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PubMed2006

Avian influenza: risk, preparedness and the roles of public health nurses in Hong Kong.

This paper provides an overview of the Hong Kong government's influenza preparedness plan and the key roles of public health nurses in that plan. The part played by Hong Kong public health nurses in the management of the avian influenza outbreak in Hong Kong in 1997 and the sudden acute respiratory syndrome outbreak in 2003, together with the capacity-building work they are now undertaking in preparing for an influenza pandemic, highlight their crucial role in public health. Recent strengthening of public health infrastructure in Hong Kong and heightened public awareness of public health issues have facilitated more proactive and effective public health nursing activities.

Attitude to Health↗
PubMed2005

Sewers in the city: a case study of individual-level mortality and public health initiatives in Northampton, Massachusetts, at the turn of the century.

Emerging industrial communities of nineteenth-century New England experienced both rapid population growth and lagging development of public health infrastructures. In turn, high mortality in these newly urban cities contributed to a delay in the regional mortality transition of the late nineteenth century. Analyzing death records and a file of linked cause-specific death and manuscript census records for the industrializing community of Northampton, Massachusetts, we show that early in the city's development, mortality clustered near industrial activities and open sewers. When industrial areas were sewered, clustering of mortality abated, and differences between industrial and commercial areas of the town were no longer significant. These findings illustrate Szreter's emphasis on considering both the benefits and costs of development. (1) Initial development contributed to high mortality in newly emergent urban-industrial centers like Northampton and was abated only when lagging public health infrastructures caught up with rapid growth and development near the turn of the century.

Adolescent↗
PubMed2006

The public health informatics infrastructure: anticipating its role in cancer.

Cancer information and surveillance, historically conducted with manual data collection and submission, are viewed increasingly as inherently dependent on the effective application of information science. One challenge is to use information technology (IT) in a manner that improves cancer-related decision-making and ultimately the quality of care that is offered to patients with cancer. In this article we begin by envisioning a future view of IT-supported surveillance and care that can be made available for application in cancer and its management. We then ask what barriers need to be overcome and what forces are at work that may help us in our efforts to effect the necessary changes. Our future vision for surveillance and information, although appealing and widely shared, requires major cultural change, financial investment, and logistical planning. Competition in the medical marketplace, coupled with fiscal pressures affecting providers and health systems, suggests that leadership for regional and national coordination will need to come from elsewhere-and likely from governments.

Decision Support Techniques↗
PubMed2004

Infant mortality trends in a region of Belarus, 1980-2000.

BACKGROUND: The Chernobyl disaster in 1986 and the breakup of the former Soviet Union (FSU) in 1991 challenged the public health infrastructure in the former Soviet republic of Belarus. Because infant mortality is regarded as a sensitive measure of the overall health of a population, patterns of neonatal and postneonatal deaths were examined within the Mogilev region of Belarus between 1980 and 2000. METHODS: Employing administrative death files, this study utilized a regional cohort design that included all infant deaths occurring among persons residing within the Mogilev oblast of Belarus between 1980 and 2000. Patterns of death and death rates were examined across 3 intervals: 1980-1985 (pre-Chernobyl), 1986-1991 (post-Chernobyl & pre-FSU breakup), and 1992-2000 (post-Chernobyl & post-FSU breakup). RESULTS: Annual infant mortality rates declined during the 1980s, increased during the early 1990s, and have remained stable thereafter. While infant mortality rates in Mogilev have decreased since the period 1980-1985 among both males and females, this decrement appears due to decreases in postneonatal mortality. Rates of postneonatal mortality in Mogilev have decreased since the period 1980-1985 among both males and females. Analyses of trends for infant mortality and neonatal mortality demonstrated continuous decreases between 1990, followed by a bell-shaped excess in the 1990's. Compared to rates of infant mortality for other countries, rates in the Mogilev region are generally higher than rates for the United States, but lower than rates in Russia. During the 1990s, rates for both neonatal and postneonatal mortality in Mogilev were two times the comparable rates for East and West Germany. CONCLUSIONS: While neonatal mortality rates in Mogilev have remained stable, rates for postneonatal mortality have decreased among both males and females during the period examined. Infant mortality rates in the Mogilev region of Belarus remain elevated compared to rates for other western countries, but lower than rates in Russia. The public health infrastructure might attempt to assure that prenatal, maternal, and postnatal care is maximized.

Cause of Death↗
PubMed2004

Public health psychology: a conceptual and practical framework.

Increasingly, the development of public health infrastructures requires psychology to reevaluate its contribution to public health at local, national and global levels. Already familiar to some psychologists, particularly those in community psychology and health promotion, the expansion of public health has implications for psychology in terms of knowledge/practice and working differently in multidisciplinary settings. In this article, I provide a critical overview of the implications of the historical and international development of health psychology and the changing nature of public health to strengthen the establishment of public health psychology. A conceptual and practical framework is proposed in which public health psychology theory, methods and practice are considered as well as its relevance to the health social sciences more generally.

Behavioral Medicine↗
PubMed1994

Public health and health care reform: the American Public Health Association's perspective.

