental school; one program's input of dental public health is provided by the school of public health; and one program has an affiliation with a dental school, but the major portion of the input for dental public health during the year of preparation for the degree of MPH is provided in the school of public health. There are seven schools of public health with eight full-time faculty who are public health dentists, although only three of the faculty spend a substantial portion of their time in activities related to dental public health. Five schoolshave no public health dentist on the faculty and they have a total of 33 part-time faculty at the rank of assistant professor or higher and a total of 36 part-time faculty with a rank lower than instructor. Twelve of the schools of public health still require only a minimum of an academic year for a dentist to receive the degree of MPH and only one school requires more than a calendar year. Only five schools require field-experience in order for a dentist to receive his degree of MPH. Most schools, it appears, do not provide a program for dentists which meets the standards established by the American Public Health Association or the American Board of Dental Public Health. It is time to question the blanket acceptance by the Council on Dental Education of the American Public Health Association's accreditation of Schools of Public Health for meeting the academic requirements in the specialty of dental public health.
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Emerging natural and man-made threats to the health of the nations population require development of a seamless laboratory network to address preventable health risks; this can be achieved only by defining the role of public health laboratories in public and private laboratory service delivery. Establishing defined core functions and capabilities for state public health laboratories will provide a basis for assessing and improving quality laboratory activities. Defining public health laboratory functions in support of public health programs is the beginning of the process of developing performance standards for laboratories, against which state public health laboratories, and eventually local public health and clinical laboratories, will establish and implement best laboratory practices. Public health is changing, and as apart of that change, public health laboratories must advocate for and implement improvements for public health testing and surveillance. These changes are outlined also in the Association of Public Health Laboratories consensus report (Association of Public Health Laboratories. Core functions and capabilities of state public health laboratories: a white paper for use in understanding the role and value of public health laboratories in protecting our nation's health. Washington, DC: Association of Public Health Laboratories, 2000).
The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.
As health care applications derived from human genetics research are likely to move increasingly from 'clinic to community', there is growing interest not just in how patients understand and take up health-related genetic information but also in the views of the wider population, as well as a range of professional groups. In this paper, issues relating public knowledge and public trust are raised and discussed in an attempt to move forward debates about public involvement in genomic research and the role of sociologists within interdisciplinary teams. As the field of public understanding of science has developed, we have seen a shift from a focus on the lack of scientific literacy as problem to a recognition of the range of different knowledges that people have and use as they confront science and technology in their everyday lives. As a mood for dialogue pervades many institutions in their relations with 'publics', attention must now be paid to the way in which knowledge and expertise is expressed, heard and acted upon in dialogic encounters. There is increasing concern about public trust in science and calls to increase public confidence, particularly through more open engagement with a range of publics. However, lack of trust or loss of confidence may be constructed as problems rather than reflecting empirical reality, where more complex relationships and attitudes prevail. Lack of trust is often privatized, deeply rooted in lived experience and routinely managed. Trust relations are generally characterized by ambivalence, uncertainty and risk, and are always provisional. Drawing on selected literature and empirical research to review and illustrate this field, this paper argues that scepticism or ambivalence on the part of publics are not necessarily problems to be overcome in the interest of scientific progress, but rather should be mobilized to enhance open and public debates about the nature and direction of genomics research, medicine, and the related social and ethical issues. Just as there can be no resolute expression of public knowledge or public opinion, it is unlikely that there is a resolute expression of public trust in genomics. However, ambivalence and scepticism can be harnessed as powerful resource for change, whether through the mobilization of public knowledges or the development of greater reflexivity within scientific institutions. This demands a sharing of power and greater public involvement in the early stages of policy formation and scientific and medical agenda setting.
In addition to establishing Canadian federal institutions for public health to work in cooperation with provincial and local health authorities, the infrastructure of public health for the future depends on a multi-disciplinary and well-prepared workforce. Traditionally, Canada trained its public health workforce in schools of public health (or hygiene), but in recent decades this has been carried out in departments and centres primarily within medical faculties. Recent public health crises in Canada have led to some new federal institutions and reorganization of public health activities as well as other reforms. This commentary proposes re-examination of the context of public health workforce training and especially for schools of public health as independent faculties within universities as in the United States or, as developed more recently in Europe, semi-independent schools within medical faculties. The multi-disciplinary nature of public health professionals and the complex challenges of the "New Public Health" call for a new debate on this vital issue of public health workforce development. Public health needs a new image and higher profile of training, research and service to meet provincial and national needs, based on international standards of accreditation and recognition.