This paper discusses the American Public Health Association's goals with regards to the current health care reform debate. By outlining the organization's historical context with regards to health care reform as well as the parameters of the current medical care and public health crises, the paper explains why APHA's advocacy efforts focused on two major issues: the adoption of a national health program that features universal coverage with a comprehensive set of benefits for all our nation's residents, and the enhancement of the federal, state, and local public health infrastructure. The paper argues that both medical care services and public health programs must be expanded if we are to improve the nation's overall health status.

Forecasting↗
PubMed2002

Public health nursing practice: aftermath of September 11, 2001.

America's experience on September 11, 2001, forms the backdrop of this review of the public health nursing role in bioterrorism preparedness. The risks and challenges to the public health infrastructure are reviewed in order to place bioterrorism preparedness in a public health context. A review of the literature provides background material on the extent to which public health has evolved in planning for a bioterrorism event. The skills and competencies that will prepare public health nurses in their planning for and response to threats of bioterrorism are addressed. Anthrax is used as an example to illustrate how public health nursing can assist in a bioterrorism response.

Anthrax↗
PubMed1995

CDC's Information Network for Public Health Officials (INPHO): a framework for integrated public health information and practice.

To strengthen the public health infrastructure, the Centers for Disease Control and Prevention (CDC) initiated the Information Network for Public Health Officials (INPHO). CDC INPHO has three goals: (1) to make communication among public health practitioners throughout the United States easy, (2) to make information accessible, and (3) to make secure data exchange as swift and smooth as contemporary technology will allow. Based on a systems approach to supporting the core functions of public health, CDC INPHO achieves its goals by creating a flexible and user-responsive infrastructure of open communications and information exchange.

Centers for Disease Control and Prevention, U.S.↗
PubMed2000

Calling the shots: immunization finance policies and practices. Executive summary of the report of the Institute of Medicine.

Federal, state, and private-sector investments in vaccine purchases and immunization programs are lagging behind emerging opportunities to reduce the risks of vaccine-preventable disease. Although federal assistance to the states for immunization programs and data collection efforts rapidly expanded in the early part of the 1990s, significant cutbacks have occurred in the last 5 years that have reduced the size of state grant awards by more than 50% from their highest point. During this same period, the vaccine delivery system for children and adults has become more complex and fragmented. This combination of new challenges and reduced resources has led to instability in the public health infrastructure that supports the U. S. immunization system. Many states have reduced the scale of their immunization programs and currently lack adequate strength in areas such as data collection among at-risk populations, strategic planning, program coordination, and assessment of immunization status in communities that are served by multiple health care providers. If unmet immunization needs are not identified and addressed, states will have difficulty in achieving the national goal of 90% coverage by the year 2010 for completion of the childhood immunization series for young children. Furthermore, state and national coverage rates, which reached record levels for vaccines in widespread use (79%, 1998), can be expected to decline and preventable disease outbreaks may occur as a result, particularly among persons who are vulnerable to vaccine-preventable disease because of their underimmunization status. The Institute of Medicine (IOM) Committee on Immunization Finance Policies and Practices has therefore concluded that a renewal and strengthening of the federal and state immunization partnership is necessary. The goal of this renewed partnership is to prevent infectious disease; to monitor, sustain, and improve vaccine coverage rates for child and adult populations within more numerous and increasingly diversified health care settings; and to respond to vaccine-safety concerns. To achieve this renewal, states require a consistent strategy, additional funds, and a multiyear finance plan that can help expedite the delivery of new vaccines; strengthen the immunization assessment, assurance, and policy development functions in each state; and adapt childhood immunization programs to serve the needs of new age groups (especially adults with chronic diseases) in different health care environments. The IOM committee recommends that federal and state governments adopt a national finance strategy that would allocate $1.5 billion in federal and state resources over the first 5 years to strengthen the infrastructure for child and adult immunization-an annual increase of $175 million over current spending levels. These resources would consist of $200 million per year in state infrastructure grants awarded by the Centers for Disease Control and Prevention (the Section 317 program) and an additional $100 million per year in increased state contributions. The committee also recommends that the Congress replace the current discretionary Section 317 grants with a formula approach for state immunization grant awards to improve the targeting and stability of federal immunization grants. The formula should provide a base level of support to all states, as well as additional amounts related to each state's need, capacity, and performance. The committee further recommends that Congress introduce a state match requirement for the receipt of increased federal funds to help strengthen and stabilize the infrastructure that supports long-term public health assessment, assurance, and policy development efforts. (ABSTRACT TRUNCATED)

Adult↗
PubMed2002

Turning point: the Robert Wood Johnson Foundation's effort to revitalize public health at the state level.

The Robert Wood Johnson (RWJ) Foundation initiated Turning Point in collaboration with the W.K. Kellogg Foundation (Kellogg) in 1997. The purpose of this major national initiative was to strengthen the public health infrastructure in the United States so that states, local communities, and their public health agencies might respond to the challenge to protect and improve the public's health in the 21st century. RWJ funded 21 states and Kellogg funded 43 communities to work together to create a new way of thinking about how health could be improved and who should be involved. Although the ultimate outcome was to improve health, both foundations expected diverse partnerships to work together to create strategic health improvement plans at both the community and state levels. The foundations funded a variety of strategies within those health improvement plans during an implementation phase. The premise in funding partnerships, as opposed to a single entity, was that effective public health systems would be developed best through a shared responsibility (including the private sector) for the health of a community.

Community Health Planning↗
PubMed1993

A national program to restructure local public health agencies in the United States.

This paper proposes a national program to restructure local public health services in the United States which are still characterized by an excessive number of very small health units. It reviews past proposals to correct this situation, and recommends specific programmatic, organizational and financial measures to strengthen the public health infrastructure and achieve an effective national network of federal, state and local public health agencies.

Community Health Services↗
PubMed2004

West Nile virus and North America: an unfolding story.

Before the introduction of the West Nile virus (WNV) into the United States of America (USA) in 1999, conditions in North America were ideal for an arboviral epidemic. Such factors as the large, susceptible and non-immune animal and human populations, the presence of competent vectors, increasing international travel and commerce, existing methods for rapid dissemination and an ill-prepared animal and public health infrastructure all combined to create the essential elements for a severe animal and public health crisis--the 'perfect microbial storm'. The introduction of WNV into New York City was the final factor, serving as the catalyst to initiate one of the most significant epidemics in the USA. The spread of WNV across the country resulted in very large populations of wildlife, equines and people being exposed and infected. The epidemic is still not fully understood and its character continues to change and adapt. The recent recognition of a number of non-vector modes of transmission has revealed the disease as a greater threat and more difficult to control than first thought. West Nile virus gives every indication that it will become a permanent part of the 'medical landscape' of the USA, continuing to threaten wildlife, domestic animals and humans as a now endemic disease. This paper discusses the features of this extraordinary epidemic, and emphasises the need for an integrated surveillance system, greater diagnostic capacity and improved control strategies.

Animals↗
PubMed2002

West Nile virus in New York City.

In 1999, a cluster of encephalitis cases was detected in New York City. The city applied larvicide to standing water and aerially sprayed pesticides to control adult mosquitoes. The causative agent was West Nile virus, a type of encephalitis that had never before been transmitted in the western hemisphere. This experience offers many lessons for the practitioners of public health and of public health law. A public health infrastructure that does not lose sight of the old threats must be maintained. The public health and environmental governmental establishments must work together. Law is closely intertwined with policy and programmatic initiatives and can facilitate a better public health outcome.

Animals↗
PubMed2000

Public opinion about public health--United States, 1999.

Previous surveys have documented a substantial gap in the public's understanding and attitudes about public health (1). The Pew Charitable Trusts, a Philadelphia-based philanthropy that supports nonprofit activities in the areas of culture, education, the environment, health and human services, public policy, and religion, commissioned two firms, the Mellman Group and Public Opinion Strategies, to conduct both qualitative and quantitative research in 1999 to characterize the public's attitudes about public health. In particular, the Pew Charitable Trusts asked the groups to explore 1) perceptions about public health in general, including levels of support and importance compared with other national priorities; 2) opinions about environmental health and its role in causing disease and promoting health; and 3) opinions about the public health infrastructure. This report summarizes the results of this survey, which indicate that the term "public health" is misunderstood, persons are concerned about the quality of the public health system, increased government spending for public health is a greater priority than other key national concerns, and that the public regard environmental factors as important contributors to certain health problems.

Attitude to Health↗
PubMed2004

"Only the best class of immigration": public health policy toward Mexicans and Filipinos in Los Angeles, 1910-1940.

Public health officials contributed to the early 20th-century campaign against Mexicans and Filipinos in Los Angeles. In 1914, the newly established city and county health departments confronted the overwhelming task of building a public health infrastructure for a rapidly growing population spread over a large area. However, for several years public health reports focused almost exclusively on the various infectious diseases associated with Mexican immigrants. Although the segregation of Mexicans was illegal in California until 1935, county officials established separate clinics for Whites and Mexicans during the 1920s. With assistance from state officials, local health authorities participated actively in efforts to restrict Mexican immigration throughout the 1920s and to expel both Mexicans and Filipinos during the 1930s.

Emigration and Immigration↗
PubMedDate not supplied

Public health workforce development: progress, challenges, and opportunities.

The public health workforce is key to strengthening public health infrastructure. National partners have articulated a vision of a sustainable and competent workforce prepared to deliver essential public health services. Six strategic elements provide a framework for action: monitoring workforce composition; identifying competencies and developing related curriculum; designing an integrated life-long learning delivery system; providing individual and organizational incentives to ensure competency development; conducting evaluation and research and assuring financial support. Partners convened in January 2003 to review progress and to re-evaluate strategies in light of the recently released Institute of Medicine reports on infrastructure and workforce issues. Although significant challenges remain, there is convergence on priorities for competency development, research questions to be addressed and next steps in the national dialogue on certification and credentialing in public health.

Disaster Planning↗